First comprehensive report on colorectal cancer care in Europe and Australia reveals need for action

Jun 25 2008

The first cross-country report on the management and funding of colorectal cancer (CRC) reveals an urgent need for action to improve the survival of patients diagnosed with this common cancer in Europe and Australia.

Key findings from the report published today by the London School of Economics (LSE) confirm that few countries have prioritized CRC screening and treatment. Problems exist with data collection from cancer registries on which to base research and policy decisions, there is limited public and political awareness of CRC, few formal screening programmes exist, treatment guidelines are variable and there is generally poor or delayed access to treatment and slow adoption of new technologies (surgical, new targeted anti-cancer drugs, etc) that can significantly improve outcomes and increase survival.(1)

CRC is the second most common cause of death across all cancer types in men and women in Europe accounting for over 200,000 deaths in 2006(2). CRC will affect more than one in 20 people in their lifetime with 400,000 new cases diagnosed every year. If diagnosed and treated early it is potentially preventable and curable, early detection and treatment could mean that 90% of people survive.(3)

Professor Panos Kanavos, lead author of the report and senior lecturer at LSE, said "This report is the first to give healthcare providers, policy makers and patient groups the detailed evidence needed to create and deliver sustainable standards and plans that will ensure people throughout Europe affected by this devastating cancer have equal access to a better future."

The report urges prioritization of this potentially preventable and curable cancer through greater pan-European co-operation and delivery of a concerted, integrated prevention programme, including screening and treatment of CRC. Member states need to give CRC a more significant voice within the global community.

Commenting on the report, Jola Gore Booth, Founder of europacolon, the only pan-European advocacy organisation dedicated to CRC said, "Compared to other high incidence cancers CRC has been largely ignored. That is why we see so much variability around Europe in the diagnosis and care of people with this common and highly treatable cancer. Now that we have a clearer understanding of where action needs to be taken we need to work towards saving even more lives."

Key study results

Seventeen countries in Europe in addition to Australia are included in the report. A 'scorecard' of positive indicators (factors which improve CRC care) and negative indicators (factors which create barriers to best care) was created by the LSE team to show what countries do well and where they have room for improvement.

Overall only a minority of countries score over 50% for positive points (including Denmark, France, Germany, Italy, Netherlands, UK and Australia) although none scored over 75% showing that each country has room for improvement.

Key findings include:

Data collection:

• Cancer care data collection remains poor in Europe. There are significant deficiencies in terms of gathering and recording cancer statistics - as well as CRC-related healthcare expenditure. This means that estimating healthcare requirements for future colorectal cancer patients becomes difficult and planning for the right level of service delivery prone to major errors.

Screening policies and prevention:

• CRC is one of the few cancers amenable to cancer screening activities. If detected at its pre-cancerous stage, CRC can be prevented. Despite these facts and in addition to rising numbers of people with CRC only a minority of countries participate in formal screening for CRC (where an eligible population is invited for testing) and some countries have no CRC screening initiatives at all.
• Of further concern is the availability of endoscopy (use of a long, flexible tube with a light and a camera lens at the end to examine the inside of the colon) as positive screened tests must be investigated further.
• To date only a limited number of countries have CRC-specific patient groups and few have active Government driven campaigns which further reduces the visibility of this cancer to the public and policymakers.

Treatment:

• Treatment for CRC consists primarily of surgery, often supplemented by chemotherapy and radiotherapy in rectal cancer. All countries reported issues with access to all types of CRC treatment modalities.
• Treatment guidelines are essential for evidence-based practice towards CRC however many countries do not have guidelines for CRC and only half of the countries with guidelines have policies in place to monitor how they are used.
• Overall the evidence on the use of targeted drug treatments which can improve survival for patients with advanced CRC suggests that only limited numbers of eligible patients have access to these novel therapies.

Surveillance (follow-up):

• Follow-up of patients, both those treated for CRC and those treated in the pre-cancerous stage is important to detect any recurrence of disease and will increase the likelihood of a cure and thus increased survival. Currently there are large variations in follow-up practice and limited monitoring of patients across countries.

Professor Richard Sullivan, Chairman, European Cancer Research Managers Foundation and co-author of the new report concludes, "This first ever cross-country study delivers a wealth of data that give a clear mandate for change in the way many countries tackle CRC. Whilst outcomes have been improving for many CRC patients many deficits in the delivery of care - adherence to evidence-based guidelines, lack of screening programmes, the use of sub-optimal treatment whether surgical or chemotherapeutic - remain and must be urgently addressed."

Notes:

• The report is published on the LSE website: http://www.lse.ac.uk/collections/LSEHealth/
• The countries involved in the survey on which the report is based are: Australia, Czech republic, Denmark, France, Germany, Greece, Hungary, Italy, Netherlands, Poland, Portugal, Romania, Russia, Slovakia, Spain, Sweden, Turkey, and UK. Feedback is still to be received from Belgium, Finland and Switzerland; this will be included in a later update.
• CRC predominantly affects the over 50s(4) with risk increasing with age and by 85 years the risk of diagnosis is around 1 in 10 for men and 1 in 15 for women.(5)
• The 5 year survival rate for CRC is 53.7 %; compared to 81.1% for breast cancer 77% for prostate cancer, although for lung cancer survival is poor at 12.6%.(6)
• Funding for the report was provided by F. Hoffmann-La Roche Ltd

References

(1)Kanavos P, Colorectal Cancer in Europe and Australia, LSE Health, June 2008 http://www.lse.ac.uk/collections/LSEHealth/

(2) Ferlay J, AutierP et al. Annals of Oncology 18: 581-592, 2007

(3) Vogelaar I, van Ballegooijen M, et al. Cancer 2006 Aug 24;107(7):1624-33

(4) Meyerhardt JA, Zu AX et al. J.Clin Onc. 24:1892-1897

(5) The Cancer Council Australia. http://www.cancer.org.au/aboutcancer/FactsFigures.htm.

(6) Berrino F, et al. Lancet 2007 DOI:10.1016/S1470-2045(07)70245-0.

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