Marked improvements in survival of patients with rectal cancer in the Netherlands following changes in therapy, 1989–2006

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Abstract

Background

Since the 1990s, treatment of patients with rectal cancer has changed in the Netherlands. Aim of this study was to describe these changes in treatment over time and to evaluate their effects on survival.

Methods

All patients in the Netherlands Cancer Registry with invasive primary rectal cancer diagnosed during the period 1989–2006 were selected. The Cochran–Armitage trend test was used to analyse trends in treatment over time. Multivariate relative survival analyses were performed to estimate relative excess risk (RER) of dying.

Results

In total, 40,888 patients were diagnosed with rectal cancer during the period 1989–2006. The proportion of patients with stages II and III disease receiving preoperative radiotherapy increased from 1% in the period 1989–1992 to 68% in the period 2004–2006 for younger patients (<75 years) and from 1% to 51% for older patients (⩾75 years), whereas the use of postoperative radiotherapy decreased. Administration of chemotherapy to patients with stage IV disease increased over time from 21% to 66% for patients younger than 75 years. Both males and females exhibited an increase in five-year relative survival from 53% to 60%. The highest increase in survival was found for patients with stage III disease. In the multivariate analyses survival improved over time for patients with stages II–IV disease. After adjustment for treatment variables, this improvement remained significant for patients with stages III and IV disease.

Conclusions

The changes in therapy for rectal cancer have led to a markedly increased survival. Patients with stage III disease experienced the greatest improvement in survival.

Section snippets

Background

Each year, over 3000 new cases of rectal cancer are diagnosed in the Netherlands, with age-standardised incidence rates (European Standard Population, ESR) increasing between 1989 and 2006 from 12.0 to 15.5 per 100,000 person-years. Incidence rates were higher for males than for females (ESR 19.6 versus 11.3 per 100,000 person-years in 2006).1

Previous regional Dutch studies have shown improved survival of patients with rectal cancer since 1980.2, 3 Especially since the mid 1990s, this

Data collection

Population-based data from the nationwide Netherlands Cancer Registry (NCR), which was started in 1989 and is maintained and hosted by the Comprehensive Cancer Centres, were used. The NCR is based on notification of all newly diagnosed malignancies in the Netherlands by the automated pathological archive (PALGA). Additional sources are the national registry of hospital discharge diagnoses, haematology departments and radiotherapy institutions.1 Information on patient characteristics, such as

Results

During the period 1989–2006, 40,888 patients were diagnosed with rectal cancer. The proportion of patients aged 45–59 years increased over time, while the proportion of patients aged 75+ years decreased. During this period, the proportion of patients with stage II disease decreased, whereas the proportion of patients with stages III and IV disease increased (Table 1). The age-standardised incidence rate (ESR) increased over time, whereas the age-standardised mortality rate decreased (Fig. 1).

Discussion

This nationwide population-based study focussed on trends in treatment and survival of patients with rectal cancer in the Netherlands during the period 1989–2006. There were several changes in treatment, which contributed to an improvement in survival, particularly for patients with stage III rectal cancer.

The incidence of rectal cancer increased in the Netherlands whereas the mortality decreased, pointing to an increase in survival possibly caused by effective treatment.15 However, there were

Conflict of interest statement

None declared.

Acknowledgements

The work on this research was performed within the framework of the project ‘Progress against cancer in the Netherlands since the 1970s?’ (Dutch Cancer Society Grant 715401). The authors thank the working group Output (Dr. K. Aben, R. Damhuis, Dr. J. Flobbe, M. van der Heiden, Dr. P. Krijnen, Dr. L. van de Poll, Dr. S. Siesling, J. Verloop) of the NCR for providing data from the cancer registry and the registration clerks for their dedicated data collection.

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