Relative impact of earlier diagnosis and improved treatment on survival for colorectal cancer: A US database study among elderly patients

Liyue Tong, Chul Ahn, Elaine Symanski, Dejian Lai, Xianglin L. Du

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Purposes: To estimate what proportion of improvement in relative survival was attributable to smaller stage/size due to early detection and what proportion was attributable to cancer chemotherapy in patients with colorectal cancer (CRC) Methods: We studied 69,718 patients with CRC aged ≥66 years in 1992-2009 from Surveillance, Epidemiology, and End Results registriesStudy periods were categorized into three periods according to the major changes or advances in screening and chemotherapy regimens: (1) Period-1 (1992-1995), during which there was no evidence-based recommendation for routine CRC screening and 5-fluorouracil was the mainstay for chemotherapy; (2) Period-2 (1996-2000), during which evidences and guidelines supported the use of fecal occult blood test (FOBT) and sigmoidoscopy for routine CRC screening; and (3) Period-3 (2001-2009), during which Medicare Program added the full coverage for colonoscopy screening to average-risk individuals, and several newly developed chemotherapy regimens were approvedOutcome variables included the likelihood of being diagnosed at an early stage or with a small tumor size, and improvement in relative survival Results: Compared to period-1, likelihood of being diagnosed with early stage CRC increased by 20% in period-2 (odds ratio=1.2, 95%CI: 1.1-1.2) and 30% in period-3 (1.3, 1.2-1.4); and likelihood of being diagnosed with small-size CRC increased by 60% in period-2 and 110% in period-3Similarly, 5-year overall relative survival increased from 51% in period-1 to 56% in period-2 and 60% in period-3Increase in survival attributable to migration in stage/size was 9% in period-2 and 20% in period-3, while the remaining survival improvement during period-2 and period-3 were largely attributable to more effective chemotherapy regimens (≥71.6%) and other treatment factors (≤25%) Conclusions: Improvements in CRC screening resulted in a migration of CRC toward earlier tumor stage and smaller size, which contributed to ≤20% of survival increaseSurvival improvement over the past 2 decades was largely explained by more effective chemotherapy regimens (≥71.6%)

Original languageEnglish (US)
Pages (from-to)733-740
Number of pages8
JournalCancer Epidemiology
Volume38
Issue number6
DOIs
StatePublished - Dec 1 2014

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Early Diagnosis
Colorectal Neoplasms
Databases
Survival
Drug Therapy
Early Detection of Cancer
Therapeutics
Sigmoidoscopy
Neoplasms
Occult Blood
Hematologic Tests
Colonoscopy
Medicare
Fluorouracil
Epidemiology
Odds Ratio
Guidelines

Keywords

  • Chemotherapy
  • Colorectal cancer
  • Survival
  • Tumor stage and size migration

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Epidemiology

Cite this

Relative impact of earlier diagnosis and improved treatment on survival for colorectal cancer : A US database study among elderly patients. / Tong, Liyue; Ahn, Chul; Symanski, Elaine; Lai, Dejian; Du, Xianglin L.

In: Cancer Epidemiology, Vol. 38, No. 6, 01.12.2014, p. 733-740.

Research output: Contribution to journalArticle

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abstract = "Purposes: To estimate what proportion of improvement in relative survival was attributable to smaller stage/size due to early detection and what proportion was attributable to cancer chemotherapy in patients with colorectal cancer (CRC) Methods: We studied 69,718 patients with CRC aged ≥66 years in 1992-2009 from Surveillance, Epidemiology, and End Results registriesStudy periods were categorized into three periods according to the major changes or advances in screening and chemotherapy regimens: (1) Period-1 (1992-1995), during which there was no evidence-based recommendation for routine CRC screening and 5-fluorouracil was the mainstay for chemotherapy; (2) Period-2 (1996-2000), during which evidences and guidelines supported the use of fecal occult blood test (FOBT) and sigmoidoscopy for routine CRC screening; and (3) Period-3 (2001-2009), during which Medicare Program added the full coverage for colonoscopy screening to average-risk individuals, and several newly developed chemotherapy regimens were approvedOutcome variables included the likelihood of being diagnosed at an early stage or with a small tumor size, and improvement in relative survival Results: Compared to period-1, likelihood of being diagnosed with early stage CRC increased by 20{\%} in period-2 (odds ratio=1.2, 95{\%}CI: 1.1-1.2) and 30{\%} in period-3 (1.3, 1.2-1.4); and likelihood of being diagnosed with small-size CRC increased by 60{\%} in period-2 and 110{\%} in period-3Similarly, 5-year overall relative survival increased from 51{\%} in period-1 to 56{\%} in period-2 and 60{\%} in period-3Increase in survival attributable to migration in stage/size was 9{\%} in period-2 and 20{\%} in period-3, while the remaining survival improvement during period-2 and period-3 were largely attributable to more effective chemotherapy regimens (≥71.6{\%}) and other treatment factors (≤25{\%}) Conclusions: Improvements in CRC screening resulted in a migration of CRC toward earlier tumor stage and smaller size, which contributed to ≤20{\%} of survival increaseSurvival improvement over the past 2 decades was largely explained by more effective chemotherapy regimens (≥71.6{\%})",
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T1 - Relative impact of earlier diagnosis and improved treatment on survival for colorectal cancer

T2 - A US database study among elderly patients

AU - Tong, Liyue

AU - Ahn, Chul

AU - Symanski, Elaine

AU - Lai, Dejian

AU - Du, Xianglin L.

PY - 2014/12/1

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N2 - Purposes: To estimate what proportion of improvement in relative survival was attributable to smaller stage/size due to early detection and what proportion was attributable to cancer chemotherapy in patients with colorectal cancer (CRC) Methods: We studied 69,718 patients with CRC aged ≥66 years in 1992-2009 from Surveillance, Epidemiology, and End Results registriesStudy periods were categorized into three periods according to the major changes or advances in screening and chemotherapy regimens: (1) Period-1 (1992-1995), during which there was no evidence-based recommendation for routine CRC screening and 5-fluorouracil was the mainstay for chemotherapy; (2) Period-2 (1996-2000), during which evidences and guidelines supported the use of fecal occult blood test (FOBT) and sigmoidoscopy for routine CRC screening; and (3) Period-3 (2001-2009), during which Medicare Program added the full coverage for colonoscopy screening to average-risk individuals, and several newly developed chemotherapy regimens were approvedOutcome variables included the likelihood of being diagnosed at an early stage or with a small tumor size, and improvement in relative survival Results: Compared to period-1, likelihood of being diagnosed with early stage CRC increased by 20% in period-2 (odds ratio=1.2, 95%CI: 1.1-1.2) and 30% in period-3 (1.3, 1.2-1.4); and likelihood of being diagnosed with small-size CRC increased by 60% in period-2 and 110% in period-3Similarly, 5-year overall relative survival increased from 51% in period-1 to 56% in period-2 and 60% in period-3Increase in survival attributable to migration in stage/size was 9% in period-2 and 20% in period-3, while the remaining survival improvement during period-2 and period-3 were largely attributable to more effective chemotherapy regimens (≥71.6%) and other treatment factors (≤25%) Conclusions: Improvements in CRC screening resulted in a migration of CRC toward earlier tumor stage and smaller size, which contributed to ≤20% of survival increaseSurvival improvement over the past 2 decades was largely explained by more effective chemotherapy regimens (≥71.6%)

AB - Purposes: To estimate what proportion of improvement in relative survival was attributable to smaller stage/size due to early detection and what proportion was attributable to cancer chemotherapy in patients with colorectal cancer (CRC) Methods: We studied 69,718 patients with CRC aged ≥66 years in 1992-2009 from Surveillance, Epidemiology, and End Results registriesStudy periods were categorized into three periods according to the major changes or advances in screening and chemotherapy regimens: (1) Period-1 (1992-1995), during which there was no evidence-based recommendation for routine CRC screening and 5-fluorouracil was the mainstay for chemotherapy; (2) Period-2 (1996-2000), during which evidences and guidelines supported the use of fecal occult blood test (FOBT) and sigmoidoscopy for routine CRC screening; and (3) Period-3 (2001-2009), during which Medicare Program added the full coverage for colonoscopy screening to average-risk individuals, and several newly developed chemotherapy regimens were approvedOutcome variables included the likelihood of being diagnosed at an early stage or with a small tumor size, and improvement in relative survival Results: Compared to period-1, likelihood of being diagnosed with early stage CRC increased by 20% in period-2 (odds ratio=1.2, 95%CI: 1.1-1.2) and 30% in period-3 (1.3, 1.2-1.4); and likelihood of being diagnosed with small-size CRC increased by 60% in period-2 and 110% in period-3Similarly, 5-year overall relative survival increased from 51% in period-1 to 56% in period-2 and 60% in period-3Increase in survival attributable to migration in stage/size was 9% in period-2 and 20% in period-3, while the remaining survival improvement during period-2 and period-3 were largely attributable to more effective chemotherapy regimens (≥71.6%) and other treatment factors (≤25%) Conclusions: Improvements in CRC screening resulted in a migration of CRC toward earlier tumor stage and smaller size, which contributed to ≤20% of survival increaseSurvival improvement over the past 2 decades was largely explained by more effective chemotherapy regimens (≥71.6%)

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