Inter-country and ethnic variation in colorectal cancer survival: Comparisons between a Philippine population, Filipino-Americans and Caucasians

Abstract

BackgroundPrevious population-based studies showed differences in international and within country colorectal cancer survival estimates, but few investigated the role of prognostic factors. Using a "high resolution approach", we aimed to determine the effect of ethnicity and health care by comparing Filipino-Americans with Philippine residents, who have the same ethnicity, and with Caucasians living in the US, who have the same health care system.MethodsUsing databases from the Manila and Rizal Cancer Registries and the United States Surveillance, Epidemiology and End Results, age-adjusted five-year absolute and relative survival estimates were computed and compared between Filipino-American colorectal cancer patients, cancer patients from the Philippines and Caucasian patients. Cox proportional hazards modelling was used to determine factors affecting survival differences.ResultsMuch lower 5-year relative survival estimates were obtained for Philippine residents (37%) as compared to those in Filipino-Americans (60.3%) and Caucasians (62.4%). Differences in age, stage and receipt of surgery explained a large proportion of the survival differences between Philippine residents and Filipino-Americans. However, strong excess risk of death for Philippine residents remained after controlling for these and other variables (relative risk, RR, 2.03, 95% confidence interval, 95% CI, 1.83-2.25).ConclusionsStrong survival disadvantages of Philippine residents compared to Filipino-American patients were disclosed, which most likely reflect differences in access to and utilization of health care. Health education and advocacy, for both patients and health practitioners, should likewise be given priority.

Oral cancer in South East Asia

“…22,23 The most recent reports for Malaysia and the Philippines were in 2011 and 2008, with reporting periods up to 2007 and 2002, respectively. 24,25 Data on Vietnam were not accessible and, therefore, the last reporting period is not known. Looking at data on oral cancer specifically, these data were available from the Thailand, Philippines and Malaysia registries in the last reporting periods, the latest data for Singapore were not available and data on oral cancer were last reported for 2003–2007 (Table 1).…”

“…Betel quid chewing which is also closely linked with oral cancer and widely practiced in SEA countries compounds the issue of tobacco control. 24,28,37–39 In some areas, for example in the north-eastern region of Thailand, betel quid chewing is the strongest risk factor for oral cancer with odds ratio of 9.01, and the habit continues to be popular among youths. 19,20,28,38,40 The betel quid chewing habit is practised both among the men and women and therefore, in contrast to many other parts of the world where there is a preponderance of oral cancer among males, the number of oral cancer diagnosed in women rival that in the men and this is in major part because of the betel quid chewing habit that is also widely practiced among the women.…”

Smoking-attributable burden of lung cancer in the Philippines

“…To address the limitations of DISMOD II (described in detail elsewhere22), local expert opinion was sought during analyses to ensure appropriateness of the model-based estimates for the Philippine scenario. Though the YLD model was unable to consider different lung cancer types or treatments due to lack of information, the effect on YLD and DALY estimates should be minimal since there is little variation in prognosis locally regardless of type or treatment26 and YLDs have a small contribution to DALYs. Finally, exclusion of passive smoking, former smoking and other tobacco products from the exposure definition would have underestimated the overall smoking-attributable fraction, but this implies that a more substantial burden could have actually been incurred by smoking, and this study may underestimate the true burden.…”

“…Based on this study's lung cancer mortality estimation within the context of all other causes of death (including other cancer sites) and consistent with previous local trends,4 5 lung cancer again emerges as the top cancer-related cause of mortality in the 2008 Philippine population. The high mortality can be attributed to late diagnosis and limited access to effective treatments for lung cancer,26 also common in other developing settings,28 and which reiterate the importance of enhancing prevention by targeting major risk factors.…”

“…Filling such data gaps could prove useful for priority setting, resource allocation and policymaking purposes. As for the high proportion of YLLs in lung cancer burden, this may be attributed to the late diagnosis and short survival time of lung cancer cases in the Philippine setting 26. That is, newly diagnosed individuals were estimated to spend a short time living with disability, resulting in minimal contribution of YLDs to the disease burden.…”