Patterns of Colorectal Cancer Care in Europe, Australia, and New Zealand

In 2008, an estimated 2.1 million individuals were diagnosed with colorectal cancer worldwide, with nearly 60% residing in developed regions (1,2). Globally, colorectal cancer is the second most common cancer in women and third in men (1,2). Although rates vary significantly by regions of the world, Australia/New Zealand and Western Europe have among the highest estimated incidence rates of colorectal cancer (1,2). For both genders, Central and Eastern Europe have the highest mortality rates because of colorectal cancer worldwide (1,2). Given that the likelihood of developing colorectal cancer increases with older age, global prevalence is rising over time because of growing proportions of elderly (1,2). Better methods of screening and early detection and advances in treatment are also improving survival, further contributing to increasing prevalence (1,2). Undoubtedly, these increases have significant implications for health-care costs, delivery, and service utilization associated with this disease. Given high rates of mortality and incidence for colorectal cancer in certain parts of Europe, this region of the world is an important area of international focus. Available comparative research on cancer in European countries has primarily come from studies conducted by EUROCARE, a research collaboration between several European population-based cancer registries that began in 1990 (3). EUROCARE was designed to develop standardized measures for improved comparability of cancer data between European countries and explore trends in patterns of cancer treatment and survival (3). Findings from these studies have demonstrated considerable variation in age-adjusted 5-year survival by country and region, with the highest colorectal cancer survival rates in northern European countries and the lowest in Eastern European countries (4–9). A study comparing colorectal cancer survival in Europe to the United States during the period of 1985–1989 found that 5-year survival ranged from 13% to 22% higher in the United States depending upon tumor subsite (10). Verdecchia et al. compared data from 47 European registries to data from Surveillance, Epidemiology, and End Results (SEER) and noted higher mean survival in the United States compared with Europe for multiple cancers, including colorectal cancer, for patients diagnosed in 1995–1999 and followed up to December 2003 (7). Although limited, existing studies have suggested that differences in stage at diagnosis, postoperative mortality, and access to care may be factors that partially explain variations in outcomes between European nations (11–13). With the larger goal of improving delivery of population-based care for colorectal cancer, assessment of current practices is a necessary first step. Therefore, we conducted this systematic review of published studies to evaluate patterns of initial care following diagnosis, post-diagnostic surveillance, and end-of-life care for colorectal cancer in Europe, Australia, and New Zealand. Examination of this literature will provide a deeper understanding of care patterns and trends over time and may identify disparities in treatment. Assessment of data comparability between nations can also inform data collection and in combination with patient outcomes and cost data, assist resource allocation, health-care delivery, and research and policy efforts targeting colorectal cancer treatment.