Zosia Chustecka

September 29, 2013

AMSTERDAM ― A new analysis of cancer mortality across the 27 countries that now make up the European Union shows that the more a country spends on health, the lower the cancer mortality rate.

"Our results show that higher expenditure in health is correlated to better cancer outcomes," concluded lead author and researcher Felipe Ades, MD, a medical oncologist at the Breast European Adjuvant Studies Team, a clinical trials and data center in Brussels, Belgium.

Dr. Ades presented the findings here at European Cancer Congress 2013 (ECCO-ESMO-ESTRO) from an article that was simultaneously published online in the Annals of Oncology.

"This is an interesting study, confirming that, just as overall life expectancy is higher in countries that spend proportionally more on health, so cancer patients' survival is also higher in these countries," commented Dr. Cornelis van de Velde, from the Leiden University Medical Center, the Netherlands, and current president of the European CanCer Organization (ECCO).

A coauthor of the article, Richard Sullivan, MD, PhD, from the Kings Health Partners Integrated Cancer Center, London, said that this is the first time that the impact of general health expenditure on cancer outcomes has been reported. The correlation between health expenditure and life expectancy is well known, but this is "not a one-way street," he pointed out, inasmuch as the United States spends the most of any country on healthcare, and yet recent data show that life expectancy is falling there. The United States spends around 17% of gross domestic product (GDP) on healthcare, whereas the highest spending country in Europe spends about 11%, he said.

Dr. Sullivan said the team has since gone further and has analyzed how cancer-specific spending (rather than general health expenditure) is correlated with cancer outcomes. These findings "paint a different picture," he told Medscape Medical News.

This is complicated, he said, because it depends on many different factors, including population-wide screening programs and also how cancer centers are coordinated and on the prevailing "culture, for example, whether cancer specialists work as a team or as individuals, which is still common in some European countries," he said. This analysis of cancer-specific spending and cancer outcomes is due to be published soon in the Lancet Onoclogy.

Marked East/West Divide

Dr. Ades and colleagues collected data from the World Health Organization, the International Monetary Fund, and the World Bank on cancer incidence and mortality, each country's GDP, and the percentage of GDP invested in healthcare and health expenditure.

They found a marked divide between Western and Eastern Europe.

Western Europe is composed of Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, and the United Kingdom. Together, these countries have a population of around 400 million, which is about 4-fold higher than that of Eastern Europe.

Eastern Europe comprises Bulgaria, Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Romania, Slovakia, and Slovenia. Most of these countries joined the European Union in 2004, and 2 joined in 2010. (The study was already under way when Croatia joined the European Union in 2013, and so this country was not included).

There was a 10-fold difference between the total GDP of countries in Western Europe (around $16.1 trillion) compared with the countries of Eastern Europe ($1.3 trillion). Not surprisingly, there was a strong correlation between a country's GDP and the amount spent on health per person. The cutoff point between Western and Eastern countries was around $2600 per person per year.

In Western Europe, the highest expenditure on health was seen in Luxembourg ($6592 per person per year) and the lowest in Portugal ($2690), and in Eastern Europe, the highest was in Slovenia ($2551) and the lowest in Romania ($818).

There was a strong association between health expenditure and cancer mortality.

"From our results, it is evident that Eastern European countries, except Cyprus, have higher mortality rates than the Western European countries for approximately the same range of incidence," Dr. Ades said.

 
The more a country spends on health, the fewer patients die after a cancer diagnosis. Dr. Felipe Andes
 

"This indicates that, proportionally, more patients die after a diagnosis of cancer in Eastern Europe than in Western Europe. This pattern is strongly associated with health expenditure," he emphasized. "The more a country spends on health, the fewer patients die after a cancer diagnosis."

"In countries spending less than $2000 per capita in healthcare, like Romania, Poland, and Hungary, around 60% of the patients die after a diagnosis of cancer," he said.

"In countries spending between $2500 to $3500, this figure is around 40% and 50%, as in the case of Portugal, Spain, and the United Kingdom," he said. "Moving up to around $4000, less than 40% of the patients die, as in the case of France, Belgium, and Germany."

Despite Fewer Deaths, Higher Incidence

However, the researchers found that despite Western Europe having a reduced cancer mortality rate when compared with Eastern Europe, there was a higher cancer incidence. The researchers speculate that this higher incidence of cancer in Western Europe is the result of there being more cancer screening programs, which detect more cancers when they are at an earlier and more treatable stage. Such a "screening increase" incidence would be accompanied by a mortality decrease, because the cancer is diagnosed at an earlier stage, they comment, and they add that this is likely the case here. In addition, there is also more availability of cancer treatments in Western Europe.

European Cancer Congress 2013 (ECCO-ESMO-ESTRO). Abstract 1400. Presented September 29, 2013.

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