Chemotherapy and radiotherapy usage for rectal cancer varies greatly from nation-to-nation within Europe, researchers from Leiden University Medical Centre, the Netherlands, reported at the European Multidisciplinary Cancer Congress 2011, Stockholm, Sweden. The presenters said that clinical practice across Europe needs to become standardized.
The EURECCA study involved 6,597 individuals from the Netherlands, Denmark, Norway and Sweden. They had all been diagnosed with rectal cancer between 2008 and 2009. The researchers compared their treatments, they also gathered data on patient death rates 30 days after surgery. (EURECCA = European Registration of Cancer Care).
Dr Colette van den Broek M.D. and team set out to find out what aspects of cancer care played a role in improving clinical practice, therapies, survival and minimized the occurrence of adverse events – they gathered data from the EURECCA study. Their aim was to create a set of recommendations that could standardize clinical practice across the continent.
After gathering data from cancer registries in the four countries over the last three years, the researchers found that patients with comparable stages of cancer had widely varying usages of radiotherapy or chemoradiotherapy.
Dr Van den Broek said:
“The use of radiotherapy or chemotherapy or both was the lowest in Denmark at 25 percent, followed by Norway at 50 percent, Sweden at nearly 61 percent and the highest in The Netherlands at 81 percent. Its use varied depending on the stage of the disease in each country. For instance, in Denmark and The Netherlands, patients with stage I, II and III disease received radiotherapy, chemotherapy or both most often; in Sweden it was patients with stage II or III disease, and in Norway patients with stage IV disease, who received it most often.”
They are currently comparing death rates within 30 days of surgery in the four countries.
Dr Van den Broek said:
“We will be able to compare treatment strategies, radiotherapy, chemotherapy, or both, for different stages of disease.
It is clear from our results so far, that different countries in Europe have different guidelines for treating rectal cancer patients. An earlier study has shown that radiotherapy, delivered before surgery, reduces local recurrences of the disease.
But, in The Netherlands, we use radiotherapy for almost all stages, while in Denmark, for example, they use a combination of radiotherapy and chemotherapy. The differences in treatment do not necessarily cause big differences in survival, and recent research has shown that, although radiotherapy decreases deaths from cancer, it increases deaths due to other causes.
So we have to find the right balance between the ‘gain and pain’ of radiotherapy and between under- and over-treatment. With this study we hope to be able to give an answer to the ongoing discussion about this and it is a first step towards a single guideline that can be used in different countries.”
The EURECCA project is also assessing other types of cancers. The researchers say they hope to look at long-term survival too. They described their present stage in this study as a first step in the process.
Professor Michael Baumann, president of ECCO (European CanCer Organization) said:
“Cancer professionals know well that treatment practice varies widely in Europe. These differences have many reasons, such as regional experience and expertise as well as available infrastructure. To some extent differences in approach may, therefore, be quite appropriate. On the other hand it appears unlikely that all different approaches could be equally effective and equally well tolerable. 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 show-case on what can be achieved for improved cancer care by such multidisciplinary, multinational clinical research projects.”
Professor David Kerr, president of ESMO ((European Society for Medical Oncology) ) and Professor of Cancer Medicine at the University of Oxford, said:
“This important study gives an insight into one aspect of the reasons underpinning variation in recurrence and survival from rectal cancer – access to optimal treatment around the time of diagnosis. Although heterogeneity in the biology of cancer is accepted and the subject of much research, unwarranted variation in clinical outcome may be related to lack of knowledge, lack of funding, inadequate healthcare systems or failure to apply effective treatment protocols. This report serves as a wake-up call to the European cancer community that further work needs to be done to find how widespread this phenomenon is.”
Written by Christian Nordqvist