Fast track — ArticlesSurvival for eight major cancers and all cancers combined for European adults diagnosed in 1995–99: results of the EUROCARE-4 study
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
References (30)
- et al.
Cancer survival in the elderly: effects of socio-economic factors and health care system features (ELDCARE project)
Eur J Cancer
(2006) - et al.
Standard cancer patient population for age standardising survival ratios
Eur J Cancer
(2004) - et al.
Cancer survival increases in Europe, but international differences remain wide
Eur J Cancer
(2001) - et al.
Ten-year survival and risk of relapse for testicular cancer: a EUROCARE high resolution study
Eur J Cancer
(2007) - et al.
Differences in colorectal cancer survival between European and US populations: the importance of sub-site and morphology
Eur J Cancer
(2003) - et al.
Survival of cancer patients in Europe: the EUROCARE study. IARC Scientific Publications number 132
(1995) - et al.
Survival of cancer patients in Europe: the EUROCARE-2 study. IARC Scientific Publications number 151
(1999) - et al.
Survival of cancer patients in Europe: the EUROCARE-3 study
Ann Oncol
(2003) - et al.
European health systems and cancer care
Ann Oncol
(2003)
OECD Health Data 2004
EUROCARE-3 summary: cancer survival in Europe at the end of the 20th century
Ann Oncol
WHO. International classification of diseases for oncology
Cancer survival corrected for heterogeneity in patient withdrawal
Biometrics
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