Rectal cancer survival in the United States by race and stage, 2001 to 2009: Findings from the CONCORD-2 study

Abstract

Background: In the first CONCORD study, 5-year survival for patients with diagnosed with rectal cancer between 1990 and 1994 was <60%, with large racial disparities noted in the majority of participating states. We have updated these findings to 2009 by examining population-based survival by stage of disease at the time of diagnosis, race, and calendar period.

Methods: Data from the CONCORD-2 study were used to compare survival among individuals aged 15 to 99 years who were diagnosed in 37 states encompassing up to 80% of the US population. We estimated net survival up to 5 years after diagnosis correcting for background mortality with state-specific and race-specific life table. Survival estimates were age-standardized with the International Cancer Survival Standard weights. We present survival estimates by race (all, black, and white) for 2001 through 2003 and 2004 through 2009 to account for changes in collecting the data for Surveillance, Epidemiology, and End Results Summary Stage 2000.

Results: There was a small increase in 1-year, 3-year, and 5-year net survival between 2001-2003 (84.6%, 70.7%, and 63.2%, respectively), and 2004-2009 (85.1%, 71.5%, and 64.1%, respectively). Black individuals were found to have lower 1-year, 3-year, and 5-year survival than white individuals in both periods; the absolute difference in survival between black and white individuals declined only for 5-year survival. Black patients had lower 5-year survival than whites at each stage at the time of diagnosis in both time periods.

Conclusions: There was little improvement noted in net survival for patients with rectal cancer, with persistent disparities noted between black and white individuals. Additional investigation is needed to identify and implement effective interventions to ensure the consistent and equitable use of high-quality screening, diagnosis, and treatment to improve survival for patients with rectal cancer. Cancer 2017;123:5037-58. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Keywords: colorectal cancer; population-based survival; rectal cancer; trends.

Figure 1

Rectal cancer: 5-year age-standardized net survival (%) for adults (15-99 years) diagnosed during 2001-2003 and 2004-2009, and absolute change (%): states grouped by U.S. Census Region. Note: Data from 37 statewide cancer registries (covering 80.6% of the population) are ranked within U.S. Census Region by the survival estimate for 2004-2009. Dark colors denote states affiliated with the National Program of Cancer Registries (NPCR); pale colors denote states affiliated with the Surveillance, Epidemiology and End Results (SEER) Program; ? denotes states affiliated with both federal surveillance programs. Change (%) not plotted if a survival estimate was not available for one calendar period or one or more estimates was not age-standardized.

Figure 2

Rectal cancer: 5-year age-standardized net survival (%) for adults (15-99 years), by state, race and calendar period of diagnosis. Note: the pooled (US) survival estimate for each calendar period is shown by the horizontal (solid) line with corresponding 95.0% and 99.8% control limits (dotted lines).