Management of colorectal cancer explains differences in 1-year relative survival between France and England for patients diagnosed 1997–2004

Abstract

Background:Few international population-based studies have provided information on potential determinants of international disparities in cancer survival. This population-based study was undertaken to identify the principal differences in disease characteristics and management that accounted for previously observed poorer survival in English compared with French patients with colorectal cancer.Methods:The study population comprised all cases of colorectal cancer diagnosed between 1997 and 2004 in the areas covered by three population-based cancer registries in France and one in England (N=40 613). To investigate the influence of clinical and treatment variables on survival, we applied multivariable excess hazard modelling based on generalised linear models with Poisson error.Results:Poorer survival for English patients was primarily due to a larger proportion dying within the first year after diagnosis. After controlling for inter-country differences in the use of chemotherapy and surgical resection with curative intent, country of residence was no-longer associated with 1-year survival for advanced colon cancer patients (excess hazard ratio (EHR)=0.99 (0.92–1.01), P=0.095)). Longer term (2–5 years) excess hazards of death for colon and rectal cancer patients did not differ between France and England.Conclusion:This study suggests that difference in management close to diagnosis of colon and rectum cancer is related to differences in survival observed between France and England. All efforts (collection and standardisation of additional variables such as co-morbidity) to investigate the reasons for these disparities in management between these two countries, and more generally across Europe, should be encouraged.

Concordance of National Cancer Registration with self-reported breast, bowel and lung cancer in England and Wales: a prospective cohort study within the UK Collaborative Trial of Ovarian Cancer Screening

“…Our data refute the suggestions ( Beral and Peto, 2010 ) that the lower UK breast cancer survival is influenced mainly by lower CR in survivors. Recent reports suggests that more likely contributors to lower UK cancer survival are low cancer awareness, increased perceived barriers to symptomatic presentation, concern about wasting the doctor's time ( Forbes et al , 2013 ), suboptimal treatment of advanced ovarian ( Maringe et al , 2012 ) and bowel cancer ( Dejardin et al , 2013 ).…”

The Continuum of Cancer Immunosurveillance: Prognostic, Predictive, and Mechanistic Signatures

“…In particular, plasticity and the modulatory role of stromal cells are becoming increasingly understood (Finak et al, 2008), and it is probable that they also contribute to the development of the inflammatory phenotype (Muthuswamy et al, 2012;Jin et al, 2012, Soc. for Immunotherapy of Cancer, abstract). Additionally, wide patient-to-patient variability is observed among tumor cell profiles, given that specific tumor cell signatures are largely modulable following different stimuli (Murtas et al, 2013). Other approaches could consist of singlecell profiling following cell sorting or laser microdissection.…”

Persistent inequalities in 90-day colon cancer mortality: an English cohort study

“…These inequalities are generally evident shortly after diagnosis ( Møller et al , 2012 ), with two-thirds of cancer deaths related to these inequalities occurring within 6 months after diagnosis ( Ellis et al , 2012 ). Socio-economic inequalities in colon cancer survival have been reported in several countries ( Wrigley et al , 2002 ; Aarts et al , 2010 ; Cavalli-Bjorkman et al , 2011 ; Ito et al , 2014 ) but have not been found in others ( Dejardin et al , 2013 ; Antunes et al , 2016 ), which underlines the importance of understanding factors contributing to inequalities and more particularly differential short-term mortality in colon cancer patients in England.…”