Independence in the exercise of the jurisdictional function since the
CONSTITUCIÓN DE CHILE DE
II.3. Características
EUROCARE recently reported that for colon cancer, as well as other cancer types, the survival gap between elderly (70-84 years) and middle-aged (55-69 years) patients was widening
in the period between 1988 and 1999.2 Due to the information available in the EUROCARE
study, adjusting for several factors, like stage, was not possible. In the present study we were able to adjust for sex, age, grade, stage, and treatment. Besides, we were able to analyse more recent data. Patients were divided into three age groups instead of two; this would make the difference between middle-aged and elderly patients more visible. We found a significant difference in survival between patients middle-aged and elderly patients over all the years, even after adjusting for sex, age, grade, stage, and treatment. The largest difference in survival was between 1997 and 1998 and between 2001 and 2002. Besides the gap between 1997 and 1998, which is similar to the gap shown by the EUROCARE, we also show a more recent survival gap in 2001 and 2002, which is similar in size to the gap in 1997 and 1998. However, the survival differences between middle-aged and elderly patients are not consistent over time. The survival gap is mainly caused by an increase in survival of middle-aged patients and a stable survival of elderly patient. In the present study, this gap did not widen any further, but is stabilising. Hopefully in the future aged and elderly patients will also benefit of the increased survival, possibly due to improved treatment.
Stage distribution differs between several countries in Europe.13 As tumour stage is one of the
most important prognostic factors in most cancer types, survival rates for several countries are difficult to compare. A new initiative is needed and founded in EURECCA, which aims to collect
prospective information about colorectal cancer patients in several countries in Europe.30
cOnclusiOn
In the mid-western region of the Netherlands no changes in treatment have occurred for stage I and II colon cancer during the study period. Patients with stage III and IV were treated with significantly more adjuvant chemotherapy over time, although less prominent for elderly patients, while the resection rate of patients with stage IV decreased for all age groups. The survival gap earlier found by the EUROCARE is confirmed for the mid-western part of the Netherlands, even after adjusting for several confounders. However, the present study did not
4
show a further increase in the survival gap between middle-aged and elderly patients. The near future will have to show if a more extensive and hopefully better tailored treatment can help elderly to close this gap.
AcknOwleDGements
The authors would like to thank Eelco Collette and the GeriOnNe foundation. This work was carried out with support of ECCO, ESSO and the Bontius Foundation.
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