Relative impact of earlier diagnosis and improved treatment on survival for colorectal cancer: A US database study among elderly patients |
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| Institution: | 1. Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA;2. Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA;3. Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA;4. Division of Biostatistics, University of Texas School of Public Health, Houston, TX, USA;5. Southwest Center for Occupational and Environmental Health, University of Texas School of Public Health, Houston, TX, USA;6. Center for Health Services Research, University of Texas School of Public Health, Houston, TX, USA;1. Division of Hematology and Medical Oncology, Department of Medicine, Myeloma Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY;2. Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY;3. Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical College, New York, NY;1. Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA;2. Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA;1. MedImmune, One MedImmune Way, Gaithersburg, MD 20878, USA;2. AstraZeneca, One MedImmune Way, Gaithersburg, MD 20878, USA;3. HealthCore, Inc., 800 Delaware Ave, 5th Floor, Wilmington, DE 19801, USA;4. University of Louisville, 201 South 5th Street, Bardstown, Suites 102 & 104, Louisville, KY 40004, USA;1. Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104;2. American Academy of Dermatology, Schaumburg, Illinois;3. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;4. Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;1. Division of Trauma & Critical Care, Temple University Hospital, Philadelphia, PA;2. Division of Trauma, Burn, Surgical Critical Care, Brigham and Women''s Hospital, Boston, MA;3. Temple University School of Medicine, Philadelphia, PA;1. School of Health Sciences, Department of Epidemiology, University of Tampere, Tampere FI-33014, Finland;2. Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland;3. School of Public Health, Division of Epidemiology, University of California, Berkeley, CA, USA |
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| Abstract: | PurposesTo estimate what proportion of improvement in relative survival was attributable to smaller stage/size due to early detection and what proportion was attributable to cancer chemotherapy in patients with colorectal cancer (CRC).MethodsWe studied 69,718 patients with CRC aged ≥66 years in 1992–2009 from Surveillance, Epidemiology, and End Results registries. Study periods were categorized into three periods according to the major changes or advances in screening and chemotherapy regimens: (1) Period-1 (1992–1995), during which there was no evidence-based recommendation for routine CRC screening and 5-fluorouracil was the mainstay for chemotherapy; (2) Period-2 (1996–2000), during which evidences and guidelines supported the use of fecal occult blood test (FOBT) and sigmoidoscopy for routine CRC screening; and (3) Period-3 (2001–2009), during which Medicare Program added the full coverage for colonoscopy screening to average-risk individuals, and several newly developed chemotherapy regimens were approved. Outcome variables included the likelihood of being diagnosed at an early stage or with a small tumor size, and improvement in relative survival.ResultsCompared to period-1, likelihood of being diagnosed with early stage CRC increased by 20% in period-2 (odds ratio = 1.2, 95%CI: 1.1–1.2) and 30% in period-3 (1.3, 1.2–1.4); and likelihood of being diagnosed with small-size CRC increased by 60% in period-2 and 110% in period-3. Similarly, 5-year overall relative survival increased from 51% in period-1 to 56% in period-2 and 60% in period-3. Increase in survival attributable to migration in stage/size was 9% in period-2 and 20% in period-3, while the remaining survival improvement during period-2 and period-3 were largely attributable to more effective chemotherapy regimens (≥71.6%) and other treatment factors (≤25%).ConclusionsImprovements in CRC screening resulted in a migration of CRC toward earlier tumor stage and smaller size, which contributed to ≤20% of survival increase. Survival improvement over the past 2 decades was largely explained by more effective chemotherapy regimens (≥71.6%). |
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| Keywords: | Colorectal cancer Chemotherapy Tumor stage and size migration Survival |
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