COMMENTARY

What Have We Learned From The Cancer Survival Statistics?

Karol Sikora, PhD, FRCR, FRCP, FFPM

Disclosures

August 14, 2019

This transcript has been edited for clarity.

Hello, it's Professor Karol Sikora here talking about British cancer statistics. This is based on a report released this week by the Office for National Statistics in Newport, South Wales.

It looks at cancer survival in England, in adults in different stages, and in childhood cancers. And it's hot data. It's completely recent data, looking at a cohort of patients between 2013 and 2017. Looking at the 1 year survival, actual obviously, the 5 year survival, actual and partly predicted for those patients that haven't gone 5 years, and then 10 years survival, which is a predicted survival rate.

Bladder Cancer

Now, statistics can be a very dry business as we all know. Really though, it does have some uses collecting this data. It's not so much the actual statistics it’s the change. What is behind the changes? Mainly improvements in survival in cancer. And now and again, you get a surprising finding. For example, in these statistics, it looks as though for some reason, bladder cancer survival has actually fallen over the last 5 years. Why is that? The suggestion in the report is that BCG has run out. So we can't infuse bladders with BCG - that doesn't seem to be likely. I can't even think of anything that would make bladder cancer worse. We've got better imaging after all.

Anyway, let's go to the report and look at the various features.

I mean, the main point is that different cancers have different survival rates. OK, we've known that all the time. And obviously, the more advanced the stage, the poorer the survival rate. There are various confounding things that have been going on over the last decade - the introduction of PET CT, better staging, better imaging, more availability of both CT and MRI. This all means that the stage is more likely to be correct. And therefore patients with hidden advanced disease aren't being grouped with stage 1 and stage 2, and therefore dragging down the 5 year survival of patients that really haven't got stage 1 or 2, but have got stage 3 or 4, but we're just not seeing it because we haven't had in the past the diagnostic capabilities to do that.

Melanoma

The second observation is that melanoma is top of the pile. Early stage melanoma does well, and it's improved. And the reason for that is almost certainly the public education and the advent of instant clinics where you can just go along, and you're seen by often a specialist nurse, sometimes a GP that's been trained, and you go into a 2 week pathway and wide excision is carried out - the standard treatment of early melanoma. The figures we've got here are a 97% 1 year survival, and 93% 10 year survival.

Testicular Cancer & Pancreatic Cancer

The other disease, which continues to be top of the pile, is testicular cancer, where the overall survival, obviously men only, is 95% 5 year survival - the highest survival of all cancers.

Going to the other end of the prognostic spectrum, is pancreatic cancer, where survival is dismal. It has gone up a little bit. That's probably just staging issues. But the overall survival for men is 6%. and women 8%. So not really any different since I was a medical student, and not likely to change unless there are new advances.

Staging Data

The interesting thing is, good stage data is being collected. In the past, the stage data was only loosely collected by cancer registries. And it's still not great for some types of cancer. But now 85% of diagnoses over the last 5 years come with the accurate stage. And that's great because that allows you to go forward to make inter-country comparisons and so on.

To be cheered up, the great thing is that childhood cancer, which has always been good, has got even better.

And there’s increasing survival benefit now. It was 77% overall in 2001, and nearly 20 years later, it's nearly 86%. So, although that sounds a small gain - 8%, 9% - for those in that 9% gain, that's a lifetime that's been given back. So I think it's just tremendous that that's happened.

Learning Lessons

Looking through the report, what's interesting is, first of all, we can look at the wide variation in cancer survival, and wonder why. What are the biological reasons for it? Why is testicular cancer so curable? And the reason is not clear. And we like to think, well, it's due to chemotherapy, it’s due to better staging, and so on. It's due to a whole range of things, and that's the same for all cancers.

Are there lessons to be learnt? Certainly, platinum-based chemotherapy, which transformed the management of testicular cancer 30-40 years ago, has not worked for other cancers. So it's not quite as straightforward as that.

Improving the completeness of staging really helps for comparative studies.

For less common cancers, it's more difficult to get the data out.

Making Comparisons

Remember, this is only for England, it doesn't include Wales, or Northern Ireland, or Scotland. And although there are separate Data Register repositories for that, it would be nice to pool the whole lot because we are one NHS after all.

The other thing is the predicted 10 year survival and to make the comparison with other countries. That's where it all comes in. There's no doubt we're seeing an improvement in everything: 1, 5, and 10. And, as we know, the 1 year survival is pretty critical to late stage diagnosis. Patients, countries or locales that have a high 1 year survival, are likely to be picking up patients at an earlier stage.

Those that have a poor 1 year survival, that's because on the day of diagnosis, the survival is low because the cancer has already spread.

And so 1 year survival is critical for the referral pathway. Five year survival is a better average of overall oncology quality of care.

The other thing is can you really make international comparisons? The data we've got here don't allow you to do that, there's nothing there.

But this is the sort of data that can be put to the International Cancer Benchmarking Partnership, EUROCARE-5, CONCORD-3, these other studies, which are going on around Europe, and some other countries, to try and find out, not so much what the differences are, but why there are differences. That's the key. If you want to improve things, you've got to know where the good places are, where the bad places are, and see how things can be done differently to make the bad into good.

And you know, the old adage that every day there's a plane crash of cancer patients in the UK because we're behind in overall survival compared to France, Germany and Italy is there. What we're going to do about it is not so clear. My hunch is that it's all about early diagnosis and driving patients within the NHS, to the GP, to a diagnostic clinic, to get imaging.

A report's been released by Mike Richards looking at screening, which we did a video on about 3 months ago, and clearly, it's not just screening, it’s access to diagnostic testing. So a potential cancer patient is quickly, within 10 days or so, put into a box: definitely cancer, definitely not cancer, or uncertain and further tests needed. And that's got to be done within 10 working days. And until we can achieve that, it's difficult. It can take much more than 10 working days just to get an appointment with your GP as you know now. And so the interface of community care, primary care, and secondary care, together with the diagnostic access, is key to speeding up that journey and keeping lots of cancers in early stages. But I think this is a great report. It's full of minutiae of data, it's pretty dry to read, and it's got lots of numbers in it, but I do commend it to you if you're interested in cancer. It looks accurate to me and it's a good job well done.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....