title: Secular trends in colon and rectal cancer relative survival.
abstract: BACKGROUND
  Treatment options for colorectal cancer (CRC) have improved substantially over the past 25 years. Measuring the impact of these improvements on survival outcomes is challenging, however, against the background of overall survival gains from advancements in the prevention, screening, and treatment of other conditions. Relative survival is a metric that accounts for these concurrent changes, allowing assessment of changes in CRC survival. We describe stage- and location-specific trends in relative survival after CRC diagnosis.
  
  
  METHODS
  We analyzed survival outcomes for 233965 people in the Surveillance Epidemiology and End Results (SEER) program who were diagnosed with CRC between January 1, 1975, and December 31, 2003. All models were adjusted for sex, race (black vs white), age at diagnosis, time since diagnosis, and diagnosis year. We estimated the proportional difference in survival for CRC patients compared with overall survival for age-, sex-, race-, and period-matched controls to account for concurrent changes in overall survival using two-sided Wald tests.
  
  
  RESULTS
  We found statistically significant reductions in excess hazard of mortality from CRC in 2003 relative to 1975, with excess hazard ratios ranging from 0.75 (stage IV colon cancer; P < .001) to 0.32 (stage I rectal cancer; P < .001), indicating improvements in relative survival for all stages and cancer locations. These improvements occurred in earlier years for patients diagnosed with stage I cancers, with smaller but continuing improvements for later-stage cancers.
  
  
  CONCLUSIONS
  Our results demonstrate a steady trend toward improved relative survival for CRC, indicating that treatment and surveillance improvements have had an impact at the population level.
authors.affiliation: Affiliations of authors: Group Health Research Institute, Seattle, WA (CMR, EAJ); Division of Cancer Control and Population Sciences National Cancer Institute, Bethesda, MD (EJF); Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston MA (ABK); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis MN (KMK); Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (DS).
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.forename: Eric A
authors.initials: EA
authors.lastname: Johnson
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Feuer
authors.forename: Amy B
authors.initials: AB
authors.lastname: Knudsen
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000328:Adult; D000368:Aged; D003110:Colonic Neoplasms / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009367:Neoplasm Staging; D016017:Odds Ratio; D012004:Rectal Neoplasms / Q000401:mortality; D018426:SEER Program; D014481:United States / Q000453:epidemiology