Interim results of a survey on the diagnosis and treatment of patients with advanced colorectal cancer in China jointly initiated by the Beijing Aipu Cancer Patient Care Foundation, the School of Public Health of Peking Union Medical College, the National Institute of Development Research Center of Peking University, and Henan Cancer Hospital. It was shown that 64% of the interviewed patients did not understand the high-risk factors of colorectal cancer at all, and 83% of the patients were in the advanced stage when they were first diagnosed.
Experts call for increasing public awareness of high-risk factors for colorectal cancer and enhancing early screening awareness, thereby reducing the incidence and mortality of colorectal cancer.
Lack of awareness of early screening
Colorectal cancer is one of the common malignant tumors in my country, and its incidence ranks third in malignant tumors.
Tumor registration data released by the National Cancer Center show that in 2015, there were about 388,000 new cases of colorectal cancer in my country, and about 187,000 patients died of colorectal cancer.
"The survey found that before getting the disease, 64% of patients did not understand the high-risk factors of colorectal cancer, 85% of the patients did not understand the knowledge of early colorectal cancer screening; 97% of the patients had not undergone colonoscopy screening, of which 86.5% Of patients who did not undergo colonoscopy screening because they did not know that they needed regular colonoscopy screening." Shi Anli, president of the Chinese Anti-Cancer Association Rehabilitation Association, pointed out that China’s colorectal cancer patients have a low level of awareness of various aspects of the disease. Go to the hospital for examination only when symptoms appear, and the first examination is in the middle and late stages.
The data showed that 85.8% of the surveyed patients' first visit was due to the discovery of suspected symptoms such as blood in the stool, severe diarrhea or abdominal pain, 7.3% of the patients found abnormalities during the diagnosis and treatment of other diseases, and only 6.9% of the patients found suspected symptoms during the physical examination.
This has also led to most patients in the middle and late stages when they were first diagnosed.
"The survey results show that 83% of colorectal cancer patients were in the middle and advanced stages when they were first diagnosed, and 44% of them had metastases to the liver and lungs." Professor Lin Lin, deputy dean of Peking University Cancer Hospital pointed out. Compared with some countries in Europe and the United States, the proportion of patients with colorectal cancer in my country at the time of diagnosis is higher, and there are more patients with metastasis, which brings great challenges to treatment and prognosis.
"It is necessary to increase the public's awareness of high-risk factors for colorectal cancer, enhance early screening awareness, and thereby reduce the incidence and mortality of colorectal cancer." Shi Anli emphasized.
Improve the concept of precision treatment
At present, the diagnosis and treatment of colorectal cancer emphasizes "precision treatment", and targeted therapy can bring about a longer survival chance for about half of patients.
In patients with colorectal cancer, 50% of the RAS gene status is wild-type. For these patients, on the one hand, they may have a relatively good prognosis, and on the other hand, they can also use specific targeted drugs (such as anti-EGFR monoclonal antibodies). ) For treatment to obtain more survival benefits.
In the "Expert Consensus on Molecular Biomarker Detection of Colorectal Cancer" released in 2018, it is recommended that RAS and BRAF gene mutation detection be performed for patients who are clinically diagnosed with recurrent or metastatic colorectal cancer.
The detection results of molecular markers for colorectal cancer efficacy prediction and prognosis evaluation are very important for clinically formulating correct treatment plans. Therefore, once the patient is diagnosed, it is necessary to clarify the genetic status to avoid delay in treatment.
The survey data shows that the RAS detection rate of Chinese patients is only 19.1%.
Compared with two foreign studies, the detection rate in Italy is 35.1% and that in the United States is 41%. The genetic detection rate of colorectal cancer patients in my country is obviously low.
Therefore, whether it is from the perspective of doctors or patients, genetic testing awareness needs to be improved.
To a certain extent, the application of targeted drugs can reflect the practice of precision therapy in clinical treatment.
From this survey, the use rate of targeted drugs in colorectal cancer patients is only 37.3%, and the use rate of EGFR drugs in the first-line treatment accounts for only 36.1% of the use of targeted drugs.
"The concept of precision treatment of colorectal cancer urgently needs to be further improved." Professor Lin Lin emphasized, "We know that the more the treatment of colorectal cancer patients, the worse the treatment effect will be, and 42.6% of the patients reported that the doctor did not recommend it during the diagnosis and treatment process. Targeted drugs. If the right treatment methods and drugs are selected at an early stage, it will prolong the patient’s survival and improve the quality of life. Second-line and later-line treatments are not necessarily required."
Optimize diagnosis and treatment mode
"From the perspective of overall medical expenditure, the proportion of patients in the middle and late stages of diagnosis is high, and the country's medical insurance burden will also increase. This requires attention." Professor Li Ling, director of the China Health Development Research Center of the National Development Institute of Peking University, said.
The analysis of the results showed that with the development of colorectal cancer, such as the first visit, the first diagnosis, the first treatment, the second treatment, and the treatment after recurrence and metastasis, the number of patients who chose to go to provincial capital city hospitals and hospitals above the provincial capital gradually increased.
Li Ling said: "Due to the imbalance of regional medical resources, most patients have experienced multiple referrals, and the resulting additional medical expenses will also put pressure on national medical insurance funds."
The report shows that among the interviewed patients, 44.1% have urban employee insurance, 36.3% have new rural cooperative medical insurance, 18.8% have urban resident medical insurance, 6.9% have serious illness medical insurance, and 5.8% have commercial insurance. Coverage is low.
By increasing the coverage of commercial insurance and helping patients reduce their burdens, it may be possible to effectively fill the parts that cannot be covered by medical insurance.
The "Healthy China Action (2019-2030)" requires that by 2022 and 2030, the overall 5-year cancer survival rate shall not be less than 43.3% and 46.6% respectively.
"The most economical and effective measure is to popularize the knowledge of healthy life, reduce the incidence, and at the same time, early detection, early treatment, early recovery, and the use of precise treatment methods, such as colorectal cancer targeted drug treatment, so that the common people are less ill, Guarantee." Li Ling said.
There are limited access to disease information for colorectal cancer patients, and it is difficult to obtain authoritative and easy-to-understand disease-related knowledge through the Internet. Therefore, there is a long way to go to educate the public and high-risk groups on disease knowledge.
Reporter: Wu Jiajia