Investigation Of Colorectal Cancer Patients: The Detection Rate Of RAS Is Less Than 20% In 83% Of Patients At The First Diagnosis

"The survey results showed that 83% of colorectal cancer patients were in advanced stage at the time of first diagnosis, and 44% of patients had liver and lung metastases." Recently, Professor Shen Lin, vice president of Peking University Cancer Hospital, pointed out that compared with some European and American countries, the proportion of patients with advanced colorectal cancer diagnosed in China is higher, and there are more patients with metastasis, which brings great challenges to the treatment and prognosis.

It is understood that the above survey covers 19 general hospitals and specialized hospitals including Peking University Cancer Hospital, Zhejiang cancer hospital and Affiliated Cancer Hospital of Sun Yat sen University. As of July 31, 2299 patients (4410 patients planned to be included) were collected, which is the first multicenter stratified random sampling survey on the survival status of patients with advanced colorectal cancer with relatively large sample size in China 。

According to the latest data released by the National Cancer Center, the total cost of cancer treatment in China in 2018 is 220 billion yuan. According to the report published by rdpac, the burden of colorectal cancer per capita in urban areas of China is the highest. "From the perspective of overall medical expenditure, the proportion of patients with advanced stage at diagnosis is high, and the national medical insurance burden will also increase. This needs attention. " Professor Li Ling, director of the China Health Development Research Center of the National Development Research Institute of Peking University, said.

In Li Ling's opinion, the most economic and effective measure is to popularize knowledge of healthy life, reduce the incidence of disease, at the same time, early detection, early treatment, early rehabilitation, and the use of precise treatment methods, such as targeted drug therapy for colorectal cancer, so that people can get less disease and have security after getting sick.

83% of the patients were in the middle and late stage

Colorectal cancer is one of the most common malignant tumors in China, and its incidence ranks the third. According to the cancer registration data released by the National Cancer Center, there were 388000 new cases of colorectal cancer in China in 2015, and the number of deaths from colorectal cancer was about 187000.

In order to fully understand the current situation of diagnosis and treatment of colorectal cancer patients in China, China carried out a survey on the diagnosis and treatment status of patients with middle and advanced colorectal cancer in China, including medical treatment and treatment status, quality of life, psychological feelings, burden of patients caused by treatment, etc.

Professor Qiao Youlin, one of the main leaders of the project, Cancer Hospital of Chinese Academy of Medical Sciences and Beijing Union Medical College / College of medicine and public health, told 21st century economic news that the project plans to enroll 4410 cases of advanced colorectal cancer patients in 19 research centers in seven major regions of the country. By July 31, 2020, 50% of the enrollment target, namely 2299, has been completed There were 1403 cases in cancer hospital and 896 cases in general hospital. All of them were one-to-one bedside questionnaires.

The survey found that before getting sick, more than half (64%) of the patients did not understand the high-risk factors of colorectal cancer, 85% of the patients did not know the knowledge of early colorectal cancer screening; 97% did not do colonoscopy screening, among which 86.5% of the patients did not know the need for regular colonoscopy screening.

On the one hand, the president of China Association for cancer prevention and rehabilitation launched a low level of cancer diagnosis for patients with advanced colorectal cancer.

According to the data, 85.8% of the patients visited the hospital for the first time because of the suspected symptoms such as bloody stool, severe diarrhea or abdominal pain, 7.3% of the patients found abnormalities in the diagnosis and treatment of other diseases, and only 6.9% of the patients found suspected symptoms during physical examination. This also led to the majority of patients with the first diagnosis has reached the middle and late stage.

Professor Shen Lin, vice president of Peking University Cancer Hospital, pointed out that the survey results showed that at the time of first diagnosis, 83% of colorectal cancer patients were in advanced stage, and 44% of patients had liver and lung metastasis. Compared with some countries in Europe and the United States, the proportion of patients with advanced colorectal cancer at the time of diagnosis is higher in China, and there are more patients with metastasis, which brings great challenges to the treatment and prognosis.

Optimizing diagnosis and treatment mode to reduce disease burden

"Therefore, it is necessary to improve the public awareness of high-risk factors for colorectal cancer and improve the awareness of early screening, so as to reduce the incidence and mortality of colorectal cancer." He stressed.

At the same time, gene detection is very important for early screening of colorectal cancer.

In the consensus on molecular biomarker detection of colorectal cancer published in 2018, RAS and BRAF gene mutation detection are recommended for patients with clinically diagnosed recurrent or metastatic colorectal cancer. The detection results of molecular markers for the prediction of curative effect and prognosis evaluation of colorectal cancer are very important for making the correct treatment plan. Once the patient has been diagnosed, it is necessary to avoid delay in gene therapy.

The detection rate of Ras was only 1% in advanced colorectal cancer. In contrast, two foreign studies showed that the detection rate was 35.1% in Italy and 41% in the United States.

According to the latest data released by the National Cancer Center, the total cost of cancer treatment in China in 2018 is 220 billion yuan. According to the report published by rdpac, the burden of colorectal cancer per capita in urban areas of China is the highest.

Professor Li Ling, director of the China Health Development Research Center of the National Development Research Institute of Peking University, pointed out that from the perspective of overall medical expenses, the proportion of patients in the middle and late stages at the time of diagnosis is high, and the national medical insurance burden will also increase.

The survey shows that the average number of patients surveyed has to go to 2.07 hospitals. Repeated visits will not only increase the cost, but also delay the process of treatment and diagnosis.

"The results showed that with the development of colorectal cancer, such as the first visit, the first diagnosis, the first treatment, the second treatment, the treatment after recurrence and metastasis, the number of patients who chose to go to the provincial capital city hospital and the hospital above the provincial capital gradually increased." Li Ling pointed out that one of the main reasons is the imbalance of regional medical resources.

It is also understood that even after the onset of the disease, 44.3% of the patients seldom went to know the hospital and department information for the treatment of colorectal cancer.

Qiao Youlin pointed out to the reporter of the 21st century economic report that in the actual investigation, the grass-roots level is relatively weak. First of all, in terms of discovery, the local hardware can be screened out, but the grassroots can not solve the problem of referral, and the patient's condition is delayed. When they go to the third grade a hospital or special hospital, many of them are in the late stage.

"Where to turn, who to look for and how to do it need to tell the grassroots a correct channel." He pointed out that it is necessary to implement "strong grassroots" and strengthen relevant training for grassroots doctors.

"Healthy China action (2019-2030)" requires that the overall 5-year survival rate of cancer should not be less than 43.3% and 46.6% by 2022 and 2030, respectively. "The most economic and effective measures are to popularize the knowledge of healthy life, reduce the incidence of disease, at the same time, early detection, early treatment, early recovery, the use of accurate treatment, do not blindly seek medical treatment, so that people get less sick, after the disease has been guaranteed." Li Ling said.

In addition, it is worth noting that the survey also investigated the medical insurance situation of patients. According to the report, 44.1% of the patients interviewed had urban employee insurance, 36.3% had new rural cooperative medical insurance, 18.8% had urban residents' medical insurance, 6.9% had serious illness insurance, and 5.8% had commercial insurance, with low coverage of commercial insurance. Li Ling believes that by improving the coverage rate of commercial insurance and helping patients reduce the burden, it may be able to effectively fill in the part that can not be covered by medical insurance. (Editor: Li Qingyu)

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