Abstract
BackgroundColorectal cancer (CRC) is among the three most common incident cancers and causes of cancer death in Switzerland for both men and women. To promote aspects of gender medicine, we examined differences in treatment decision and survival by sex in CRC patients diagnosed 2000 and 2001 in the canton of Zurich, Switzerland.MethodsCharacteristics assessed of 1076 CRC patients were sex, tumor subsite, age at diagnosis, tumor stage, primary treatment option and comorbidity rated by the Charlson Comorbidity Index (CCI). Missing data for stage and comorbidities were completed using multivariate imputation by chained equations. We estimated the probability of receiving surgery versus another primary treatment using multivariable binomial logistic regression models. Univariable and multivariable Cox proportional hazards regression models were used for survival analysis.ResultsFemales were older at diagnosis and had less comorbidities than men. There was no difference with respect to treatment decisions between men and women. The probability of receiving a primary treatment other than surgery was nearly twice as high in patients with the highest comorbidity index, CCI 2+, compared with patients without comorbidities. This effect was significantly stronger in women than in men (p-interaction = 0.010). Survival decreased with higher CCI, tumor stage and age in all CRC patients. Sex had no impact on survival.ConclusionThe probability of receiving any primary treatment and survival were independent of sex. However, female CRC patients with the highest CCI appeared more likely to receive other therapy than surgery compared to their male counterparts.
Highlights
Colorectal cancer (CRC) is among the three most common incident cancers and causes of cancer death in Switzerland for both men and women
In the binomial logistic regression models, we evaluated the effect of sex on the association of subsite, Charlson Comorbidity Index (CCI), tumor stage, age with primary treatment option
HR Hazard ratio, CI Confidence interval, LCRCLeft-sided colorectal cancer, RCCRight-sided colon cancer, CCI Charlson Comorbidity Index a Radiotherapy, radio-chemotherapy, chemotherapy or non-tumor-specific therapy either sex had basically twice the risk to die after another primary treatment than after surgery [Hazard ratio (HR) = 2.04]
Summary
Colorectal cancer (CRC) is among the three most common incident cancers and causes of cancer death in Switzerland for both men and women. To promote aspects of gender medicine, we examined differences in treatment decision and survival by sex in CRC patients diagnosed 2000 and 2001 in the canton of Zurich, Switzerland. The probability of receiving a primary treatment other than surgery was nearly twice as high in patients with the highest comorbidity index, CCI 2+, compared with patients without comorbidities. This effect was significantly stronger in women than in men (p-interaction = 0.010). According to the recommendations of the American Heart Association (AHA) and the European Society of Cardiology, women should be carefully followed in their three phases of hormonal life: contraception, pregnancy and perimenopause
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