Utilisation of specialist care in patients with incurable rectal cancer. A population-based study from Western Norway

Figures & data

Figure 1.  Distribution of 1 167 patients diagnosed with rectal cancer in Western Norway between 1997 and 2002 with regard to intention of treatment. In 3% of the patients, the intent changed from curative to palliative treatment either due to incomplete resection or insufficient effect of the preoperative tumour treatment.

Figure 2.  Distribution of various treatment modalities in 287 patients with incurable rectal cancer according to age groups. Oncological treatment includes chemotherapy and/or radiotherapy. Age groups were divided according to median age into younger patients <77 years and older patients >77 years.

Table I.  Distribution of patients with regard to palliative surgery for rectal cancer. Major resections (i.e. anterior resection, abdomino-perineal resection or Hartmann's procedure) were performed in 88 patients, whilst 97 patients underwent minor procedures (i.e. surgical exploration, stoma, local resection) or non-surgical treatment (n=112).

	Major resection n (%)	Minor procedures or non-surgical treatment n (%)	P-value
Age
<77 years	48 (49)	50 (51)	<0.000
>77 years	40 (20)	159 (80)
Marital status
Spouse	48 (37)	83 (63)	0.027
No spouse	26 (19)	108 (81)
Type of residence
Home	70 (31)	155 (69)	0.007
Institution	3 (9)	31 (91)
Distance to hospital
Urban area	35 (26)	102 (74)	0.63
<1 hour	24 (30)	56 (70)
>1 hour/ferry	15 (32)	32 (68)

Table II.  Hospital consumption in terms of outpatient visits and hospital admissions for 287 patients palliatively treated for incurable rectal cancer.

	No. of patients (%)	Total no. of contacts	Median (range) per patient
Outpatient visits
Surgery	123 (43)	298	1 (1–13)
Oncology	99 (33)	1118	5 (1–83)
Pain clinic	3 (1)	7	1 (1–5)
Others	44 (15)	87	1 (1–11)
Hospital admissions	No. of patients (%)	Total no. of contacts	Median (range) per patient	Purpose: best supportive care (median; range)	Purpose: active treatment (median; range)
Surgery	244 (85)	585	2 (1–20)	2 (1–15)	2 (1–20)
Oncology	73 (25)	411	2 (1–35)	1 (1–19)	3 (1–35)
Others	83 (29)	168	1 (1–12)	1 (1–4)	1 (1–12)

Table III.  Hospital consumption of 287 patients treated palliatively for incurable rectal cancer with regard to age, marital status, and type of residence, distance to hospital facilities and treatment modalities. Oncological treatment includes chemotherapy and/or radiotherapy.

	No. of admissions; median (range)	P-value	No. of admission days; median (range)	P-value
Age
<77 years	3 (1–36)	0.002*	34 (1–156)	0.002*
>77 years	2 (1–28)		23 (1–167)
Marital status
Spouse	3 (1–32)	<0.05*	28 (1–156)	0.4*
No spouse	2 (1–28)		25 (1–167)
Type of residence
Home	3 (1–36)	0.08*	28 (1–156)	0.03*
Institution	2 (1–19)		15 (1–167)
Distance to hospital
Urban area	2 (1–36)	0.55**	25 (1–167)	0.93**
<1 hour	3 (1–28)		28 (1–132)
>1 hour/ferry	2 (1–20)		29 (1–153)
Treatment modality
Oncological treatment	3 (1–36)	0.009**	42 (3–167)	0.000**
Major resection	4 (1–20)		29 (3–94)
Major resection+oncol. treat.	3 (1–32)		34 (2–132)
None	1 (1–32)		15 (1–101)

*Mann-Whitney test applied; **Kruskal-Wallis test applied.

Figure 3.  Survival of 287 rectal cancer patients treated with palliative intent. Median survival was 10 months regardless of age.

Figure 4.  Survival in 283 patients with primarily incurable rectal cancer with regard to various treatment modalities. Oncological treatment alone (chemo- and/or radiotherapy), group 1; major resections alone, group 2; combined oncological treatment and major resections, group 3; none, group 4.