Abstract:
BACKGROUND. Colorectal cancer (CRC) is the fourth most common cancer in South Africa (SA), and the sixth most lethal. Approximately
25% of patients will have synchronous metastatic disease at the time of their primary CRC diagnosis. Although chemotherapy is used in
most stages of the disease, surgical resection of the primary tumour and metastases remains the most successful treatment modality to
achieve cure or prolong survival. To date, no data on CRC presentation and management have been published in SA.
OBJECTIVES. To determine CRC presentation, general management patterns and overall survival in the SA private healthcare sector.
METHODS. A retrospective review of a private healthcare funder’s database from 1 January 2008 to 31 December 2015. International Statistical
Classification of Diseases and Related Health Problems (10th revision) (ICD-10) diagnosis codes were used to identify colorectal cancer and
liver and/or pulmonary metastatic disease. Procedure codes assigned to hospital admissions were used to identify type of surgical treatment.
Chemotherapy was identified by the World Health Organization Anatomical Therapeutic Chemical Classification System of medicines.
Treatment patterns were determined and 5-year survival rates for these were calculated. Survival was estimated using the Kaplan-Meier
method, and Cox proportional hazards regression was used for between-group comparisons of survival. Data analysis was carried out using
SAS version 9.4 for Windows.
RESULTS. A total of 3 412 patients were included in the study, 2 267 with CRC only and 1 145 with liver (LM) or pulmonary metastases
(PM). The mean age was 64.1 years (range 21 - 97), and 54.6% were male; these did not differ statistically between the study groups. Twenty
percent of patients with LM or PM underwent surgical resection of their metastases. Five-year survival rates following surgical resection of
all disease for CRC only, CRCLM, CRCPM and CRCLMPM were 71.7%, 57.3%, 31.5% and 26.0%, respectively.
CONCLUSIONS. SA CRC patients treated in the private healthcare sector have similar disease presentation to that in published international
series, with similar outcomes following various treatment pathways; however, it seems that fewer resections of metastases are undertaken
compared with international trends.
