Regional variations in management of rectal cancer in France.
BACKGROUND
Population-based registries provide excellent data for drawing an accurate picture of disease management practices. The purpose of this study was to determine whether diagnostic and therapeutic management practices for rectal cancer vary in different geographic regions of France.


METHODS
Data Issued from nine cancer registries covering 11% of the French population. The files of 683 patients with a rectal cancer diagnosed in 1995 were selected for analysis.


RESULTS
Colonoscopy was performed in a mean of 91.6% of patients (range: 80.9%-98.2%) (P=0.01). The practice of colonoscopy concomitantly with barium enema varied greatly, ranging from 1.9%-57.7% of patients (P<0.001). Pretherapeutic work-up practices were significantly different depending on the region with respect to: abdominal CT scans (13.4%-69.2%), thoracic CT scans (0.9%-13.2%) and tumor markers (46.8%-80.8%). There were no significant differences between geographic regions concerning rate of resection, use of colostomy, or tumor stage at diagnosis. Administration of adjuvant radiotherapy (mean, 46.8%; range: 21.6%-70%; P<0.001) and adjuvant chemotherapy (mean, 24.1%; range: 10.3%-40.6%; P<0.05) varied significantly between regions.


CONCLUSIONS
Diagnostic practices and administration of adjuvant treatments vary significantly between geographic regions in France. The recommendations of the French consensus guidelines are only partially adhered to. Practitioners and healthcare Authorities should be aware of these differences in order to provide more harmonious patient care.
Phelip
Jean-Marc
JM
Registre Bourguignon des Cancers Digestifs, CHU de Grenoble, BP 217, 38043 Grenoble Cedex.
Launoy
Guy
G
Colonna
Marc
M
Grosclaude
Pascale
P
Velten
Michel
M
Danzon
Arlette
A
Raverdy
Nicole
N
Tretarre
Brigitte
B
Bouvier
Anne-Marie
AM
Faivre
Jean
J
D001466:Barium Sulfate; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D003113:Colonoscopy / Q000706:statistics & numerical data; D003287:Contrast Media; D004733:Enema; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012042:Registries
D003287:Contrast Media; D001466:Barium Sulfate