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ECC 2015: EUROCARE Results Show Large Variations in Survival Among European Countries

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Key Points

  • In general, 5-year relative survival increased steadily over time in Europe, particularly in Eastern Europe, for most cancers. However, the most dramatic geographic variations were observed for cancers of the blood, where there have been recent advances in treatment.
  • Between 1999–2001 and 2005–2007, the largest increases in 5-year relative survival were seen in cancers such as chronic myeloid leukemia, prostate cancer, and rectal cancer.
  • In connection with the publication of the EUROCARE 5 results, the European Cancer Patient Coalition calls for a reduction in the fragmentation of care services and the promotion of comprehensive multidisciplinary cancer care centers.

Comparisons of cancer patients’ survival and care in Europe up to 2007 showed that although more patients are surviving for at least 5 years after diagnosis, there are large variations among countries, which are particularly significant in cancers of the blood. Milena Sant, MD, from the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy, presented these findings (Abstract 1LBA) at the 2015 European Cancer Congress in Vienna, Austria.

New analysis of data from the EUROCARE 5 study has provided information on patients diagnosed after 2000 in each European country and revealed that survival is generally low in Eastern Europe and high in Northern and Central Europe, confirming trends highlighted in previous EUROCARE studies.

“In general, 5-year relative survival increased steadily over time in Europe, particularly in Eastern Europe, for most cancers. However, the most dramatic geographical variations were observed for cancers of the blood, where there have been recent advances in treatment, such as chronic myeloid and lymphocytic leukemias; non-Hodgkin lymphoma and two of its subtypes (follicular and diffuse large B-cell lymphoma); and multiple myeloma. Hodgkin lymphoma was the exception, with smaller regional variations and a fairly good prognosis in most countries,” said Dr. Sant.

EUROCARE 5 has records from 22 million cancer patients diagnosed between 1978 and 2007 in 30 European countries and has been reporting results since the late 1990s. These latest data are on over 10 million patients diagnosed from 1995 up to 2007 and followed up to 2008, with an unprecedented coverage of 50% of the European population. They are published in 11 papers in the European Journal of Cancer simultaneously with presentation at the 2015 European Cancer Congress.

Overall Survival by Cancer Type

The average 5-year relative survival (standardized for age) for Hodgkin lymphoma was the highest of all the blood cancers at 81%, with variations ranging from 79.4% for Ireland and the United Kingdom, to 85% in Northern European countries, to 74.3% in Eastern European countries.

By contrast, average 5-year survival for chronic myeloid leukemia was 53% (but this varied enormously according to age), with the geographic variation the greatest of all the blood cancers: 33.4% in Eastern Europe vs 51% to 58% in the rest of Europe. Significant deviations from the regional average were found in Sweden (69.7%), Scotland (64.6%), France (71.7%), Austria (48.2%), Croatia (37.8%), Estonia (48.9%), Czech Republic (45.2%), and Latvia (22.1%).

For cancers that have a fairly good prognosis, the European average 5-year relative survival was 82% for breast (with a variation of 74% in Eastern Europe compared with 85% in Northern Europe), 57% for colon (49% in Eastern Europe, 61% in central Europe), 56% for rectum (45% in Eastern Europe, 60% in central Europe), 83% for melanoma (74% in Eastern Europe, 88% in Northern Europe), and 83% for prostate (72% for Eastern Europe, 88% for central Europe).

Smaller variations were seen in cancers with a poor prognosis; lung cancer had a European average 5-year relative survival of 13% (9% in Ireland and the United Kingdom, 15% in central Europe), ovarian cancer (average 38%, 31% in Ireland and the United Kingdom, 41% in Northern Europe), stomach cancer (average 25%, 17% in Ireland and the United Kingdom, 30% in Southern Europe), pancreas (average 7%, 5% in Northern Europe, Ireland, and the United Kingdom, 8% in Southern Europe), esophagus (average 12%, 8% Eastern Europe, 15% central Europe), and brain (average 20%, 18% in Ireland and the United Kingdom, 24% in northern Europe).

“Between 1999–2001 and 2005–2007, the largest increases in 5-year relative survival were seen in cancers such as chronic myeloid leukemia, where survival increased from 32% to 54%; prostate cancer, which increased from 73% to 82%; and rectal cancer, which increased from 52% to 58%,” said Dr. Sant.

Overall Survival for All Cancers

Another analysis of the data reported in these articles looked at overall survival for all cancers in Europe, taking data from over 7.5 million cancer patients in 29 European countries. This showed that Denmark, the United Kingdom, and Eastern Europe have lower survival than neighboring countries. Five-year relative survival, standardized for age, was 59.6% in Northern Europe; 58% in Central Europe; 54.3% in Southern Europe; 50.1% in Ireland and the United Kingdom; and 45% in Eastern Europe. In Denmark, it was 50.9%. Within Eastern European countries, survival for most cancers was significantly lower than the regional average in Bulgaria, Latvia, and Poland: 39%, 42%, and 41%, respectively. In the Czech Republic, survival was significantly higher than the regional average at 51%.

“Survival correlated with gross domestic product (GDP) and total national expenditure on health (TNEH). Countries with recent higher increases in GDP and TNEH had a higher increase in cancer survival. However, this was not the case for countries such as Denmark and the United Kingdom, which continue to perform worse than expected for their level of TNEH,” said Dr. Sant.

She said that variations in survival were due to a number of factors: differences in the biology and behavior of some cancers and in screening and diagnosis (eg, for breast, prostate, and colorectal cancers), which can result in cancers being detected earlier and, potentially, at a more treatable stage, as well as the availability of newer and better treatments. “Socioeconomic status, lifestyle, and general health differences between populations may also play a role,” said Dr. Sant.

She concluded, “Results from EUROCARE can help to identify regions of low survival where action is needed to improve patients’ outcomes. Population-based survival information is essential for physicians, policymakers, administrators, researchers, and patient organizations who deal with the needs of cancer patients, as well as with the issue of the growing expenditure on health care. It is vital to close the gap between the world of research and that of patient advocacy groups in order to improve cancer care. In connection with the publication of the EUROCARE 5 results, the European Cancer Patient Coalition calls for a reduction in the fragmentation of care services and the promotion of comprehensive multidisciplinary cancer care centers, in order to help reduce survival inequalities across Europe, and it stresses that survival is also affected by the organization and funding of health care systems.”

EUROCARE was possible thanks to a consolidated partnership between two Italian research institutes (the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan and the Istituto Superiore di Sanità in Rome) and the network of  European cancer registries.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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