Colorectal cancer survival in the USA and Europe: A CONCORD high-resolution study

Claudia Allemani, Bernard Rachet, Hannah K. Weir, Lisa C. Richardson, Côme Lepage, Jean Faivre, Gemma Gatta, Riccardo Capocaccia, Milena Sant, Paolo Baili, Claudio Lombardo, Tiiu Aareleid, Eva Ardanaz, Magdalena Bielska-Lasota, Susan Bolick, Rosemary D Cress, Marloes Elferink, John P. Fulton, Jaume Galceran, Stanislaw GóźdźTimo Hakulinen, Maja Primic-Žakelj, Jadwiga Rachtan, Chakameh Safaei Diba, Maria José Sánchez, Maria J. Schymura, Tiefu Shen, Giovanna Tagliabue, Rosario Tumino, Marina Vercelli, Holly J. Wolf, Xiao Cheng Wu, Michel P. Coleman

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Objectives: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. Design: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. Setting and participants: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. Outcome measures: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. Results: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. Conclusions: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.

Original languageEnglish (US)
Article numbere003055
JournalBMJ Open
Volume3
Issue number9
DOIs
StatePublished - 2013
Externally publishedYes

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Colorectal Neoplasms
Survival
Eastern Europe
Radiotherapy
Logistic Models
Drug Therapy
Quality Control
Medical Records
Registries
Neoplasms
Therapeutics
Outcome Assessment (Health Care)
Guidelines
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Allemani, C., Rachet, B., Weir, H. K., Richardson, L. C., Lepage, C., Faivre, J., ... Coleman, M. P. (2013). Colorectal cancer survival in the USA and Europe: A CONCORD high-resolution study. BMJ Open, 3(9), [e003055]. https://doi.org/10.1136/bmjopen-2013-003055

Colorectal cancer survival in the USA and Europe : A CONCORD high-resolution study. / Allemani, Claudia; Rachet, Bernard; Weir, Hannah K.; Richardson, Lisa C.; Lepage, Côme; Faivre, Jean; Gatta, Gemma; Capocaccia, Riccardo; Sant, Milena; Baili, Paolo; Lombardo, Claudio; Aareleid, Tiiu; Ardanaz, Eva; Bielska-Lasota, Magdalena; Bolick, Susan; Cress, Rosemary D; Elferink, Marloes; Fulton, John P.; Galceran, Jaume; Góźdź, Stanislaw; Hakulinen, Timo; Primic-Žakelj, Maja; Rachtan, Jadwiga; Diba, Chakameh Safaei; Sánchez, Maria José; Schymura, Maria J.; Shen, Tiefu; Tagliabue, Giovanna; Tumino, Rosario; Vercelli, Marina; Wolf, Holly J.; Wu, Xiao Cheng; Coleman, Michel P.

In: BMJ Open, Vol. 3, No. 9, e003055, 2013.

Research output: Contribution to journalArticle

Allemani, C, Rachet, B, Weir, HK, Richardson, LC, Lepage, C, Faivre, J, Gatta, G, Capocaccia, R, Sant, M, Baili, P, Lombardo, C, Aareleid, T, Ardanaz, E, Bielska-Lasota, M, Bolick, S, Cress, RD, Elferink, M, Fulton, JP, Galceran, J, Góźdź, S, Hakulinen, T, Primic-Žakelj, M, Rachtan, J, Diba, CS, Sánchez, MJ, Schymura, MJ, Shen, T, Tagliabue, G, Tumino, R, Vercelli, M, Wolf, HJ, Wu, XC & Coleman, MP 2013, 'Colorectal cancer survival in the USA and Europe: A CONCORD high-resolution study', BMJ Open, vol. 3, no. 9, e003055. https://doi.org/10.1136/bmjopen-2013-003055
Allemani C, Rachet B, Weir HK, Richardson LC, Lepage C, Faivre J et al. Colorectal cancer survival in the USA and Europe: A CONCORD high-resolution study. BMJ Open. 2013;3(9). e003055. https://doi.org/10.1136/bmjopen-2013-003055
Allemani, Claudia ; Rachet, Bernard ; Weir, Hannah K. ; Richardson, Lisa C. ; Lepage, Côme ; Faivre, Jean ; Gatta, Gemma ; Capocaccia, Riccardo ; Sant, Milena ; Baili, Paolo ; Lombardo, Claudio ; Aareleid, Tiiu ; Ardanaz, Eva ; Bielska-Lasota, Magdalena ; Bolick, Susan ; Cress, Rosemary D ; Elferink, Marloes ; Fulton, John P. ; Galceran, Jaume ; Góźdź, Stanislaw ; Hakulinen, Timo ; Primic-Žakelj, Maja ; Rachtan, Jadwiga ; Diba, Chakameh Safaei ; Sánchez, Maria José ; Schymura, Maria J. ; Shen, Tiefu ; Tagliabue, Giovanna ; Tumino, Rosario ; Vercelli, Marina ; Wolf, Holly J. ; Wu, Xiao Cheng ; Coleman, Michel P. / Colorectal cancer survival in the USA and Europe : A CONCORD high-resolution study. In: BMJ Open. 2013 ; Vol. 3, No. 9.
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abstract = "Objectives: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. Design: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. Setting and participants: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. Outcome measures: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. Results: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38{\%} vs 21{\%}) and of Dukes' D more frequent in Europe (22{\%} vs 10{\%}). Resection with curative intent was more frequent in the USA (85{\%} vs 75{\%}). Elderly patients (75-99 years) were 70-90{\%} less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58{\%}) and Northern and Western Europe (54-56{\%}) and lowest in Eastern Europe (42{\%}). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. Conclusions: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.",
author = "Claudia Allemani and Bernard Rachet and Weir, {Hannah K.} and Richardson, {Lisa C.} and C{\^o}me Lepage and Jean Faivre and Gemma Gatta and Riccardo Capocaccia and Milena Sant and Paolo Baili and Claudio Lombardo and Tiiu Aareleid and Eva Ardanaz and Magdalena Bielska-Lasota and Susan Bolick and Cress, {Rosemary D} and Marloes Elferink and Fulton, {John P.} and Jaume Galceran and Stanislaw G{\'o}źdź and Timo Hakulinen and Maja Primic-Žakelj and Jadwiga Rachtan and Diba, {Chakameh Safaei} and S{\'a}nchez, {Maria Jos{\'e}} and Schymura, {Maria J.} and Tiefu Shen and Giovanna Tagliabue and Rosario Tumino and Marina Vercelli and Wolf, {Holly J.} and Wu, {Xiao Cheng} and Coleman, {Michel P.}",
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TY - JOUR

T1 - Colorectal cancer survival in the USA and Europe

T2 - A CONCORD high-resolution study

AU - Allemani, Claudia

AU - Rachet, Bernard

AU - Weir, Hannah K.

AU - Richardson, Lisa C.

AU - Lepage, Côme

AU - Faivre, Jean

AU - Gatta, Gemma

AU - Capocaccia, Riccardo

AU - Sant, Milena

AU - Baili, Paolo

AU - Lombardo, Claudio

AU - Aareleid, Tiiu

AU - Ardanaz, Eva

AU - Bielska-Lasota, Magdalena

AU - Bolick, Susan

AU - Cress, Rosemary D

AU - Elferink, Marloes

AU - Fulton, John P.

AU - Galceran, Jaume

AU - Góźdź, Stanislaw

AU - Hakulinen, Timo

AU - Primic-Žakelj, Maja

AU - Rachtan, Jadwiga

AU - Diba, Chakameh Safaei

AU - Sánchez, Maria José

AU - Schymura, Maria J.

AU - Shen, Tiefu

AU - Tagliabue, Giovanna

AU - Tumino, Rosario

AU - Vercelli, Marina

AU - Wolf, Holly J.

AU - Wu, Xiao Cheng

AU - Coleman, Michel P.

PY - 2013

Y1 - 2013

N2 - Objectives: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. Design: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. Setting and participants: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. Outcome measures: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. Results: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. Conclusions: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.

AB - Objectives: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. Design: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. Setting and participants: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. Outcome measures: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. Results: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. Conclusions: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.

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