Elsevier

The Lancet Oncology

Volume 8, Issue 9, September 2007, Pages 773-783
The Lancet Oncology

Fast track — Articles
Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995–99: results of the EUROCARE-4 study

https://doi.org/10.1016/S1470-2045(07)70245-0Get rights and content

Summary

Background

EUROCARE is the largest population-based cooperative study on survival of patients with cancer. The EUROCARE project aims to regularly monitor, analyse, and explain survival trends and between-country differences in survival. This report (EUROCARE-4) presents survival data for eight selected cancer sites and for all cancers combined, diagnosed in adult (aged ≥15 years) Europeans in 1995–99 and followed up until the end of 2003.

Methods

We analysed data from 83 cancer registries in 23 European countries on 2 699 086 adult cancer cases that were diagnosed in 1995–99 and followed up to December, 2003. We calculated country-specific and mean-weighted age-adjusted 5-year relative survival for eight major cancers. Additionally, case-mix-adjusted 5-year survival for all cancers combined was calculated by countries ranked by total national expenditure on health (TNEH). Changes to survival were analysed relative to cases diagnosed in 1990–94.

Findings

Mean age-adjusted 5-year relative survival for colorectal (53·8% [95% CI 53·3–54·1]), lung (12·3% [12·1–12·5]), breast (78·9% [78·6–79·2]), prostate (75·7% [75·2–76·2]), and ovarian (36·3% [35·7–37·0]) cancer was highest in Nordic countries (except Denmark) and central Europe, intermediate in southern Europe, lower in the UK and Ireland, and worst in eastern Europe. Survival for melanoma (81·6% [81·0–82·3]), cancer of the testis (94·2% [93·4–95·0]), and Hodgkin's disease (80·0% [79·0–81·0]) varied little with geography. All-cancer survival correlated with TNEH for most countries. Denmark and UK had lower all-cancer survival than countries with similar TNEH; Finland had high all-cancer survival, but moderate TNEH. Survival increased and intercountry survival differences narrowed between the data for 1990–94 and 1995–99 for, notably, Hodgkin's disease (range 66·1–82·9 [IQR 72·2–78·6] vs 74·0–83·9 [78·6–81·9]), colorectal (29·4–56·7 [45·8–54·1] vs 38·8–59·7 [50·7–57·5]), and breast (61·7–82·7 [72·3–78·3] vs 69·3–87·6 [76·6–82·7]) sites.

Interpretation

Increases in survival and decreases in geographic differences over time, which are mainly due to improvements in health-care services in countries with poor survival, might indicate better cancer care. Wealthy countries with high TNEH generally had good cancer outcomes, but those with conspicuously worse outcomes than those with similar TNEH might not be allocating health resources efficiently.

Introduction

Information necessary for planning health-care responses to the cancer burden includes: mortality (number of cancer deaths in a given period in a defined population); incidence (number of new cancer diagnoses in a given period); and population-based survival (proportion of incident cases alive at a given time after diagnosis). Population-based survival, which can be obtained only from population-based cancer registries, is usually lower than survival calculated from hospital series or clinical trials because it includes patients who do not have access to adequate treatment or who are not eligible for clinical trials. Survival is also required to estimate the number of patients with a cancer diagnosis who are alive at any one time (prevalence).

If survival in one country is substantially lower than that in other countries, especially those of similar wealth, the health system is probably not functioning as it should. In-depth studies are advisable to find the reason for this problem (eg, late diagnosis, inadequate availability, or poor access to treatment) and to suggest remedies.

Population-based cancer registries have provided population-based survival statistics since the 1960s.1 However, the largest coordinated study is EUROCARE,2, 3, 4 a European cancer registry-based project on the survival and care of patients with cancer; the study aims are to monitor, analyse, and explain survival trends and between-country differences in survival. EUROCARE currently includes data from 83 adult and ten childhood cancer registries in 23 European countries. This report presents survival data for eight selected cancer sites and for all cancers combined, in adult (aged ≥15 years) Europeans diagnosed between 1995 and 1999 and who were followed up until the end of 2003 (EUROCARE-4). The eight sites (breast, colorectum, lung, melanoma, ovary, prostate, testis, and Hodgkin's disease) were selected because they are common or are major and potentially curable diseases.

Previous EUROCARE reports5, 6 showed that survival correlated with macroeconomic variables. Therefore, in this report—to assist between-country comparisons—all-cancer survival has been presented with countries ranked by mean total national expenditure on health (TNEH)7 in 1994–2002.

Section snippets

Cancer cases

For 13 countries, the entire population was covered by cancer registration; the other ten countries were represented by regional cancer registries that covered variable proportions of the population (table 1). These countries constituted a large proportion of Europe and are from now on referred to in this report as Europe. The important issue of whether mean survival figures are representative of those of Europe as a whole has been addressed in a previously published report.8

All cancer

Results

Table 1 shows the percentages of populations of each country that were covered by cancer registration; total numbers of cancer cases diagnosed in 1995–99; numbers of records excluded from analyses for major errors (mean 0·1%, range 0·0–0·7); and percentages of cases excluded because they were not first malignancy, were known by death certificate only (DCO), or were diagnosed at autopsy. Also shown are the numbers of cases included in the survival analyses, percentages censored after less than 5

Discussion

This European study on the survival of patients with cancer who were diagnosed in the second half of the 1990s and followed up to the end of 2003 has shown that—after correcting for non-cancer mortality, age at diagnosis, and case-mix—survival for all cancers combined 5 years after diagnosis was 44·8% (95% CI 44·6–45·0) for men, 54·6% (54·4–54·8) for women, and 49·6% (49·5–49·7) overall. An important finding is that all-cancer survival increased notably in countries where all-cancer survival

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