Editorial Comment
Comparative cancer survival information in Europe

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The need for population-based survival studies

Accurate population-based information on cancer patient survival is indispensable for effective cancer control, and cancer registries have the essential task of collecting that information.1 While clinicians need survival from clinical series to evaluate the efficacy of their treatments, only population-based survival comparisons can provide information on the effectiveness of healthcare systems.2, 3 Population-based cancer registration is also necessary for monitoring cancer incidence and for

Publication delay

Population-based survival studies may be criticised because too much time elapses between the latest diagnosis year and the presentation of results. During the intervening years, more effective treatments are introduced, and the picture presented may no longer be current and hence of limited relevance. However, progress in cancer treatment is seldom followed by rapid changes in population-based long-term survival estimates. More often, survival improves gradually as the new protocols become

What is new in EUROCARE-4

As noted above, the new technique of period survival has been applied for the first time in this EUROCARE round. Other important novelties have also been introduced. Extensive estimates of the proportions of patients cured of their disease are now presented for selected major cancer sites by country. These estimates were obtained using cure or mixture models.22 The main indicator presented by EUROCARE is 5-year relative survival which is perceived as approximating to the probability of being

How representative are EUROCARE data?

A persistent problem with EUROCARE is that for several European countries cancer registration covers only a small fraction of the total national population. Summary results for these countries may not therefore represent the situation in the country as a whole; and for EUROCARE-4 this is likely to be the case for Czech Republic, Germany, Italy, Poland and Spain. In Italy, for example, the richer northern part of the country is better covered by cancer registration than the south of the country,

Mortality versus survival

Some authorities argue that mortality statistics are preferable to survival statistics for comparing cancer outcomes between nations, because mortality data are generally available for entire national populations, and because length or lead time bias due to screening can have a major impact on cancer survival differences.28, 29 We have repeatedly stressed that survival is a complex indicator: longer survival may reflect earlier diagnosis, over-diagnosis or later death. However, all these

Relevance of population-based survival to clinicians

In general, clinicians tend to under-use the results from population-based survival studies. They more often rely on data from randomised clinical trials or outcome studies from hospitals or groups of hospitals, with the data broken down by disease stage, age, and performance status. Nevertheless, oncologists are often disconcerted to learn that population-based survival is lower than in clinical series, particularly for adult cancer patients. The reasons are not difficult to find: patients

Relevance of population-based survival to administrators and policy makers

Although some countries have used cancer survival statistics to set priorities for the provision of cancer care, the economic and social implications2 of changes in cancer incidence and survival are not widely appreciated. Cancer incidence is increasing – mainly because life expectancy is increasing – and this is being accompanied by a steady increase in survival for many major cancers. The resulting increase in prevalence implies the need to devote more resources to the clinical surveillance

Relevance of population-based survival to cancer survivors and the public

Highlighting international survival differences in the media may convey the wrong message. Inflammatory newspaper headlines, such as those reporting that cancer survival is worse than a lottery (Daily Mail, April 23, 1999) or that only miracles can save cancer patients in southern Italy (L’Espresso, June 22, 2000), or politicians declaring that it is better to be treated in the US than in the UK (The New York Times, October 31, 2007) suggest that scientists need to communicate more effectively

What Europe has learned from the EUROCARE studies

The main lesson is that the survival of European cancer patients varies markedly by country, region, age and sex. Table 2 summarises these differences, as determined by EUROCARE-4, in terms of relative excess risks of death for all cancers combined, after adjustment for case mix. The relative excess risk of death is 28% higher in Eastern Europe than central Europe; the relative excess risk of death is much higher for patients of age 55–99 years than those of age 15–54 years, and male cancer

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

Acknowledgments

We thank Roberta Ciampichini for providing the analysis shown in Table 2, Don Ward for help with the English, and Samba Sowe for editorial support. The research was supported by the Compagnia di San Paolo, Torino, Italy.

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