EUROCARE-4. Survival of cancer patients diagnosed in 1995–1999. Results and commentary

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Abstract

EUROCARE-4 analysed about three million adult cancer cases from 82 cancer registries in 23 European countries, diagnosed in 1995–1999 and followed to December 2003. For each cancer site, the mean European area-weighted observed and relative survival at 1-, 3-, and 5-years by age and sex are presented. Country-specific 1- and 5-year relative survival is also shown, together with 5-year relative survival conditional to surviving 1-year. Within-country variation in survival is analysed for selected cancers.

Survival for most solid cancers, whose prognosis depends largely on stage at diagnosis (breast, colorectum, stomach, skin melanoma), was highest in Finland, Sweden, Norway and Iceland, lower in the UK and Denmark, and lowest in the Czech Republic, Poland and Slovenia. France, Switzerland and Italy generally had high survival, slightly below that in the northern countries. There were between-region differences in the survival for haematologic malignancies, possibly due to differences in the availability of effective treatments.

Survival of elderly patients was low probably due to advanced stage at diagnosis, comorbidities, difficult access or lack of availability of appropriate care.

For all cancers, 5-year survival conditional to surviving 1-year was higher and varied less with region, than the overall relative survival.

Introduction

EUROCARE, which began in 1990,1, 2, 3 is the largest co-operative cancer registry-based study on the survival and care of European cancer patients. Its aims are to monitor, analyse and explain cancer survival trends and between-country differences in survival and care. Summary results of EUROCARE-4, pertaining to patients diagnosed in 1995–1999 and later, have already been published.4, 5 The aim of the present paper is to illustrate and comment on the results of survival analyses in greater detail for each cancer site included in EUROCARE-4 by country, follow-up interval, age at diagnosis and sex. In addition to these conventional survival analyses − presented in the previous EUROCARE projects − the present paper also analyses 5-year survival conditional to surviving the first year after diagnosis (5-year conditional survival). Overall survival is greatly influenced by the mortality that occurs soon after diagnosis, due in part to perioperative mortality, but also to advanced disease stage or significant comorbidity at diagnosis.

In order to provide an indication of within-country variation in survival, we also give, for selected cancers, survival for individual cancer registries (CRs) within countries, and coefficients of within-country survival variation.

Section snippets

Cancer cases

This analysis was carried out on 2,718,346 adult (aged ⩾15 years) cancer cases diagnosed in 1995–1999. A detailed description of the dataset used for the analysis is reported elsewhere in this issue.6 The data provided by the Polish cancer registry of Kielce were not included in this analysis due to partial incompleteness of follow-up for vital status. A total of 82 cancer registries from 23 European countries were therefore considered. For 13 countries (Austria, Denmark, Finland, Iceland,

Results

The main results are presented as a series of pages (938–983), one for each cancer site. The top left table on each page shows the number of men, of women and the total diagnosed with the cancer in each country, arranged in 5 European regional groupings: northern Europe (Denmark, Finland, Iceland, Norway and Sweden); the UK (England, Wales, Scotland and Northern Ireland) and Ireland; central Europe (France, Belgium, Austria, Germany, the Netherlands and Switzerland), southern Europe (Italy,

Conflict of interest statement

None declared.

EUROCARE-4 Working Group

Austria: W Oberaigner (Tyrol Cancer Registry); M Hackl (Austrian National Cancer Registry); Belgium: E Van Eycken; Martine Verstreken (Flemish Cancer Registry), Czech Republic: J Holub, L Jurickova (West Bohemia Cancer Registry); Denmark: HH Storm; G Engholm (Danish Cancer Society, Dept. Cancer Prevention & Documentation); Finland: T Hakulinen (Finnish Cancer Registry); France: A Belot (FRANCIM); G Hédelin, M Velten (Bas-Rhin Cancer Registry); I Tron, E Le Gall (Bretagne Childhood Cancer

Acknowledgements

We thank Don Ward for help with the English, and Chiara Margutti for editorial support. The EUROCARE-4 project was supported by the Compagnia di San Paolo di Torino.

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