COMMENTARY

Seeking High-Quality Cancer Care for Everyone

Hannah K. Weir, PhD

Disclosures

September 17, 2018

Editorial Collaboration

Medscape &

Hello. I'm Dr Hannah Weir in the Division of Cancer Prevention and Control at CDC. It is my pleasure to join you as part of the CDC Expert Commentary Series on Medscape.

Cancer may soon become the leading cause of death in the United States. The Division of Cancer Prevention and Control is well positioned to respond to the growing cancer burden from a public health perspective. CDC's National Program of Cancer Registries helps support a nationwide network of cancer registries, and the National Comprehensive Cancer Control Program works with state partners to promote prevention, early diagnosis, and access to treatment.

Many of our cancer registries have participated in the CONCORD Programme CONCORD is a program at the London School of Hygiene & Tropical Medicine for the global surveillance of population-based cancer survival.

Population-based survival differs in a fundamental way from survival seen in clinical trials or in managed care settings, such as veterans' hospitals. Clinical trials are essential for assessing new treatments and reflect the highest achievable survival under optimal conditions. Selected cancer patients receive the latest diagnostic techniques and treatments, administered by experienced oncologists, often in specialized hospitals. For these reasons, cancer survival seen in clinical trials is typically higher than the average for all cancer patients.

In contrast to measuring survival in clinical settings, population-based survival is the average survival achieved for all cancer patients, regardless of their age, sex, race and ethnicity, health insurance status, underlying medical conditions, socioeconomic position, or cancer treatment setting.

When we compile high-quality population-based survival data, we are able to compare cancer survival and trends between populations and over time. You can think of population-based survival as measuring the overall effectiveness of the healthcare system to deliver its services to all patients.

The first CONCORD study[1] looked at survival for patients diagnosed from 1990 through 1994 with four common cancers, including female breast, prostate, colon, and rectum. The second CONCORD study (CONCORD-2,[2]) included additional cancers for adults and acute lymphoblastic leukemia in children. CONCORD-2 was the largest analysis of population-based cancer survival, covering 84% of the US population. Results for the United States were published in 2017 in a supplement in the journal Cancer.[3] Links to the supplement and to the CONCORD papers are provided below.

CONCORD-2 findings include 5-year survival by race, cancer stage at diagnosis, and state of residence. The good news is that survival in the United States is among the highest in the world. However, the data also told a troubling story about the disproportionate burden of lower cancer survival experienced by black Americans. These inequalities represent a large and growing number of potentially avoidable premature deaths.

The 5-year survival of black men and women diagnosed with colon cancer in 2004 through 2009 had yet to reach that of white men and women diagnosed in 1990-1994. The same was true for black women diagnosed with breast cancer and black men diagnosed with rectal cancer. Across all cancers examined (with the exception of stomach cancer), black men and women tended to be diagnosed at a later stage, and their survival tended to be lower, regardless of stage.

Our supplement contains information on 10 leading cancers. Each article includes graphic representation of these disparities. And each paper highlights how clinical practice, such as improved supportive care and reduced treatment toxicity for childhood acute lymphoblastic leukemia, and improved diagnosis and treatment for ovarian cancer, may have improved survival over the study's time period. Each paper also highlights how these data can be used to inform cancer control activities, particularly those focused on the need for primary prevention and recommended cancer screening.

We may see further improvements in survival in an era of personalized cancer care and as federal and state initiatives seek to improve patient access to healthcare. These initiatives aim to ensure that all cancer patients benefit equally from gains made in improving access to high-quality care. The data contained in our supplement can help measure progress in achieving these important public health goals.

Thank you.

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