Editorial CommentComparative cancer survival information in Europe
Section snippets
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.
References (50)
- et al.
Childhood cancer survival in Europe: an overview
Eur J Cancer
(2001) - et al.
Geographical comparison of cancer survival in European children (1988–1997): report from the automated childhood cancer information system project
Eur J Cancer
(2006) - et al.
Cancer survival increases in Europe, but international differences remain wide
Eur J Cancer
(2001) - et al.
Survival trends in European cancer patients diagnosed from 1988 to 1999
Eur J Cancer
(2009) - et al.
Variation in survival after diagnosis of breast cancer in Switzerland
Ann Oncol
(2005) - et al.
Can the survival difference between breast cancer patients in Denmark and Sweden 1989 and 1994 be explained by patho-anatomical variables?-a population-based study
Eur J Cancer
(2004) - et al.
Long-term survival expectations of cancer patients in Europe in 2000–2002
Eur J Cancer
(2009) - et al.
Recent cancer survival in Europe: a 2000–02 period analysis of EUROCARE-4 data
Lancet Oncol
(2007) - et al.
The EUROCARE-4 database on cancer survival in Europe: Data standardisation, quality control and methods of statistical analysis
Eur J Cancer
(2009) - et al.
The cure of cancer: A European perspective
Eur J Cancer
(2009)