'Distressing' Differences in Survival Across Europe

Liam Davenport

September 25, 2015

VIENNA ― Although survival for cancer patients in Europe has improved in recent years, there are substantial variations between countries and regions, particularly for hematologic malignancies, reveals a series of analyses of outcomes for more than 10 million patients.

Data presented here at European Cancer Congress (ECC) 2015 and simultaneously published in a collection of 11 articles in the European Journal of Cancer show that 5-year relative cancer survival is typically lower in Eastern Europe than in Central and Northern Europe.

Lead researcher Milena Sant, MD, from the Fondazione IRCCS Istituto Nazionale dei Tumori, in Milan, Italy, emphasized that the findings, which are from the EUROCARE 5 study, can help identify regions with poor cancer survival where "action is needed to improve patient outcomes."

Dr Milena Sant

"Population-based survival information is essential for physicians, policy makers, administrators, researchers, and patient organizations who deal with the needs of cancer patients, as well as with the issue of the growing expenditure on healthcare," she said in a statement.

She added: "In connection with the publication of the EUROCARE 5 results, the European Cancer Patient Coalition calls for a reduction in the fragmentation of care services and the promotion of comprehensive multidisciplinary cancer care centers in order to help reduce survival inequalities across Europe, and it stresses that survival is also affected by the organization and funding of healthcare systems."

Commenting on the findings, President of the European CanCer Organisation (ECCO) Martine Piccart, MD, PhD, professor of oncology at the Université Libre de Bruxelles, in Belgium, said: "I find it quite distressing to see that we have such big differences in the chance of surviving a cancer 5 years across European countries."

"I would like to stress the fact that these cancer registries are incredibly important, but they are not sufficiently funded in many, many countries.

"So the data that the scientists there are able to put together are very often not standardized from one cancer registry to another, not detailed enough," she said, speaking at a press briefing to announce the findings.

Dr Piccart explained that although it is clear that the chances of surviving cancer are much less in some countries than in others, the lack of standardization means "it's going to be not so easy to go back and find what is the reason."

She stressed how important she believes it is "to support these cancer registries," adding: "It's the only way we can monitor how well or poorly we are treating cancer patients."

Building on Previous Data

The current set of analyses builds on previous work from the EUROCARE project. These include an evaluation of adults and children diagnosed with cancer between 2000 and 2007 that showed that overall cancer survival has improved throughout Europe during the past decade.

A further analysis published last year also showed that 5-year survival rates for most patients with hematologic malignancies have increased during the past 15 years in Europe. However, regional variations in survival were identified in both studies.

The latest results are based on data on more than 10 million cancer patients diagnosed between 1995 and 2007, which were provided by 107 cancer registries from 29 European countries. The patients were followed until 2008.

Five-year relative survival and trends were then estimated by European region ― Northern, Central, Southern, Eastern, and Ireland/UK ― and, for some cancers, by morphology.

The average 5-year relative survival for Hodgkin's lymphoma was the highest for all the blood cancers, at 81%, and had the smallest regional variation, ranging from 74.3% in Eastern Europe to 85% in Northern Europe.

In contrast, the greatest variation was seen for chronic myeloid leukemia, at an average 5-year relative survival of 53.0%, which ranged from 33.4% in Eastern Europe to 51% - 58% in the rest of Europe.

The regional variations tended to be larger for cancers associated with a good prognosis. For example, the average 5-year relative survival was 82% for breast cancer, but ranged from 74% in Eastern Europe to 85% in Northern Europe.

Average 5-year relative survival was 57% for patients with colon cancer (range: 49% in Eastern Europe to 61% in Central Europe), 56% for those with rectal cancer (range: 45% in Eastern Europe, 60% in Central Europe), 83% for melanoma (range: 74% in Eastern Europe, 88% in Northern Europe) and 83% for patients with prostate cancer (range: 72% for Eastern Europe, 88% for Central Europe).

The variations were smaller for cancers associated with a poor prognosis. For example, patients with lung cancer had an average 5-year relative survival of 13%, which ranged from 9% in Ireland and the UK to 15% in Central Europe.

For ovarian cancer, the average was 38%; it ranged from 31% in Ireland and the UK to 41% in Northern Europe. The average for stomach cancer was 25% (range: 17% in Ireland and the UK, 30% in Southern Europe); the average for pancreatic cancer was 7% (range: 5% in Northern Europe and Ireland and the UK, 8% in Southern Europe).

The average 5-year relative survival for patients with esophageal cancer was also low, at 12% (range: 8% Eastern Europe, 15% Central Europe); for those with brain cancer, it was 20% (range: 18% in Ireland and the UK, 24% in Northern Europe).

In general, 5-year relative survival rates adjusted for causes of death other than cancer increased steadily during the study period for the majority of cancers, particularly in Eastern Europe.

Dr Sant said: "Between [the periods] 1999-2001 and 2005-2007, the largest increases in 5-year relative survival were seen in cancers such as chronic myeloid leukemia, where survival increased from 32% to 54%; prostate cancer, which increased from 73% to 82%; and rectal cancer, which increased from 52% to 58%."

Low Rates in Denmark, the UK, and Eastern Europe

Another analysis published as part of the European Journal of Cancer collection examined overall survival for all cancers in Europe, using data on more than 7.5 million cancer patients in 29 European countries.

This revealed that Denmark, the UK, and Eastern European countries had lower survival rates than their neighboring countries.

Taking into account patient age, the researchers found that 5-year relative cancer survival was 59.6% in Northern Europe vs 58% in Central Europe, 54.3% in Southern Europe, 50.1% in Ireland and the UK, and 45% for Eastern Europe. In Denmark, 5-year survival was 50.9%.

Survival was significantly lower than the Eastern European regional average in Bulgaria, Latvia, and Poland, at 39%, 42%, and 41%, respectively.

Dr Sant commented: "Survival correlated with gross domestic product [GDP] and total national expenditure on health [TNEH]."

"Countries with recent higher increases in GDP and TNEH had a higher increase in cancer survival. However, this was not the case for countries such as Denmark and the UK, which continue to perform worse than expected for their level of TNEH."

She said that there were a number of factors at play, including differences in cancer biology and behavior, in screening and diagnosis, in the availability of newer treatments, and in socioeconomic status, lifestyle, and general health.

Summarizing, Peter Naredi, MD, PhD, professor of surgery at Sahlgrenska University Hospital, in Gothenburg, Sweden, and scientific co-chair of ECC 2015, said in a release: "EUROCARE 5 once again shows how important it is that we follow the outcome of cancer care in Europe. When we improve diagnostics and treatments of a cancer type, it does not take long to improve survival for that patient population as well."

"But what Dr Sant and coworkers also indicate is that improved survival does not come without a financial incentive from the governments. I hope this will continue to encourage the European community to spend money on cancer care and research."

EUROCARE 5 was funded by the Italian Ministry of Health and the European Partnership for Action Against Cancer. The authors and participants have disclosed no relevant financial relationships.

European Cancer Congress (ECC) 2015. Abstract LBA 1. Presented September 26, 2015.


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