Changing practices for diagnosis and treatment of colorectal cancer in Calvados: 1990-1999.

Summary Aim Two consensus conferences on management of colorectal cancer were conducted in France during the last ten years: one regarding rectal cancers in 1994 and the other regarding colonic cancer in 1998. In the present study, we examined data collected in a local gastrointestinal cancer registry to investigate changes in management practices for colorectal cancer in a well-defined population seen between 1990 and 1999. Methods The study population consisted of 3 135 patients with colorectal cancer diagnosed in Calvados (an administrative district in northern France) from 1990 to 1999. Two periods were defined: P1 = 1990-1994 and P2 = 1995-1999. Multivariate logistic regression analysis was performed. Results No trends in stage of disease at diagnosis or rate of surgical resection were observed. For patients with cancer of the rectum, the rate of sphincter preservation increased significantly from 65.6% in P1 to 72.3% in P2, in men and in all patients under the age of 75 years. For patients with cancer of the colon, the number of resection specimens with at least eight examined lymph nodes increased from 50.7% in P1 to 60.2% in P2. This trend predominated in university centers; for rectal cancer patients it was significant only in university centers. Prescription of adjuvant chemotherapy for stage III colonic cancer increased significantly: 41.4% in P1 and 52.5% in P2. No changes in prescription of adjuvant radiotherapy for rectal cancer were observed, irrespective of the stage at diagnosis. The proportion of patients managed in university centers decreased significantly over time from 30.5% in P1 to 27.6% in P2, with a corresponding increase in private clinics. Conclusion Most of the trends observed during the study period began before the consensus conference guidelines were issued. The consensus guidelines appear to have influenced management practices mainly in university centers, while the majority of patients are managed in non-university centers.