Survival Rates From Blood Cancers Rising in Europe

Fran Lowry

July 17, 2014

Five-year survival rates for most hematological malignancies have increased over the past 15 years in Europe, although some regions show better outcomes than others, according to a large registry study by EUROCARE-5 researchers.

Failure to get the best treatment and variations in the quality of care are the most likely reasons why such survival disparities persist, write the study authors, led by Milena Sant, MD, from the Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

Their findings are published in Lancet Oncology.

"These improvements coincide with the introduction of new treatments, particularly rituximab for non-Hodgkin lymphoma and imatinib for chronic myeloid leukemia," Dr. Sant told Medscape Medical News.

"But, despite this positive trend, the persisting survival differences across Europe suggest inequalities in the provision of adequate care and availability of effective treatments. This is similar to what we found for solid cancers," she said.

The EUROCARE-5 study analyzed data from 30 cancer registries covering all patients aged 15 years or older diagnosed in 20 European countries to compare changes in 5-year survival.

The registries, which provided continuous incidence and good quality data from 1992 to 2007, comprised a total of 560,444 cases that were diagnosed with a range of 11 lymphoid and myeloid malignancies up to 2007 and followed up to December 31, 2008.

Analysis of the data showed that from 1997-1999 to 2006-2008, the 5-year relative survival increased significantly for most malignancies.

The largest increases were for diffuse large B-cell lymphoma, which went from 42.0% in the earlier period to 55.4% in the later period (P < .0001); follicular lymphoma, which went from 58.9% to 74.3% (P < .0001), chronic myeloid leukemia, which went from 32.3% to 54.4% (P < .0001), and acute promyelocytic leukemia, which went from 50.1% to 61.9%, P = .0038).

Increased survival was also seen for Hodgkin's lymphoma, which went from 75.1% in 1997-1999, to 79.3% in 2006-2008 (P < .0001), chronic lymphocytic leukemia/small lymphocytic lymphoma, which went from 66.1% to 69.0% (P < .0001), multiple myeloma/plasmacytoma, which went from 29.8% to 39.6% (P < .0001), precursor lymphoblastic leukemia/lymphoma (29.8% to 41.1%; P < .0001), acute myeloid leukemia (excluding acute promyelocytic leukemia), which went from 12.6% to 14.8% (P < .0001), and other myeloproliferative neoplasms, excluding chronic myeloid leukemia, which went from 70.3% to 74.9% (P < .0001).

Good Results Not Seen Everywhere

The increase in survival was slight in southern Europe (Italy, Malta, and Slovenia), and somewhat greater in the UK (England, Northern Ireland, Scotland, and Wales).

The greatest improvement in survival was seen in northern (Denmark, Iceland, Norway), central (Austria, France, Germany, Switzerland, and the Netherlands), and Eastern (Bulgaria, Estonia, Lithuania, Poland, Slovakia) Europe.

But, even though survival increased in Eastern Europe from what it had been in 1997, when it was the lowest, people with blood cancers in this region still had lower survival than elsewhere.

"Rituximab and imatinib were approved later and their market uptake was lower in eastern Europe. The main factors influencing poorer survival for haematological and also solid cancers in eastern Europe include a shortage of public funding, lack of national cancer plans, and inadequate access to up-to-date treatment protocols," Dr. Sant said.

"Population-based cancer registry studies collecting data on stage and treatment are necessary to monitor variations in cancer survival and effectiveness of new treatments," she added.

Survival gains in southern Europe were lower because survival rates were high to begin with, Dr. Sant noted.

But in the UK, gains in survival were low at the beginning of the study period and failed to rise. "This was also true for many solid tumors included in EUROCARE. Main factors influencing suboptimum survival for UK haematological cancer patients could be related to delayed diagnosis due to under-evaluation of disease symptoms, suboptimal access to proper care in the elderly and comorbidity factors," she said.

In an accompanying Comment, Alastair J. Munro, MD, from the University of Dundee School of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland, writes that survival discrepancies throughout Europe may not be due to the uptake of drugs alone.

"Better understanding of the conclusions from EUROCARE-5 requires additional information about changes over time (and space) affecting: survival according to the broad categories of disease (Hodgkin's lymphoma, non-Hodgkin lymphoma, leukaemias, myeloma, and other myeloid malignancies); the distribution of histological subtypes and their relation with the age distribution of the population; the distribution of stages at diagnosis; and the timing of active intervention for indolent tumours," Dr. Munro writes.

He concludes: "When making comparisons, whether across time or space, one should consider the effect of potential confounders. Is it all about the drugs? The answer is, not entirely."

The study was funded by the Compagnia di San Paolo, Fondazione Cariplo, European Commission, and Italian Ministry of Health. Dr. Sant and Dr. Munro report no relevant financial relationships.

Lancet Oncol. 2014. Published online July 14, 2014. Summary

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