Colorectal Cancer Treatment Characteristics and Concordance With Guidelines in Sri Lanka: Results From a Hospital-Based Cancer Registry

Author:

Wijeratne Don Thiwanka1ORCID,Gunasekara Sanjeeva2ORCID,Booth Christopher M.34ORCID,Berry Scott34ORCID,Jalink Matthew45ORCID,Carson Laura M.4ORCID,Gyawali Bishal34ORCID,Promod Hasitha6,Jayarajah Umesh7ORCID,Seneviratne Sanjeewa7ORCID

Affiliation:

1. Department of Medicine, Queen's University, Kingston, Canada

2. National Cancer Institute, Maharagama, Sri Lanka

3. Department of Oncology, Queen's University, Kingston, Canada

4. Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada

5. Department of Public Health Sciences, Queen's University, Kingston, Canada

6. Health Information Unit, Ministry of Health, Colombo, Sri Lanka

7. Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

Abstract

PURPOSE Colorectal cancer (CRC) ranks among the top five incident cancers in Sri Lanka (SL). Here, we describe disease characteristics and treatment patterns of patients with CRC in SL. METHODS All adult patients (age > 18 years) diagnosed with CRC during 2016-2020 were identified from the National Cancer Institute SL cancer registry. Cancer stage at diagnosis was defined according to the seventh edition of the TNM staging system. Concordance between recommendations for adjuvant therapy and actual rates of delivery was also analyzed. Descriptive statistics were used to describe the study cohort and treatment patterns. RESULTS A total of 1,578 patients were diagnosed with CRC during the study period, 53% (n = 830) with colon cancer and 47% (n = 748) with rectal cancer. Mean age was 61 (range, 18-91) years. Stage distribution was 13%, 28%, 46%, and 12% for stage I, II, III, and IV cancers, respectively. Adjuvant chemotherapy was delivered to 82% of patients with stage III colon cancer. There was a lack of concordance with delivery of neoadjuvant chemoradiotherapy, which was only delivered to 50% of patients with stage III rectal cancer for whom this treatment was indicated. CONCLUSION Aging population and advanced stage of CRC at diagnosis will continue to challenge the provision of high-quality CRC care in SL. Further quantitative and qualitative research may help better understand the nonconcordance with treatment guidelines. Such information would help ease the burden of advanced-stage CRC in SL.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

Reference19 articles.

1. Delivery of cancer care in Sri Lanka

2. World Health Organization International Agency for Research on Cancer (IARC). GLOBOCAN 2020: Estimated cancer incidence, mortality and prevalence worldwide in 2020, 2020. https://gco.iarc.fr/today/data/factsheets/cancers/10_8_9-Colorectum-fact-sheet.pdf

3. Colorectal cancer screening: a global overview of existing programmes

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