title: Improvement in survival of metastatic colorectal cancer: are the benefits of clinical trials reproduced in population-based studies?
abstract: OBJECTIVE
  To describe trends in survival of non-resectable metastatic colorectal cancer (MCRC) over a 34-year period in a French population-based registry taking into account major advances in medical therapy.
  
  
  METHODS
  3804 patients with non-resectable metastatic colorectal cancer diagnosed between 1976 and 2009 were included. Three periods (1976-96, 1997-2004 and 2005-09) were considered.
  
  
  RESULTS
  The proportion of patients receiving chemotherapy dramatically increased from 19% to 57% between the first two periods, then increased steadily thereafter reaching 59% during the last period (p<0.001). Median relative survival increased from 5.9 months during the 1976-96 period to 10.2 months during the 1997-2004 period but, despite the availability of targeted therapies, remained at 9.5 months during the 2005-09 period. During the last study period, less than 10% of elderly patients received targeted therapies compared to more than 40% for younger patients. Their median relative survival was 5.0 months compared to 15.6 months in younger patients.
  
  
  CONCLUSIONS
  There was an improvement in survival in relation with the increased use of more effective medical treatment. However, at a population-based level, patients are not all treated equally and most of them, especially the elderly, do not benefit from the most up-to-date treatment options.
authors: Institut Curie, Département d'Oncologie Médicale, 35 Rue Dailly, 92210 Saint-Cloud, France.
authors: E
authors: E
authors: Mitry
authors: F
authors: F
authors: Rollot
authors: V
authors: V
authors: Jooste
authors: B
authors: B
authors: Guiu
authors: C
authors: C
authors: Lepage
authors: F
authors: F
authors: Ghiringhelli
authors: J
authors: J
authors: Faivre
authors: A M
authors: AM
authors: Bouvier
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D010166:Palliative Care; D018579:Patient Selection; D012042:Registries; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Colorectal cancer; Elderly; Population-based study; Survival; Targeted therapies