Colorectal cancer patterns of care in the western Sydney and Wentworth Area Health Services

Introduction: Colorectal cancer is a leading cause of morbidity and mortality in Australia. Recent clinical trials show that the recurrence of colorectal cancer decreases with chemotherapy and/or radiotherapy in advanced disease. The present study aimed to document the patterns of care by the type of treatment, document the preoperative investigations and provide results to the Area Health Services. Methods: A prospective data collection was initiated in May 1994 and ended in May 1996 in the Western Sydney and Wentworth Area Health Services of New South Wales. Deaths and recurrences were followed up until July 2002. Results: There were 253 colon cancers, 107 rectal cancers and 10 patients with tumours in both the colon and rectum. Forty-one surgeons performed 299 curative procedures with 78% of them performing one to four procedures annually. One hundred and twenty-two patients had non-fatal complications and six (2%) died postoperatively. Twenty-eight per cent of rectal cancer patients underwent abdomino-perineal resection and 56% underwent low anterior resection. Forty-five per cent of rectal cancer patients and 51% of colon cancer patients who were potentially eligible received appropriate adjuvant therapy. Ninety-one per cent of patients who received chemotherapy had no or mild toxicity. By the end of follow-up period, 30% of rectal cancer patients and 24% of colon cancer patients had developed recurrence. At last follow up, 197 patients had died. Median overall survival from time of diagnosis was 73 months. Overall 5-year survival for colonic and rectal cancers was 50% and 57%, respectively. For the 299 patients who had curative procedures, the 5-year survival was 63% and 62% for colonic and rectal cancers, respectively. Conclusion: Colorectal cancer patients who were eligible for and received adjuvant therapy had significantly better survival. Rectal cancer patients whose tumours only required low anterior resection had a better survival than those who needed an abdomino-perineal resection. High-volume surgeons have less postoperative complications than low-volume surgeons. The high proportion of late presentations seen in colon cancer patients supports the need for screening to improve early detection.