Treatment of Rectal Cancer Varies Widely in Europe

Roxanne Nelson

September 25, 2011

September 25, 2011 (Stockholm, Sweden) — There is tremendous variation in the guidelines for the treatment of rectal cancer among different countries in Europe. More standardization of clinical practice is needed, experts reported here at the 2011 European Multidisciplinary Cancer Congress.

Using a large international comparison survey, investigators looked at the management of rectal cancer in 4 European nations, and found that there are substantial differences in the use of chemotherapy and radiotherapy.

They found that the use of radiotherapy, chemotherapy, or both was lowest in Denmark (at 24.9%) and highest in the Netherlands (at 81%); Norway was at 50% and Sweden was at 60.7%.

"The use of chemotherapy and radiotherapy differed according to stage in each country," said lead author Colette van den Broek, MD, a PhD student and research fellow at Leiden University Medical Centre, the Netherlands. "As an example, in Denmark and the Netherlands, patients with stage I, II, and III disease received radiotherapy, chemotherapy, or both most frequently, In Sweden, patients with stage II or III disease received treatment with these modalities most often, whereas in Norway, it was patients with stage IV disease who received it most often."

"There was also a huge difference in the use of preoperative radiotherapy," explained Dr. van den Broek. "In the Netherlands it is over 60%, while in Denmark it is only 5%."

"When looking at chemoradiotherapy, you can see that Norway utilized it more often than the other countries," she added.

EURECCA Project

The European Registration of Cancer Care (EURECCA) study, which was initiated by the European CanCer Organisation (ECCO), compared the treatment of 6597 patients in Sweden, Norway, Denmark, and the Netherlands who were diagnosed with rectal cancer in either 2008 or 2009. In Denmark, it was both 2008 and 2009. It also compared the mortality rate 30 days after surgery.

The survey set out to identify the aspects of cancer care that appear to improve clinical practice, treatments and survival, and to reduce adverse events. The goal is to use the data from this project and develop recommendations for treatment that could lead to a greater standardization of clinical practice in Europe.

Thirty-Day Mortality

The investigators noted that Denmark had a significantly higher unadjusted 30-day mortality rate than the other countries (5.1% vs 2.4% to 2.5%).

Dr. van den Broek emphasized that only surgical patients with completed follow-up were included in the study. "There may be an underestimation of 30-day mortality the Netherlands because this is only in-hospital mortality," she said. In Norway, a number of patients who were registered for surgery did not have an operation date and could not be included in the analysis.

After adjustment for age, sex, stage, and country, Denmark still had a higher 30-day morality rate (P < .05). However, in further multivariable analyses, there were no significant differences in 30-day mortality among the 4 countries.

Improving Cancer Care

In a statement, ECCO president Michael Baumann, MD, said that oncologists in Europe are aware that their treatment practices vary widely. "These differences have many reasons, such as regional experience, expertise, and available infrastructure," he said. "To some extent, differences in approach may, therefore, be quite appropriate."

However, it appears unlikely that all approaches are equally effective and equally tolerable, he pointed out. "Comparison of outcome after different approaches in large cohorts is an evidence-based way to identify shortcomings in specific services."

"For this reason, ECCO and several of its member societies strongly support the EURECCA study, which provides a showcase of what can be achieved for improved cancer care by such multidisciplinary, multinational clinical research projects," Dr. Baumann explained.

2011 European Multidisciplinary Cancer Congress (EMCC): Abstract 6000. Presented September 24, 2011.

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