title: Management of colorectal cancer explains differences in 1-year relative survival between France and England for patients diagnosed 1997-2004.
abstract: BACKGROUND
  Few international population-based studies have provided information on potential determinants of international disparities in cancer survival. This population-based study was undertaken to identify the principal differences in disease characteristics and management that accounted for previously observed poorer survival in English compared with French patients with colorectal cancer.
  
  
  METHODS
  The study population comprised all cases of colorectal cancer diagnosed between 1997 and 2004 in the areas covered by three population-based cancer registries in France and one in England (N=40 613). To investigate the influence of clinical and treatment variables on survival, we applied multivariable excess hazard modelling based on generalised linear models with Poisson error.
  
  
  RESULTS
  Poorer survival for English patients was primarily due to a larger proportion dying within the first year after diagnosis. After controlling for inter-country differences in the use of chemotherapy and surgical resection with curative intent, country of residence was no-longer associated with 1-year survival for advanced colon cancer patients (excess hazard ratio (EHR)=0.99 (0.92-1.01), P=0.095)). Longer term (2-5 years) excess hazards of death for colon and rectal cancer patients did not differ between France and England.
  
  
  CONCLUSIONS
  This study suggests that difference in management close to diagnosis of colon and rectum cancer is related to differences in survival observed between France and England. All efforts (collection and standardisation of additional variables such as co-morbidity) to investigate the reasons for these disparities in management between these two countries, and more generally across Europe, should be encouraged.
authors: U1086 INSERM UCBN, Cancers & Preventions, Caen, France.
authors: O
authors: O
authors: Dejardin
authors: B
authors: B
authors: Rachet
authors: E
authors: E
authors: Morris
authors: V
authors: V
authors: Bouvier
authors: V
authors: V
authors: Jooste
authors: R
authors: R
authors: Haynes
authors: E G
authors: EG
authors: Coombes
authors: D
authors: D
authors: Forman
authors: A P
authors: AP
authors: Jones
authors: A M
authors: AM
authors: Bouvier
authors: G
authors: G
authors: Launoy
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D004739:England / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D016019:Survival Analysis; D013997:Time Factors
references: Int J Epidemiol. 2010 Feb;39(1):118-28
references: 19858106
references: Lancet Oncol. 2009 Apr;10(4):351-69
references: 19303813
references: Gut. 2000 Oct;47(4):533-8
references: 10986214
references: Lancet Oncol. 2008 Aug;9(8):730-56
references: 18639491
references: Acta Oncol. 2010 Aug;49(6):776-83
references: 20429733
references: Int J Cancer. 2007 Sep 1;121(5):1115-22
references: 17455250
references: BMJ. 2010 Aug 11;341:c4112
references: 20702551
references: Br J Cancer. 2008 Jan 15;98(1):60-70
references: 18059401
references: N Engl J Med. 1990 Feb 8;322(6):352-8
references: 2300087
references: Br J Cancer. 2009 Oct 20;101(8):1269-73
references: 19773758
references: Ann Oncol. 2010 May;21 Suppl 5:v70-7
references: 20555107
references: Br J Cancer. 2009 Dec 3;101 Suppl 2:S115-24
references: 19956155
references: Int J Cancer. 2009 Nov 15;125(10):2406-12
references: 19588486
references: Int J Cancer. 2012 Oct 1;131(7):1649-58
references: 21607946
references: BMJ. 2011 Jun 09;342:d3399
references: 21659366
references: Stat Med. 2004 Jan 15;23(1):51-64
references: 14695639
references: Gut. 2005 Feb;54(2):268-73
references: 15647193
references: Br J Cancer. 2011 Jun 28;105(1):170-6
references: 21559016
references: Gut. 2011 Aug;60(8):1087-93
references: 21303917
references: Br J Cancer. 2004 Nov 1;91(9):1751-2
references: 15381931
references: Eur J Cancer. 2007 Jan;43(1):149-60
references: 17084622
references: Br J Cancer. 2004 Apr 19;90(8):1479-85
references: 15083172
references: Eur J Cancer. 2007 Nov;43(17):2467-78
references: 17931854
references: Lancet Oncol. 2007 Sep;8(9):773-83
references: 17714991