The Current Landscape of Staging and Treatment of Colorectal Cancer in a Region of Ukraine: a Mixed Methods Study

Abstract

Background In Ukraine, the 1‐year mortality for colorectal cancer is much higher than that seen in high‐income countries. We investigated practice patterns of colorectal cancer treatment in a region of Ukraine to account for high mortality rates. Methods An explanatory sequential mixed methods design was used. Data from patients who underwent surgery for colorectal cancer in Ivano‐Frankivsk from 2011 to 2015 were collected via retrospective chart review, and descriptive statistics were calculated. Semi‐structured interviews were performed with local practicing surgeons and oncologists until thematic saturation was reached. Results A total of 960 patients who underwent surgery were identified in the Ivano‐Frankivsk region with colon (689) or rectal (271) cancer. 11.7% of patients underwent preoperative CT of the abdomen and pelvis, and only 1.7% underwent CT of the chest. 4.1% of patients underwent a complete preoperative colonoscopy, while 31.0% had incomplete colonoscopies. Postoperatively, 31.1% of patients with stage II colon cancer and 43.9% of patients with stage III colon cancer underwent adjuvant chemotherapy. For patients with stage II and III rectal cancers, 20.9% and 33.3% underwent chemotherapy, while 68.4% and 66.7% underwent radiation therapy, respectively. Fifteen physicians completed interviews. Two major themes emerged regarding physician perceptions on providing colorectal cancer care: lack of resources and systems level issues negatively impacting patient care. Conclusion In this region in Ukraine, staging practices for colorectal malignancies are inconsistent and inadequate, and adjuvant treatments are varied. This is likely attributable to the lack of resources facing providers and the prohibitively high cost of care to patients.

Global Health 101

“…33 They characterized gaps and inconsistencies in pre-operative staging practices with CT and colonoscopy, and also found significant inconsistencies in utilization of adjuvant chemotherapy or radiation therapy following surgery for rectal cancer. 33 Lack of resources and access to medical literature, despite an eagerness to provide standardized and evidence-based care, were highly emphasized barriers identified by treating clinicians in Ukraine. 33 34…”

“…33 Lack of resources and access to medical literature, despite an eagerness to provide standardized and evidence-based care, were highly emphasized barriers identified by treating clinicians in Ukraine. 33 34…”

“…25 Building on the importance of establishing clear guidelines and standards of care in light of high rates of one-year mortality, Melnitchouk et al studied peri-operative treatment trends in patients undergoing surgery for colorectal cancer in Ukraine. 33 They characterized gaps and inconsistencies in pre-operative staging practices with CT and colonoscopy, and also found significant inconsistencies in utilization of adjuvant chemotherapy or radiation therapy following surgery for rectal cancer. 33 Lack of resources and access to medical literature, despite an eagerness to provide standardized and evidence-based care, were highly emphasized barriers identified by treating clinicians in Ukraine.…”

“…33 They characterized gaps and inconsistencies in pre-operative staging practices with CT and colonoscopy, and also found significant inconsistencies in utilization of adjuvant chemotherapy or radiation therapy following surgery for rectal cancer. 33 Lack of resources and access to medical literature, despite an eagerness to provide standardized and evidence-based care, were highly emphasized barriers identified by treating clinicians in Ukraine. 33,34 With their work, Melnitchouk et al have been able to collaborate and communicate with Ukrainian stakeholders to characterize the colorectal cancer disease burden and perceived barriers to standardized care, and establish the cost-effectiveness and potential benefit of screening strategies to promote the reduction in burden of disease.…”

“…33 Lack of resources and access to medical literature, despite an eagerness to provide standardized and evidence-based care, were highly emphasized barriers identified by treating clinicians in Ukraine. 33,34 With their work, Melnitchouk et al have been able to collaborate and communicate with Ukrainian stakeholders to characterize the colorectal cancer disease burden and perceived barriers to standardized care, and establish the cost-effectiveness and potential benefit of screening strategies to promote the reduction in burden of disease. Thus, their transnational collaborative efforts have been comprehensive, inclusive, and directly in line with addressing existing gaps and needs identified in communication with notable stakeholders.…”