Colorectal cancer patients in England have worse outcomes than patients diagnosed in other high-income countries with similar healthcare coverage. We aim to compare clinical characteristics and survival of colorectal cancer patients in England, Norway and Sweden to understand whether differences in stage and treatment could help to explain international differences in survival.
Information on patients aged 15-99 years diagnosed with primary malignant tumours of the colon and rectum in England, Norway and Sweden during 2010-2012 was extracted from national cancer registration and/or specialised colorectal cancer registry data. Six-month, one-year and two-year net survival was estimated for each country, stage at diagnosis, and surgical treatment status.
There were 93,125 colorectal cancer diagnoses in England, 11,155 in Norway, and 17,925 in Sweden during the time period. Stage was more advanced in colon than in rectal tumours. England had slightly poorer stage distribution, and a higher proportion of missing stage, than Norway and Sweden. Overall, 64.1% of colorectal cancer patients diagnosed in England, 68.8% diagnosed in Norway and 70.3% diagnosed in Sweden had evidence of receiving potentially curative surgery. These surgically treated patients were on average younger in England than in Norway and Sweden, in each stage category. Stage-specific net survival was generally highest in patients in Sweden and lowest in those in England. The survival deficit of English patients was particularly large compared to similar patients in the other countries among those diagnosed with advanced disease and/or who did not receive potentially curative surgery.
Stage-specific survival from colorectal cancer in England was lower than in Norway and Sweden. This survival deficit may be partly explained by the higher proportion, and lower survival, of patients who did not receive potentially curative surgery in England. The different proportions of missing data may somewhat affect the comparability of the results; however these remain informative.
Clinical trial identification
Legal entity responsible for the study
Cancer Survival Group, London School of Hygiene and Tropical Medicine
Cancer Research UK
All authors have declared no conflicts of interest.