Assessment of the effect of the National project “Health” on survival among patients with rectal cancer in the Arkhangelsk Region, Northwest Russia

Valkov, Mikhail

Assessment of the effect of the National project “Health” on survival among patients with rectal cancer in the Arkhangelsk Region, Northwest Russia

Tuesday, 19 August 2014

Exhibit hall (Dena'ina Center)

Daria Dubovichenko , Northern State Medical University, Arkhangelsk, Russia

Lyudmila Valkova , Northern State Medical University, Arkhangelsk, Russia

Mikhail Levit, PhD , Northern State Medical University, Arkhangelsk, Russia

Timur Izmailov, PhD , Russian Scientific Center of Roentgenoradiology, Moscow, Russia

Dmitri Korotov , Northern State Medical University, Arkhangelsk, Russia

Andrej M Grjibovski, PhD , Northern State Medical University, Arkhangelsk, Russia

Z Manambaeva, PhD , Semey State Medical University, Semey, Kazakhstan

La Pak , Semey State Medical University, Semey, Kazakhstan

A Masadykov , Semey State Medical University, Semey, Kazakhstan

Mikhail Valkov, PhD , Northern State Medical University, Arkhangelsk, Russia

INTRODUCTION: The incidence of and mortality from rectal cancer (RC) in Russia is higher than in most countries in Europe and North America. Moreover, most cases are diagnosed at late stages. The National project “Health” was initiated in 2007 to improve primary health care and could therefore increase the rate of early detection of RC in Russia. The aim of the study is to assess whether of RC patients increased in Russia after initiation of this project.

METHODS: Data on all cases of rectal cancer (ICD codes: C20-C21) were obtained from the Arkhangelsk Regional Cancer Registry for the period 2000-2011. One- and five-year survival was calculated using life-tables. The effect of the implementation of the National project “Health” on survival was assessed by comparing survival in time-periods before and after the initiation of the project adjusted for the stage at diagnosis, age, gender and place of residence using multivariable Cox proportional hazard analysis.

RESULTS: Altogether, there were 2440 cases of and 1385 deaths from RC during the study period. One- and five-year survival increased considerably from 66.2% and 29.8% in 2000-2006 to 71.4% and 47.3% in 2007-2011, respectively. Crude analysis revealed significant difference in survival before and after initiation of the National project “Health” (HR=0.65, 95%CI: 0.58-0.73). Adjustment for other factors did not change the association (HR=0.64, 95% CI: 0.57-0.72). Men (HR=0.87, 95% CI: 0.77-0.97) and urban residents (HR=0.86, 95% CI: 0.77-0.96) had better survival than women and rural residents. No interaction between time-periods and other variables was observed.

CONCLUSIONS: After initiation of the project, the survival of patients with RC increased by 56% on average. Adjustment for stage did not alleviate the association between the project and survival suggesting that better treatment, but not earlier diagnosis was the main contributing factor to the improvement in survival of patients with RC.