Table 5.
Patterns of care for the initial receipt of radiotherapy for colorectal cancer in the United States and Canada*
| Site | First author, year (ref.) | Country | Stage | Diagnosis year | Sample size | Age, y, %† | Health delivery setting and data sources | Findings |
|---|---|---|---|---|---|---|---|---|
| Colon | Dunn, 2010 (29) | United States | I–III | 1988–2005 | 187 004 | ≥60, 81 | Multiple states; patients and health services data identified from SEER | Less than 10% of nonmetastatic patients received RT; patients diagnosed in 1988 were 2.5 times more likely to receive RT than those diagnosed in 2005 |
| Rectal | Kuo, 2010 (30) | United States | II | 1994–2003 | 329 | Range 28–93 | California; patients and health services data identified through the registry’s Desert Sierra Cancer Surveillance Program | 54% of patients received pelvic RT; among these, 71% received RT postoperatively |
| Lin, 2010 (31) | United States | II–III | 1998–2005 | 8978 | ≥18, 100 | Multiple states; patients and health services data identified from SEER | 31% of patients received preoperative RT, 37% received postoperative RT, and 31% received no RT | |
| Pisu, 2010 (10) | United States | I–III | 1999–2003 | 675 | ≥65, 100 | Alabama; patients identified through registry; health services data from Medicare claims | 15% of patients received neoadjuvant RT, 25% received adjuvant RT; over time, a higher proportion of patients received preoperative RT compared with postoperative RT | |
| Latosinsky, 2009 (12) | Canada | I–III | 1984–1997 | 333 | Range 22–88 | Manitoba; patients and health services data obtained through CancerCare Manitoba, which houses registry and treatment data | 47% of patients received adjuvant RT; receipt of RT increased by stage; 1% of patients received neoadjuvant RT | |
| Romanus, 2009 (32) | United States | I–IV | 2005–2008 | 2042 | ≥65, 50 | Multiple states; patients and health services data obtained from the NCCN Outcomes Database Project | 93% of stage III patients aged ≤80 y and who underwent curative surgery received RT within 6 mo of diagnosis | |
| Demers, 2008 (13) | Canada | NR | 1985–1999 | 2925 | ≥60, 79 | Manitoba; patients and health services data from CancerCare Manitoba (cancer registry and treatment data) | Receipt of RT increased 32% to 40% between 1985 and 1999 | |
| Dobie, 2008 (33) | United States | II–III | 1992–1999 | 2886 | ≥66, 100 | Multiple states; patients and health services data identified from SEER–Medicare | 55% of all patients received RT; 48% of stage II and 62% of stage III patients received RT | |
| Morris, 2008 (34) | United States | II–III | 1992–1999 | 2716 | ≥66, 100 | Multiple states; patients and health services data identified from SEER–Medicare | 57% of blacks and 65% of whites consulted with a radiation oncologist; among these, 74% of blacks and 83% of whites received RT after consultation | |
| Chang, 2007 (15) | United States | I–III | 1991–2002 | 21 390 | Median 68 | Multiple states; patients and health services data identified through SEER | 47% of patients received adjuvant RT; increasing age was associated with decreased receipt of RT | |
| Morris, 2006 (34) | United States | I–IV | 1992–1999 | 10 940 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare | Among patients with stage II to IV disease, black patients were less likely to receive RT compared with white patients (25% vs 34%) | |
| Baxter, 2005 (35) | United States | Local regional |
1976–2005 | 45 627 | ≥18, 100 | Multiple states; patients and health services data identified from SEER | Overall, 32% of patients received RT; receipt increased 15% to 42% from 1976 to 2000; younger age, male sex, and regional spread was associated with RT use | |
| Morris, 2004 (19) | United States | Any | 1988–1999 | 52 864 | ≥35, 100 | Multiple states; patients and health services data identified from SEER | 47% of white patients and 44% of black patients received any RT; 7% of white patients and 7% of black patients received neoadjuvant RT | |
| Phang, 2003 (20) | Canada | 0–IV | 1996 | 481 | Median 70 | British Columbia; patients were identified through the British Columbia Cancer Agency; chart review and physician surveys were used to obtain health services data | 60% of stage II and stage III patients received RT; of these, 89% received postoperative radiation and 11% received neoadjuvant radiation | |
| Neugut, 2002 (36) | United States | II–III | 1991–2002 | 55 204 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare | Overall, 48% of patients received RT following surgery; 11% of patients received RT only for adjuvant therapy | |
| Schrag, 2001 (37) | United States | II–III | 1992–1996 | 1411 | ≥65, 100 | Multiple states; patients and health services data identified from SEER–Medicare | 57% of patients received RT; increasing age was associated with decreased likelihood of RT receipt | |
| Shroen, 2001 (21) | United States | I–IV | 1994–1996 | 637 | Range 22–94 | California; patients and health services data identified from the Cancer Surveillance Program (Sacramento) | 14% of stage I, 53% of stage II, 63% of stage III, and 30% of stage IV patients received RT | |
| Colorectal | Chan, 2010 (22) | Canada | IV | 2000–2002 | 411 | ≥70, 40% | British Columbia; patients and health services data identified through the British Columbia Cancer Agency | 63% of resected and 58% of nonresected rectal cancer patients received RT |
| Ayanian, 2003 (38) | United States | II–III | 1996–1997 | 1956 | ≥18, 100% | California; patients were identified from the registry; health services data obtained from physician surveys or hospital records | Based on registry data, 58% of patients received RT; this proportion increased to 64% with additional data obtained from physician surveys or hospital records; black and older patients were less likely to receive RT | |
| Wudell, 2002 (26) | United States | I–IV | 1990–1999 | 668 | Median 69, 74‡ | Tennessee; data were collected through cancer registry databases at a university medical center and a city hospital in the Nashville area | There was no significant difference in RT receipt by race or hospital; at the university hospital, 7% of black patients and 10% of white patients received RT; at the city hospital, 7% of black patients and 6% of white patients received RT | |
| Roetzheim, 2000 (27) | United States | Any | 1994 | 9551 | Mean 72 | Florida; patients identified through the Florida Cancer Data System; health services data were obtained from statewide hospital and ambulatory surgical centers, freestanding RT centers, and diagnostic imaging centers | Overall, 26% of patients received RT; a higher proportion of male, married, lower income, smoking, Medicaid, distant stage, and rectal cancer patients received surgery |
* NCCN = National Comprehensive Cancer Network; NR = not reported; RT = radiotherapy; SEER = Surveillance, Epidemiology, and End Results.
† For studies where age distributions were not explicitly stated, we include measures of mean, median, or range as reflected in the original study’s presentation.
‡ Median shown at university medical center, city hospital, respectively.