BACKGROUND AND SCOPE MATERIALS AND ... Colorectal cancer is the second most commonly diagnosed cancer

BACKGROUND AND SCOPE MATERIALS AND ... Colorectal cancer is the second most commonly diagnosed cancer

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  • M. Sharmin1, A. Berthelsen1, M. Morgan2, A. Fowler3, S. Avery1

    1SWSLHD Clinical Cancer Registry, Liverpool Hospital, 2Division of Surgery, Bankstown Hospital, 3Cancer Therapy Centre, SWSLHD

    BACKGROUND AND SCOPE

    Colorectal cancer is the second most commonly diagnosed cancer in females and the third in males, with over 1.2 million new cancer

    cases diagnosed per year worldwide. The highest incidence rates are found in Australia/ New Zealand, Europe, and North America [1].

    The latest national figures available reveals colorectal cancer was the second most common cancer in New South Wales (NSW),

    comprising 13% of all cancers diagnosed in NSW and 12.8% in the South Western Sydney Local Health District (SWSLHD) [2].

    South Western Sydney is a large metropolitan area in NSW, Australia, covering an area of 6237km2. SWSLHD is one of the most

    populous area health districts in NSW providing healthcare to over 819,000 residents [3].

    Rectal cancer represents approximately 35% of all colorectal cancers diagnosed and/treated in SWSLHD and approximately 4.5% of

    all malignant cancers in the district [4].

    Guidelines have been introduced for management of rectal cancer internationally and in Australia. In 2005, the National Health &

    Medical Research Council (NHMRC) published the update of the 1999 document 'Clinical practice guidelines for the prevention, early

    detection and management of colorectal cancer' which was developed by the Australian Cancer Network. These guidelines are

    evidence-based. They have been produced by a multidisciplinary team and are proposed as basis for sound decision making [5].

    NHMRC’s guidelines have recommended adjuvant radiotherapy (RT) for patients with stage II and III rectal cancer. Previous clinical

    studies indicate that utilisation of RT in rectal cancer remains low and there seems to be a correlation between patients’ age and

    utilisation of RT [6].

    Figure 1: Age-Standardized Colorectal Cancer Incidence Rates by Gender

    and World Area, 2008 [1].

    60 40 20 0 20 40

    South-Eastern Asia

    Micronesia/ Polynesia

    Southern Africa

    Eastern Asia

    Central and Eastern Europe

    Northern America

    Northern Europe

    Southern Europe

    Western Europe

    Australia/ New Zealand

    Males Females

    0.3%

    0.8%

    1.3%

    1.6%

    2.8%

    2.9%

    3.6%

    4.2%

    7.5%

    7.7%

    8.7%

    11.1%

    12.1%

    12.8%

    22.7%

    Eye

    Bone and connective…

    Myelodysplasia

    Neurological

    Ill Defined and…

    Head and Neck

    Thyroid/Endocrine

    Gynaecological

    Skin

    Lymphohaematopoietic

    Upper GI

    Respiratory

    Breast

    Colorectal

    Urogenital

    The objective of this investigation is to examine the incidence, demographics, stage and preoperative or postoperative status

    of radiotherapy in newly diagnosed and treated rectal cancer patients within the SWSLHD over a 12 year period.

    MATERIALS AND METHOD

    The data on newly diagnosed rectal cancer cases used in this analysis were collected from the

    SWSLHD Clinical Cancer Registry (ClinCR).

    ClinCR collects a minimum data set for each new cancer and the colorectal dataset extension

    for each new colorectal case that is diagnosed and/or treated within the SWSLHD public

    facilities [see figure 3].

    • The core dataset describes cancer type, staging, treatment and quality of care.

    • The dataset extension captures additional measures and indicators specific to the tumour stream.

    Figure 3: South Western Sydney Local Health District. Eligibility:

    Patients identified for inclusion in this investigation were drawn from the SWSLHD ClinCR database according to the following criteria:

    • A diagnosis of primary rectal cancer between January 1997 and December 2008.

    • Patients with previously diagnosed rectal cancers or secondary malignancies were excluded.

    • Recto-sigmoid cancers were excluded.

    • Diagnosed and/ or treated within SWSLHD public facilities. RT is provided by Liverpool and Macarthur Cancer Therapy Centres.

    • Treatments analysed were only the first course treatment provided in SWSLHD public facilities.

    Staging:

    The American Joint Committee on Cancer (AJCC) TNM staging system was used in this study. For the purpose of this study, the staging of

    some patients has been modified to incorporate the pre-operative staging for patients receiving preoperative chemoradiation. In instances

    where patients did not have preoperative treatment, the pathological stage became the final stage regardless of initial clinical stage.

    Treatment guidelines:

    • National Guideline on rectal cancer: NHMRC guidelines (2005) for rectal cancer patients recommend RT for high risk patients with stage II (T3/T4) and stage III (node

    positive) disease [6].

    • International Guideline on rectal cancer: Commission on Cancer (CoC) Quality of care measures states, RT should be considered or administered within 6 months (180 days) of

    diagnosis for patients under the age of 80 with clinical or pathologic AJCC T4N0M0 or Stage III receiving surgical resection for rectal

    cancer [9].

    Figure 2: Top 14 Groups, Incidence, Persons, South Western Sydney, 2008 [4].

    RESULTS

    n = 1031 (%)

    Gender

    Female 341 (33)

    Male 690 (67)

    Age Range

    20 - 29 4 (