Clinical characteristics, medical service utilization, and expenditure for colorectal cancer in China, 2005 to 2014: Overall design and results from a multicenter retrospective epidemiologic survey.
China
colorectal neoplasms
epidemiology
health expenditures
health services
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
01 06 2021
01 06 2021
Historique:
revised:
21
08
2020
received:
17
07
2020
accepted:
27
08
2020
pubmed:
31
3
2021
medline:
31
12
2021
entrez:
30
3
2021
Statut:
ppublish
Résumé
Colorectal cancer (CRC) is the third most common cancer in China, however, publicly available, descriptive information on the clinical epidemiology of CRC is limited. Patients diagnosed with primary CRC during 2005 through 2014 were sampled from 13 tertiary hospitals in 9 provinces across China. Data related to sociodemographic characteristics, the use of diagnostic technology, treatment adoption, and expenditure were extracted from individual medical records. In the full cohort of 8465 patients, the mean ± SD age at diagnosis was 59.3 ± 12.8 years, 57.2% were men, and 58.7% had rectal cancer. On average, 14.4% of patients were diagnosed with stage IV disease, and this proportion increased from 13.5% in 2005 to 20.5% in 2014 (P value for trend < .05). For diagnostic techniques, along with less use of x-rays (average, 81.6%; decreased from 90.0% to 65.7%), there were increases in the use of computed tomography (average, 70.4%; increased from 4.5% to 90.5%) and magnetic resonance imaging (average, 8.8%; increased from 0.1% to 20.4%) over the study period from 2005 to 2014. With regard to treatment, surgery alone was the most common (average, 50.1%), but its use decreased from 51.3% to 39.8% during 2005 through 2014; and the use of other treatments increased simultaneously, such as chemotherapy alone (average, 4.1%; increased from 4.1% to 11.9%). The average medical expenditure per patient was 66,291 Chinese Yuan (2014 value) and increased from 47,259 to 86,709 Chinese Yuan. The increasing proportion of late-stage diagnoses presents a challenge for CRC control in China. Changes in diagnostic and treatment options and increased expenditures are clearly illustrated in this study. Coupled with the recent introduction of screening initiatives, these data provide an understanding of changes over time and may form a benchmark for future related evaluations of CRC interventions in China.
Sections du résumé
BACKGROUND
Colorectal cancer (CRC) is the third most common cancer in China, however, publicly available, descriptive information on the clinical epidemiology of CRC is limited.
METHODS
Patients diagnosed with primary CRC during 2005 through 2014 were sampled from 13 tertiary hospitals in 9 provinces across China. Data related to sociodemographic characteristics, the use of diagnostic technology, treatment adoption, and expenditure were extracted from individual medical records.
RESULTS
In the full cohort of 8465 patients, the mean ± SD age at diagnosis was 59.3 ± 12.8 years, 57.2% were men, and 58.7% had rectal cancer. On average, 14.4% of patients were diagnosed with stage IV disease, and this proportion increased from 13.5% in 2005 to 20.5% in 2014 (P value for trend < .05). For diagnostic techniques, along with less use of x-rays (average, 81.6%; decreased from 90.0% to 65.7%), there were increases in the use of computed tomography (average, 70.4%; increased from 4.5% to 90.5%) and magnetic resonance imaging (average, 8.8%; increased from 0.1% to 20.4%) over the study period from 2005 to 2014. With regard to treatment, surgery alone was the most common (average, 50.1%), but its use decreased from 51.3% to 39.8% during 2005 through 2014; and the use of other treatments increased simultaneously, such as chemotherapy alone (average, 4.1%; increased from 4.1% to 11.9%). The average medical expenditure per patient was 66,291 Chinese Yuan (2014 value) and increased from 47,259 to 86,709 Chinese Yuan.
CONCLUSIONS
The increasing proportion of late-stage diagnoses presents a challenge for CRC control in China. Changes in diagnostic and treatment options and increased expenditures are clearly illustrated in this study. Coupled with the recent introduction of screening initiatives, these data provide an understanding of changes over time and may form a benchmark for future related evaluations of CRC interventions in China.
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1880-1893Subventions
Organisme : Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences
ID : 2017-I2M-1-006
Organisme : The National Natural Science Foundation of China
ID : 81773521
Organisme : China Medical Board, Health Policy and System Sciences, Open Competition Grant
ID : 19-340
Organisme : The National Health Commission of China
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 American Cancer Society.
Références
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394-424.
Zheng RS, Sun KX, Zhang SW, et al. Report of cancer epidemiology in China, 2015 [article in Chinese]. Zhonghua Zhong Liu Za Zhi. 2019;41:19-28.
Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2017 (GBD 2017) Results. Institute for Health Metrics and Evaluation (IHME); 2018. Accessed December 11, 2018. http://ghdx.healthdata.org/gbd-results-tool
Shi JF, Liu GX, Wang H, et al. Medical expenditures for colorectal cancer diagnosis and treatment: a 10-year tertiary-hospital-based multicenter retrospective survey in China (2002-2011). Chin J Cancer Res. 2019;31:825-837.
Huang HY, Shi JF, Guo LW, et al. Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China: a hospital-based, multicenter, cross-sectional survey. Chin J Cancer. 2017;36:41.
Cai Y, Xue M, Chen W, et al. Expenditure of hospital care on cancer in China, from 2011 to 2015. Chin J Cancer Res. 2017;29:253-262.
Shi JF, Wang L, Wu N, et al. Clinical characteristics and medical service utilization of lung cancer in China, 2005-2014: overall design and results from a multicenter retrospective epidemiologic survey. Lung Cancer. 2019;128:91-100.
Li J, Zhang BN, Fan JH, et al. A nation-wide multicenter 10-year (1999-2008) retrospective clinical epidemiological study of female breast cancer in China. BMC Cancer. 2011;11:364.
Wang L, Shi JF, Wu N, et al. Trends on clinical characteristics and medical service use of lung cancer in China 2005-14: a multicentre retrospective survey [abstract]. Lancet. 2017;390:S25.
National Health and Family Planning Commission. Yearbook of Health and Family Planning Statistics in China (2017). Chinese Union Medical University Press; 2017.
Zhang YQ, Fan JH, Qiao YL. A nation-wide multicenter 10-year (2001-2010) retrospective clinical epidemiological study of pancreatic neuroendocrine tumors in China. Pancreatology. 2016;16:S45.
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC Cancer Staging Manual and the future of TNM. Ann Surg Oncol. 2010;17:1471-1474.
National Bureau of Statistics of China. China Statistical Yearbook, 2015 [in Chinese]. Accessed June 5, 2016. http://www.stats.gov.cn/tjsj/ndsj/2015/indexch.htm
Writing Committee of the Expert Consensus on Nutritional Medical Treatment for Overweight/Obesity in China. Expert consensus on nutritional medical treatment for overweight/obesity in China (2016) [article in Chinese]. Chin J Diabetes Mellitus. 2016;8:525-540. doi: 10.3760/cma.j.issn.1674-5809.2016.09.004
National Cancer Center. 2017 China Cancer Registration Annual Report. People's Medical Publishing House; 2018.
Lin HN, Gu XY, Zhang SW, Zeng HM, Wei WQ, Zheng RS. Analysis on incidence and mean age at diagnosis for global cancer [article in Chinese]. Zhonghua Zhong Liu Za Zhi. 2018;40:543-549.
Population Dynamics, Department of Economic and Social Affairs, United Nations. World Population Prospects 2019. Accessed May 12, 2020. https://esa.un.org/unpd/wpp/Download/Standard/Population/
Altieri MS, Thompson H, Pryor A, et al. Incidence of colon resections is increasing in the younger populations: should an early initiation of colon cancer screening be implemented? Surg Endosc. Published online August 4, 2020.
Feletto E, Yu XQ, Lew JB, et al. Trends in colon and rectal cancer incidence in Australia from 1982 to 2014: analysis of data on over 375,000 cases. Cancer Epidemiol Biomarkers Prev. 2019;28:83-90.
Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer. Gut. 2013;62:933-947.
Chen WQ, Xia CF, Zheng RS, et al. Disparities by province, age, and sex in site-specific cancer burden attributable to 23 potentially modifiable risk factors in China: a comparative risk assessment. Lancet Glob Health. 2019;7:e257-e269.
Gu JF. Interpretation of the report on nutrition and chronic diseases of Chinese residents (2015) [article in Chinese]. Acta Nutrimenta Sinica. 2016;6:525-529.
Gong YM, Peng P, Bao PP, et al. The implementation and first-round results of a community-based colorectal cancer screening program in Shanghai, China. Oncologist. 2018;23:928-935.
Wu WM, Wang Y, Jiang HR, et al. Colorectal cancer screening modalities in Chinese population: practice and lessons in Pudong New Area of Shanghai, China. Front Oncol. 2019;9:399.
Cai SR, Huang YQ, Zhang SZ, et al. Effects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening results. BMC Cancer. 2019;19:47.
Chen HD, Lu M, Liu CC, et al. Comparative evaluation of participation and diagnostic yield of colonoscopy vs fecal immunochemical test vs risk-adapted screening in colorectal cancer screening: interim analysis of a multicenter randomized controlled trial (TARGET-C). Am J Gastroenterol. 2020;115:1264-1274.
Zhao LZ, Zhang WH, Ma DW, et al. Analysis of colorectal cancer screening practices in the general population of Tianjin [article in Chinese]. Chin J Clin Oncol. 2015;42:760-764.
Shen YZ, Huang YQ. Performance evaluation of colorectal cancer screening program in Haining [article in Chinese]. Chin J Prev Contr Chron Dis. 2015;23:836-838. https://doi.org/10.16386/j.cjpccd.issn.1004-6194.2015.11.009
Shi JF, Mao AY, Bai YN, et al. Priority setting in scaled-up cancer screening in China: an systematic review of economic evaluation evidences [article in Chinese]. Zhonghua Yu Fang Yi Xue Za Zhi. 2020;54:306-313.
Chen HD, Li N, Ren JS, et al. Participation and yield of a population-based colorectal cancer screening programme in China. Gut. 2019;68:1450-1457.
Bray F, Colombet M, Mery L, et al, eds. Cancer Incidence in Five Continents, Vol. XI (electronic version). International Agency for Research on Cancer. Accessed September 30, 2019. http://ci5.iarc.fr
Li M, Gu J. Changing patterns of colorectal cancer in China over a period of 20 years. World J Gastroenterol. 2005;11:4685-4688.
Wang L, Lo CH, He X, et al. Risk factor profiles differ for cancers of different regions of the colorectum. Gastroenterology. 2020;159:241-256.
Lu M, Luo X, Li N, Chen H, Dai M. Diagnostic accuracy of fecal occult blood tests for detecting proximal versus distal colorectal neoplasia: a systematic review and meta-analysis. Clin Epidemiol. 2019;11:943-954.
Australian Institute of Health and Welfare (AIHW). Cancer in Australia 2019. Cancer Series 119. Catalog no. CAN 123. AIHW’ 2019.
National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Explorer. Accessed May 12, 2020. https://seer.cancer.gov/explorer/application.php
The State Council of China. State Council's Opinions on Implementing Healthy China Action. Accessed August 1, 2019. http://www.gov.cn/xinwen/2019-07/15/content_5409565.htm
Yip W, Fu H, Chen AT, et al. 10 Years of health-care reform in China: progress and gaps in universal health coverage. Lancet. 2019;394:1192-1204.
Hospital Authority of National Health and Family Planning Commission of the People′s Republic of China; Chinese Society of Oncology. Chinese protocol of diagnosis and treatment of colorectal cancer [article in Chinese]. Zhonghua Wai Ke Za Zhi. 2018;56:241-258.
Yu HH, Huang HY, Jiang YS, et al. Accuracy of CT colonography for the detection of colorectal neoplasm: a subgroup meta-analysis [article in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi. 2017;38:814-820.
Pickhardt PJ, Correale L, Delsanto S, Regge D, Hassan C. CT colonography performance for the detection of polyps and cancer in adults ≥65 years old: systematic review and meta-analysis. AJR Am J Roentgenol. 2018;211:40-51.
Spada C, Stoker J, Alarcon O, et al. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Eur Radiol. 2015;25:331-345.
Fakih M. Metastatic colorectal cancer: current state and future directions. J Clin Oncol. 2015;33:1809-1824.
Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries. Lancet Glob Health. 2018;6:e555-e567.
Lew JB, St John DJB, Xu XM, et al. Long-term evaluation of benefits, harms, and cost-effectiveness of the National Bowel Cancer Screening Program in Australia: a modelling study. Lancet Public Health. 2017;2:e331-e340.