title: Differences in pre-operative treatment for rectal cancer between Norway, Sweden, Denmark, Belgium and the Netherlands.
abstract: Several studies have shown remarkable differences in colorectal cancer survival across Europe. Most of these studies lacked information about stage and treatment. In this study we compared short-term survival as well as differences in tumour stage and treatment strategies between five European countries: Norway, Sweden, Denmark, Belgium, and the Netherlands. For this retrospective cohort study all patients aged 18 years or older and operated on adenocarcinoma of the rectum without distant metastases and diagnosed in 2008 and 2009 were selected in national audit registries from Norway, Sweden, Denmark, Belgium, and the Netherlands. Differences in pre-operative treatment between the countries were compared using univariable and multivariable logistic regression. One year relative survival and one year relative excess risk of death (RER) were compared between the five countries. Large variation in the use of preoperative radiotherapy and chemoradiation was found between the countries. Even though, there was little variation in relative survival between the countries, except Sweden, which had a significant better one year RER of death among the elderly patients after adjustment. The differences in survival are expected to be caused by differences in peri-operative care, selection of patients, and especially management of elderly patients. The effects of preoperative treatment are expected to be seen on long term follow-up.
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: C B M
authors.initials: CB
authors.lastname: van den Broek
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: van Gijn
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Bastiaannet
authors.affiliation: Department of Registration, Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway(m).
authors.forename: B
authors.initials: B
authors.lastname: Møller
authors.affiliation: Department of Radiation Science, Oncology, Umea University, Umea, Sweden(n).
authors.forename: R
authors.initials: R
authors.lastname: Johansson
authors.affiliation: Department of Research, Comprehensive Cancer Center The Netherlands, Utrecht, The Netherlands.
authors.forename: M A G
authors.initials: MA
authors.lastname: Elferink
authors.affiliation: Norwegian University of Science and Technology, Trondheim, Norway; Colorectal Cancer Registry, Cancer Registry of Norway, Oslo, Norway(m).
authors.forename: A
authors.initials: A
authors.lastname: Wibe
authors.affiliation: Department of Surgical Science, Uppsala University, Uppsala, Sweden(n).
authors.forename: L
authors.initials: L
authors.lastname: Påhlman
authors.affiliation: Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark(o).
authors.forename: L H
authors.initials: LH
authors.lastname: Iversen
authors.affiliation: Department of Abdominal Surgery, UZ Gasthuisberg, Leuven, Belgium(p).
authors.forename: F
authors.initials: F
authors.lastname: Penninckx
authors.affiliation: Department of Radiotherapy, Catholic University of the Sacred Heart, Rome, Italy(q).
authors.forename: V
authors.initials: V
authors.lastname: Valentini
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: C.J.H.van_de_Velde@lumc.nl.
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D001530:Belgium; D057186:Comparative Effectiveness Research; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D009426:Netherlands; D009664:Norway; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden
keywords: Audit; Mortality; Population-based; Preoperative treatment; Quality assurance; Rectal neoplasms