title: Colorectal cancer treatment and survival: the experience of major public hospitals in south Australia over three decades.
abstract: BACKGROUND
  Registry data from four major public hospitals indicate trends in clinical care and survival from colorectal cancer over three decades, from 1980 to 2010.
  
  
  METHODS
  Kaplan-Meier product- limit estimates and Cox proportional hazards models were used to investigate disease-specific survival and multiple logistic regression analyses to explore first-round treatment trends.
  
  
  RESULTS
  Five-year survivals increased from 48% for 1980-1986 to 63% for 2005-2010 diagnoses. Survival increases applied to each ACPS stage (Australian Clinico-Pathological Stage), and particularly stage C (an increase from 38% to 68%). Risk of death from colorectal cancer halved (hazards ratio: 0.50 (0.45, 0.56)) over the study period after adjusting for age, sex, stage, differentiation, primary sub-site, health administrative region, and measures of socioeconomic status and geographic remoteness. Decreases in stage were not observed. Survivals did not vary by sex or place of residence, suggesting reasonable equity in service access and outcomes. Of staged cases, 91% were treated surgically with lower surgical rates for older ages and more advanced stage. Proportions of surgical cases having adjuvant therapy during primary courses of treatment increased for all stages and were highest for stage C (an increase from 5% in 1980-1986 to 63% for 2005-2010). Radiotherapy was more common for rectal than colonic cases. Proportions of rectal cases receiving radiotherapy increased, particularly for stage C where the increase was from 8% in 1980-1986 to 60% in 2005-2010. The percentage of stage C colorectal cases less than 70 years of age having systemic therapy as part of their first treatment round increased from 3% in 1980-1986 to 81% by 1995-2010. Based on survey data on uptake of adjuvant therapy among those offered this care, it is likely that all these younger patients were offered systemic treatment.
  
  
  CONCLUSIONS
  We conclude that pronounced increases in survivals from colorectal cancer have occurred at major public hospitals in South Australia due to increases in stage-specific survivals. Use of adjuvant therapies has increased and the patterns of change accord with clinical guideline recommendations. Reasons for sub-optimal use of radiotherapy for rectal cases warrant further investigation, including the potential for limited rural access to impede uptake of treatments at metropolitan-based radiotherapy centres.
authors.affiliation: School of Population Health, University of South Australia, Adelaide, South Australia E-mail : roder@internode.on.net.
authors.forename: David
authors.initials: D
authors.lastname: Roder
authors.forename: Christos S
authors.initials: CS
authors.lastname: Karapetis
authors.forename: David
authors.initials: D
authors.lastname: Wattchow
authors.forename: James
authors.initials: J
authors.lastname: Moore
authors.forename: Nimit
authors.initials: N
authors.lastname: Singhal
authors.forename: Rohit
authors.initials: R
authors.lastname: Joshi
authors.forename: Dorothy
authors.initials: D
authors.lastname: Keefe
authors.forename: Kellie
authors.initials: K
authors.lastname: Fusco
authors.forename: Kate
authors.initials: K
authors.lastname: Powell
authors.forename: Marion
authors.initials: M
authors.lastname: Eckert
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Price
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006779:Hospitals, Public; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data*; D013021:South Australia / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors