On-going improvement and persistent differences in the survival for patients with colon and rectum cancer across Europe 1999–2007 – Results from the EUROCARE-5 study

doi:10.1016/j.ejca.2015.07.024

European Journal of Cancer

Volume 51, Issue 15, October 2015, Pages 2158-2168

https://doi.org/10.1016/j.ejca.2015.07.024 Get rights and content

Abstract

Background

Previous population-based studies revealed major variation in survival for patients with colorectal cancer (CRC) in Europe by age and between different countries and regions, but also a sustained improvement in survival for patients with CRC in recent years. This EUROCARE-5 paper aims to update available knowledge from previous studies and to provide the latest survival estimates for CRC patients from Europe.

Methods

The study analysed data of patients diagnosed with CRC from population-based cancer registries diagnosed in 29 European countries. Estimates of 1-year and 5-year relative survival (RS) were derived for patients diagnosed in 2000–2007 by European region, country and age at diagnosis. Additionally to these cohort estimates, time trends in 5-year RS were obtained for the calendar periods 1999–2001 and 2005–2007, using the period analysis methodology.

Results

European average 5-year RS for patients diagnosed with colon and rectum cancer was 57% and 56%, respectively. The analyses showed persistent differences in cancer survival across Europe with lowest survival for CRC patients observed in Eastern Europe. The analyses further showed a strong gradient in age-specific survival. Even though the study revealed sustained improvement in patient survival between 1999–2001 and 2005–2007 (absolute increase of 4 and 6 percentage points for colon and rectum, respectively), the differences in the survival for CRC patients observed at the beginning of the millennium persisted over time.

Conclusion

Although survival for CRC patients in Europe improved markedly in the study period, significant geographic variations and a strong age gradient still persisted. Enhanced access to effective diagnostic procedures and treatment options might be the keys to reducing the existing disparities in the survival of CRC patients across Europe.

Introduction

Colorectal cancer (CRC) is among the commonest cancers in Europe, accounting for an estimated 471,000 new cases and 228,000 deaths in 2012 [1].

Previous studies using population-based cancer registry (CR) data revealed major variation in survival for patients with colon and rectum cancer in Europe [2], [3]. Major findings included (i) age-related differences in the survival for CRC patients with lower survival for elderly ones, and (ii) geographical variation with lower survival particularly observed for patients from Eastern Europe. Mortality rates decreased throughout most European countries and this was accompanied by a sustained increase in population-based survival for CRC patients in many countries, whilst incidence rates increased modestly in men and remained stable in women, respectively [4].

Possible reasons for the higher incidence rates observed in Europe as well as in many developed regions [1] are life style related factors with increased consumption of sugar, red and processed meat, less consumption of fibre and physical activity, which result in an increased amount of overweight people [5]. The aforementioned increase in survival, especially in younger patients, has been attributed to advances in detection and treatment of CRC during the past 20 years including increased availability of colonoscopy, improved surgery and more widespread use of radiotherapy for rectal cancers [3].

This EUROCARE-5 paper aims to update available knowledge from previous population-based survival studies and to provide the latest survival estimates for patients with invasive malignant colon and rectum cancers from Europe.

Section snippets

Study database

The study analysed data of patients followed up to the end of 2008 and diagnosed with invasive malignant cancer of the colon and rectum, anal canal and anus (ICD-O-3 topography codes: C18-C21, morphology codes: 8000/3-9589/3, according to International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) [6]). We analysed a first dataset including 1,054,018 patients diagnosed with CRC in 2000–2007 from 29 European countries provided by 89 population-based CRs and grouped into five

Results

Table 1 provides an overview on the included patients. Altogether, 1,054,018 CRC patients representing 96% of all registered cancers were included into the survival analyses. The proportions of DCO notified cases and cancer cases without microscopic verification were less than 5% and less than 10%, respectively, in each European region. Overall, 51% of the patients were aged 55–74 years at diagnosis. The proportion of elderly patients aged 75+ years was highest in Northern Europe and Ireland and

Discussion

This article presents patterns and trends in survival for patients diagnosed with CRC from different European countries and regions. European average 5-year RS of patients who were diagnosed with colon and rectum cancers in 2000–2007 was 57% and 56%, respectively. The analyses demonstrated persistent differences in the survival of patients with colon and rectum cancer across Europe with below average survival consistently observed in Eastern Europe. Similar increases in patient survival were

Conclusions

To summarise, this study updates previous studies and reveals on-going improvement of survival for patients with CRC in Europe between 1999 and 2007. It highlighted the persistent differences in survival for patients with CRC within Europe, with lowest survival observed for patients from Eastern Europe. Several screening strategies have meanwhile been demonstrated to have a large potential to reduce mortality from colon and rectum cancer, and their implementation might carry a large potential

Role of the funding source

The study was funded by the Compagnia di San Paolo, the Fondazione Cariplo Italy, the Italian Ministry of Health (Ricerca Finalizzata 2009, RF-2009-1529710) and the European Commission (European Action Against Cancer, EPAAC, Joint Action No. 20102202). The funding sources had no role in study design, the collection, analysis or interpretation of data, the writing of the report, or the decision to submit the article for publication.

Conflict of interest statement

None declared.

Acknowledgements

We thank Chiara Margutti, Simone Bonfarnuzzo and Camilla Amati for secretarial assistance.

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On-going improvement and persistent differences in the survival for patients with colon and rectum cancer across Europe 1999–2007 – Results from the EUROCARE-5 study

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Study database

Results

Discussion

Conclusions

Role of the funding source

Conflict of interest statement

Acknowledgements

Eur J Cancer

Eur J Cancer

Eur J Cancer

Eur J Cancer

Ann Epidemiol

Eur J Cancer

Eur J Cancer

Eur J Cancer

Ann Oncol

Lancet

Prev Med

Clin Gastroenterol Hepatol

Clin Colorectal Cancer

Acta Oncol

Ann Oncol

Lancet

Lancet Oncol

Clin Oncol (R Coll Radiol)

GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11

Progress in colorectal cancer survival in Europe from the late 1980s to the early 21st century: the EUROCARE study

Int J Cancer