Doctoral defence: Heigo Reima “Colorectal cancer care and outcomes – evaluation and possibilities for improvement in Estonia”

On 26 August at 12:00 Heigo Reima will defend his doctoral thesis “Colorectal cancer care and outcomes – evaluation and possibilities for improvement in Estonia”.

Supervisors:
Lecturer Jaan Soplepmann, University of Tartu
Senior Research Fellow Kaire Innos, The National Institute for Health Development

Opponent:
Associate Professor Toni Seppälä, Tampere University (Finland)

Summary
Colorectal cancer is one of the leading causes of cancer incidence and mortality with increasing occurrence in the world. Organised screening programs can effectively reduce incidence and mortality. 

The general aim of this thesis was to evaluate colorectal cancer incidence, quality of care and survival in Estonia and find possibilities for improvement. 
Estonian Cancer Registry provided data for the analysis of long-term incidence and survival trends. Changes in diagnosis and treatment were examined using data on two patient cohorts diagnosed in 1997 and 2011. A randomised controlled trial was conducted to assess the effect of intra-arterial methylene blue staining of resected colorectal cancer specimens on the accuracy of lymph node staging. 

Colorectal cancer incidence steadily increased over the study period. A recent surge in age group 60–69 along with the rise of stage I tumours suggest an effect of the introduction of screening. Survival improved significantly but remained considerably lower than in Northern Europe. Substantial heterogeneity was observed across subsites, sex, age and stage groups. The distinct survival disadvantage among stage III hepatic flexure cancer patients could be explained by shortcomings in surgery. Major improvements were seen in diagnosis, staging and treatment, but several areas of improvement were identified. Diagnostic delay is a major obstacle, the proportion of metastatic disease remained high and an increase in emergency surgery was seen. By significantly improved staging accuracy, methylene blue staining could avoid unnecessary adjuvant chemotherapy in a number of patients. 

To reduce CRC incidence and mortality, it is necessary to tackle risk factors and increase screening effectiveness through better participation and quality assurance. Efforts are necessary to ensure early detection, timely diagnosis and treatment for all patients and continuous monitoring of the quality of care.