title: Utilisation of specialist care in patients with incurable rectal cancer. a population-based study from Western Norway.
abstract: BACKGROUND
  About 25% of patients with rectal cancer have incurable disease at the time of diagnosis. In the current study from Western Norway (population of 981 000) we focused on the utilisation of specialist care in patients with primarily incurable rectal cancer.
  
  
  METHODS
  Between 1997 and 2002, 1 167 patients were diagnosed with rectal cancer, of whom 297 (25%) had incurable disease, according to consecutive and prospective reporting to the Norwegian Colorectal Cancer Registry. Consumption of specialist care facilities was studied with regard to outpatient contacts, hospital admissions, and various treatment modalities. Data were analysed with regard to age, sex, marital status, type of residence, and geographical access to hospital facilities. Data were available for 287 patients (97%).
  
  
  RESULTS
  The median age was 77 years. Elderly patients (>77 years) more often lived in nursing homes without a spouse. About 60% of the patients were treated with major surgery, chemotherapy or radiotherapy, either alone or in combination. Of those who did not receive such treatment, 87% were elderly. Oncological treatment, either alone or combined with surgery, predicted increased hospital admissions and outpatient contacts. Age >77 years predicted fewer hospital admissions. Survival varied statistically significantly with the various treatment modalities, and was highest for major resections combined with oncological treatment. The majority of the patients living at home died in hospitals (54%) and only 26% died in their homes, while two-thirds of residents of nursing homes died there.
  
  
  CONCLUSIONS
  Patients with primary incurable rectal cancer are heterogeneous with regard to their needs of treatment. While younger patients receive extensive tumour-related treatment, elderly patients are most commonly treated according to their symptoms. Prospective studies of the effect of various treatment options on the ease of symptoms and improved quality of life in unselected populations are needed.
authors.affiliation: Department of Surgery, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Helgi Kjartan
authors.initials: HK
authors.lastname: Sigurdsson
authors.forename: Jon Arne
authors.initials: JA
authors.lastname: Søreide
authors.forename: Olav
authors.initials: O
authors.lastname: Dahl
authors.forename: Arne
authors.initials: A
authors.lastname: Skarstein
authors.forename: Sebastian
authors.initials: S
authors.lastname: Von Hofacker
authors.forename: Hartwig
authors.initials: H
authors.lastname: Kørner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010166:Palliative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000628:therapy*; D015996:Survival Rate