An overview of 25 years of incidence, treatment and outcome of colorectal cancer patients

Abstract

Regarding the continuous changes in the diagnostic process and treatment of colorectal cancer (CRC), it is important to evaluate long-term trends which are relevant in giving direction for further research and innovations in cancer patient care. The aim of this study was to analyze developments in incidence, treatment and survival for patients diagnosed with CRC in the Netherlands. For this population-based retrospective cohort study, all patients diagnosed with CRC between 1989 and 2014 in the Netherlands were identified using data of the nationwide population-based Netherlands Cancer Registry (n = 267,765), with follow-up until January 1, 2016. Analyses were performed for trends in incidence, mortality, stage distribution, treatment and relative survival measured from the time of diagnosis. The incidence of both colon and rectal cancer has risen. The use of postoperative chemotherapy for Stage III colon cancer increased (14-60%), as well as the use of preoperative (chemo)radiotherapy for rectal cancer (2-66%). The administration of systemic therapy and metastasectomy increased for Stage IV disease patients. The 5-year relative survival increased significantly from 53 to 62% for colon cancer and from 51 to 65% for rectal cancer. Ongoing advancements in treatment, and also improvement in other factors in the care of CRC patients-such as diagnostics, dedicated surgery and pre- and postoperative care-lead to a continuous improvement in the relative survival of CRC patients. The increasing incidence of CRC favors the implementation of the screening program, of which the effects should be monitored closely.

Keywords: colon cancer; colorectal cancer; epidemiology; incidence; mortality; rectal cancer; stage distribution; survival; treatment; trends.

Figure 1

European age standardized (ESR) incidence and mortality rates per 100,000 person‐years, according to gender and tumor site.

Figure 2

Stage‐specific relative survival and relative survival for all stages combined for colon and rectal cancer, according to postoperative stage. (a) Relative survival among patients with postoperative Stage I colon cancer (including postoperative Stage 0). (b) Relative survival among patients with postoperative Stage II colon cancer. (c) Relative survival among patients with postoperative Stage III colon cancer. (d) Relative survival among patients with postoperative Stage IV colon cancer. (e) Relative survival among patients with postoperative Stage I rectal cancer (including postoperative Stage 0). (f) Relative survival among patients with postoperative Stage II rectal cancer. (g) Relative survival among patients with postoperative Stage III rectal cancer. (h) Relative survival among patients with postoperative Stage IV rectal cancer. (i) Relative survival among patients with colon cancer, all postoperative stages and ages. (j) Relative survival among patients with rectal cancer, all postoperative stages and ages.