The New Zealand PIPER Project: colorectal cancer survival according to rurality, ethnicity and socioeconomic deprivation-results from a retrospective cohort study.

AIM: To investigate differences in survival after diagnosis with colorectal cancer (CRC) by rurality, ethnicity and deprivation. METHODS: In this retrospective cohort study, clinical records and National Collections data were merged for all patients diagnosed with CRC in New Zealand in 2007-2008. Prioritised ethnicity was classified using New Zealand Cancer Registry data; meshblock of residence at diagnosis was used to determine rurality and socioeconomic deprivation. RESULTS: Of the 4,950 patients included, 1,938 had died of CRC by May 2014. The five-year risks of death from CRC were: Maori 47%; Pacific 59%; non-Maori-non-Pacific (nMnP) 38%. After adjustment for demographic characteristics, comorbidity and disease stage at diagnosis, compared to nMnP the relative risk (RR) for Maori was 1.1 (95%CI: 0.8-1.3) and for Pacific 1.8 (95% CI: 1.4-2.5). We found no differences in risk of death from CRC by rurality, but some differences by deprivation. CONCLUSIONS: Disparity in outcome following diagnosis with CRC exists in New Zealand. Much of this disparity can be explained by stage of disease at diagnosis for Maori, but for Pacific peoples and those in deprived areas other factors may influence outcome. Further analyses of the PIPER data will explore the impact of any differences in management.

Methods of a national colorectal cancer cohort study: the PIPER Project.

AIM: Colorectal cancer is one of the most common cancers, and second-leading cause of cancer-related death, in New Zealand. The PIPER (Presentations, Investigations, Pathways, Evaluation, Rx [treatment]) project was undertaken to compare presentation, investigations, management and outcomes by rurality, ethnicity and deprivation. This paper reports the methods of the project, a comparison of PIPER patient diagnoses to the New Zealand Cancer Registry (NZCR) data, and the characteristics of the PIPER cohort. METHOD: National, retrospective cohort review of secondary care medical records (public and private) of all cases of ICD-10-AM C18-C20 on the NZCR in the calendar years 2007 and 2008 (main cohort) and an extended sample of Maori and Pacific cases, and non-Maori non-Pacific controls in 2006 and 2009 (extended cohort). RESULTS: Of the 6,387 patients identified from the NZCR 5,610 (88%) were eligible for PIPER. Reasons for exclusion were non-adenocarcinoma histology (3%) and non-colorectal primary (2%). Data were collected on 3,695 patients with colon cancer, 1,385 with rectal cancer and 466 with cancer of the recto sigmoid junction. CONCLUSIONS: The PIPER Project has generated comprehensive population level data detailing the diagnosis and management of colorectal adenocarcinoma in New Zealand. This will be used to assess the care provided to patients, and the impact of variations in care occurring between patient groups.

Summary of guidance for the management of early bowel cancer.

Colorectal cancer is an important public health problem and one of the most common cancers registered in New Zealand. In 2009 the New Zealand Guidelines Group were commissioned to produce and evidence-based summary of current New Zealand and international data to inform best practice in the management of people with early bowel cancer. A guideline development team was convened, representing a range of stakeholder groups who met to discuss and agree on the recommendations for a clinical practice guideline. This article summarises the guideline methods and reports the recommendations from the Management of Early Bowel Cancer guideline, published in 2011.

Colorectal cancer management in the provincial New Zealand setting of Nelson.

BACKGROUND: Colorectal cancer surgery, and rectal surgery in particular, has benefited from increased regionalization and subspecialization. With increasing focus on dedicated colorectal units in tertiary centres, the role of smaller provincial hospitals in colorectal cancer surgery has been of topical interest. Little data of relevance to this issue are available from provincial centres in New Zealand. The present study determines the workload and outcomes of a general surgeon with a colorectal subspecialty interest operating in the provincial New Zealand setting of Nelson. METHODS: A retrospective review of consecutive case notes was conducted for the period January 2000 to December 2004, including all colorectal cancer patients managed by the relevant surgeon. The complete management pathway was evaluated. RESULTS: One hundred and fifty colorectal cancers were managed; 133 operations were conducted, including 41 anterior resections and 13 abdominoperineal (AP) resections. Of these operations, 91% were scheduled and 9% were emergencies. The postoperative mortality rate was 0.8% and unplanned return-to-theatre rate 3.1%. Anastomotic leak occurred in 4.6%, all after anterior resection (anterior resection rate: 12.2%). Two were 'major' leaks, requiring return to theatre. The local recurrence rate following anterior resection was 7.3% at a median follow-up duration of 31 months. CONCLUSIONS: Incidence is such that high-volume colorectal surgery is possible even in a smaller New Zealand province. Surgical practice and outcomes withstood comparison to published results - a broad general surgical case mix and low-volume hospital environment were not significant barriers to quality of colorectal care. Provincial colorectal cancer management remains an important resource for patients living outside major New Zealand centres.