Abstract
BackgroundPrevious population-based studies showed differences in international and within country colorectal cancer survival estimates, but few investigated the role of prognostic factors. Using a "high resolution approach", we aimed to determine the effect of ethnicity and health care by comparing Filipino-Americans with Philippine residents, who have the same ethnicity, and with Caucasians living in the US, who have the same health care system.MethodsUsing databases from the Manila and Rizal Cancer Registries and the United States Surveillance, Epidemiology and End Results, age-adjusted five-year absolute and relative survival estimates were computed and compared between Filipino-American colorectal cancer patients, cancer patients from the Philippines and Caucasian patients. Cox proportional hazards modelling was used to determine factors affecting survival differences.ResultsMuch lower 5-year relative survival estimates were obtained for Philippine residents (37%) as compared to those in Filipino-Americans (60.3%) and Caucasians (62.4%). Differences in age, stage and receipt of surgery explained a large proportion of the survival differences between Philippine residents and Filipino-Americans. However, strong excess risk of death for Philippine residents remained after controlling for these and other variables (relative risk, RR, 2.03, 95% confidence interval, 95% CI, 1.83-2.25).ConclusionsStrong survival disadvantages of Philippine residents compared to Filipino-American patients were disclosed, which most likely reflect differences in access to and utilization of health care. Health education and advocacy, for both patients and health practitioners, should likewise be given priority.
Highlights
Previous population-based studies showed differences in international and within country colorectal cancer survival estimates, but few investigated the role of prognostic factors
Databases US SEER Using the United States Surveillance, Epidemiology and End Results (SEER) 13 database [15], Colorectal cancer (CRC) patients identified to be of Filipino or of Non-Hispanic White ethnicity were selected
In situ cases and those who were identified by death certificates only (DCO) or autopsy only, which consist
Summary
Previous population-based studies showed differences in international and within country colorectal cancer survival estimates, but few investigated the role of prognostic factors. In the United States, incidence and mortality among Caucasians were lower than among African-Americans, but higher than among Asian and Pacific Islanders (API) and Hispanics [3]. While international and interracial CRC survival comparisons have been reported, high resolution studies that could elucidate the role of prognostic factors, such as stage and treatment, are rare [2,4,5,7]. The term “high resolution study” was first used by the EUROCARE group in comparing cancer survival estimates between populations in Europe, and aims to elucidate possible explanations for survival differences [7,8,9]. It incorporates information that are usually not available in standard format in population-based registries, such as disease stage and treatment
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