Colorectal cancer gains are not enough

Cancer

By Amanda Sheppeard

10 Jun 2016

Colorectal cancer could be largely eradicated from Australia with a sustained and determined approach to screening, and by following treatment guidelines.

Professor David Roder, Chair of Cancer Epidemiology and Population Health at the University of South Australia’s School of Health Sciences, says research shows survival rates were among the best in the world, but Australia still had a serious problem with incidence.

“Colorectal cancer is a big deal in Australia, we need to take it seriously,” he said. “Australia has double the world average (in incidence rates). It is also increasing remarkably in young people so we need to watch this very carefully, because we don’t know why it is occurring.”

Professor Roder was the lead author of an article in the European Journal of Cancer Care that examined colorectal cancer treatment and survival at four major South Australian public hospitals over three decades.

The data indicated five-year disease-specific survivals for colorectal cancer from 48% to 63% between 1980-1986 and 2005-2010.

“If you’re going to get colorectal cancer get it in Australia,” he told the limbic.

However for people aged 80 or more, the increase was smaller, from 47% to 52%.

Risk of case fatality halved overall, adjusting for age, gender, stage, differentiation and sub-site, although again, improvements were less in the 80-plus age group, which recorded a lower risk reduction of about a third.

“The 50% reduction in case fatality rates is a hell of a change,” Professor Roder said. “That’s a function of the improvements in adjuvant therapy (including radiotherapy and chemotherapy).”

Percentages having surgery and other specified treatments were also lower for the 80-plus age group than younger cases.

Professor Roder said it was clear that while there was greater use of adjuvant therapies in accordance with treatment guidelines, there were still patients who were not accessing these therapies.

Those groups included the aged and patients in rural and remote areas. While access may be an issue, and consideration of other co-morbidities in aged patients might influence this, he said it should not be a reason not to find a way to provide it.

“We believe (access) is a reason for lower adherence to the guidelines in rural areas and older people,” he said. “Access to services is a big issue that needs to be addressed.”

Professor Roder said clinicians needed to follow the guidelines where possible in order to achieve best outcomes.

“If you look at the data and see that people are not being treated according to the guidelines, you have to ask yourself the question why is that happening?” he said.

“When we don’t follow guidelines, there needs to be a conscious decision not to, and perhaps that should be recorded in the (patient) notes. I think documenting it makes you think more about it,” he said.

While he pointed out that nor every colorectal cancer qualifies for adjuvant therapies, the guidelines were constantly being updated to keep abreast of new research.

“I think we could largely eradicate colorectal cancer in Australia with a united approach to screening, following the guidelines and prevention,” he said.

“We’re doing extraordinarily well on survival but that doesn’t mean that there isn’t slack to be taken up.”

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