VALUE OF CANCER REGISTRIES FOR THE EVALUA TION OF CANCER TREATMENTS -EXAMPLE OF RECTAL-CANCER

Improvement of health care policy requires an assessment of health car e practices. In France, morbidity registries might be the best tool fo r such an assessment. This study shows how the treatment of rectal can cer can be assessed by French cancer registries. Two studies were cond ucted: a cross-sectional study on data from 7 cancer registries in 199 0 and a longitudinal study on data from 2 digestive cancer registries (departments of Calvados and Cote d'Or) between 1978 and 1990. Finally , we conducted a regional audit concerning quality control in rectal r esection for cancer in Lower Normandy between 1988 and 1993. In 1990 t he mean resection rate was 77.8%. The sphincter preservation rate was also significantly increased to 53.9% in 1990. The use of adjuvant rad iotherapy significantly increased between 1978 and 1990, more rapidly in university centres. In more recent years, the use of radiotherapy c oncerned 50% of resected rectal cancers with no differences between th e various types of health care centres. However, in 1990, major geogra phical variations were observed for the use of adjuvant radiotherapy. Similar geographical variations were observed for the use of chemother apy which did not increase with time. Rectal cancers were not diagnose d earlier from 1978 to 1990 in the two departments of Calvados and Cot e d'Or. The use of reproducible quality criteria (length of distal exc ision, number of nodes examined and histological status of lateral mar gins) showed a global deficiency and marked variations between the var ious types of hearth care centres and levels of surgical training. The French network of French cancer registries (FRANCIM) provides accurat e and reliable knowledge on medical practices, geographical variations , trends and quality control. The potential of cancer registries has n ot been clearly determined, although such information is required to p lan health care policy.