5.3.5 Survival data discussion

 

EUROCARE is the largest cooperative study of population-based cancer registries on patients survival in various European countries. The EUROCARE project aims at regularly monitoring, analysing, and explaining survival trends and country differences in survival. The EUROCARE-3 report presents survival data in adult in 1990–94, whilst the EUROCARE-4 presents survival data in 1995-1999 and 2000-2002. In this Section mainly macro-analysis results are presented. The results of various countries are based mostly only on regional (local) cancer registries. These can be used as proxy-older for other countries in macro-areas (i.e. Northern, Western, Southern and Eastern Europe).

 

5.3.5.1 Childhood cancer survival

 

In EUROCARE, Gatta et al (2005) analyzed survival in 129,440 children diagnosed under the age of 15 years from 1983 to 1994. Sex-and-age-adjusted 5-year survival trends for all childhood cancers combined were estimated for five regions (West Germany, the United Kingdom, Eastern Europe, Nordic countries, and West and South Europe) and Europe as a whole. Europe-wide trends for 14 childhood cancers were also estimated.

For all childhood cancers combined, 5-years survival increased from 65% for diagnoses in 1983 to 1985 to 75% in 1992 to 1994. Survival improved also for all individual childhood cancers considered. The most marked improvements (50% to 66%) occurred in Eastern Europe although still under the European average. These improvements in survival can often be possibly related to advances in treatment. Moreover, it is important to consider that the prevalence of European adults with a history of childhood cancer will inevitably increase.

 

5.3.5.2 Adult cancer survival

 

Patients diagnosed in 1990-1994

Survival for all cancers reflects the case mix by cancer site. For this reason Figures 5.3.29 show 5-year relative survival for all malignant cancers not only adjusted by age but also by cancer site. Women generally had better survival than men. Countries with 5-year relative survival higher then 40% for men and 55% for women were Northern countries (Finland, Sweden, Iceland and Norway), Austria, France, Germany, the Netherlands, Italy, Switzerland and Spain. Denmark and England had lower survival than the other countries with similar GDP both for men and women. Lower levels of survival were reported in Eastern Europe (Sant et al, 2003).

 

Figure 5.3.29a.          All cancers (ICD9 140-172, 174-208) age- and site-standardized 5-year relative survival by sex. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999 A) Men

Figure 5.3.29b.          All cancers (ICD9 140-172, 174-208) age- and site-standardized 5-year relative survival by sex. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999 B) Women

 

Countries fell into two stomach cancer survival groups both for men and women: on the one hand, most countries of Northern and Western Europe with the best prognosis, and on the other hand the UK, Denmark and Eastern European countries, i.e  those with the lowest level of prognosis (Figures 5.3.30). 5-year relative survival was higher in women than in men in most countries.

Data on survival trends (not shown) indicate that in Europe there was a moderate improvement in survival attributed to decreased post-operative mortality (Sant et al, 2003).

 

Figure 5.3.30a. Stomach cancer (ICD9 151) age-standardized 5-year relative survival by sex. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999 A) Men

Figure 5.3.30b. Stomach cancer (ICD9 151) age-standardized 5-year relative survival by sex. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999 B) Women

 

5-year colorectal cancer relative survival (Figures 5.3.31) was over than 48% for men and 50% for women in Finland, Norway and Sweden and in most Western European countries (France, Germany, Italy, Switzerland, the Netherlands and Spain); but was lower - between 25 and 35% - in Eastern Europe (Estonia, Poland, Slovakia and Slovenia) both for men and women. Survival in the UK and Denmark was intermediate at around 45%.

Data on survival trends (not shown) indicate that in Europe 5-year relative survival for colorectal cancer increased from 44% in the period 1986-1989 to 52% in 1992-1994, improving equally for men and women, younger and older patients, and rectal and colon cancer sites (Sant et al, 2003).

 

Figure 5.3.31a.          Colorectal cancer (ICD9 153,154) age-standardized 5-year relative survival by sex. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999 A) Men

Figure 5.3.31b.          Colorectal cancer (ICD9 153,154) age-standardized 5-year relative survival by sex. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999 B) Women

 

Survival for lung cancer patients remains poor, with age-adjusted 5-year relative survival ~10% in men and women (Figures 5.3.32). Estimates of 1-year relative survival are ~30% for both sexes (data not shown). Data on survival trends (not shown) indicate that in Europe there was a modest tendency of lung cancer survival improvement in time. 5-year age-adjusted relative survival for the entire Europe increased from 7.5% in men diagnosed in 1983–1985 to 9.2% in 1992–1994 and from 8.1% to 9.8% in women (Sant et al, 2003).

 

Figure 5.3.32a.          Lung cancer (ICD9 162) age-standardized 5-year relative survival by sex. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999 A) Men

Figure 5.3.32b.          Lung cancer (ICD9 162) age-standardized 5-year relative survival by sex. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999 B) Women

 

The prognosis for breast cancer is relatively good, with 5-year relative survival (Figure 5.3.33) exceeding 75% in most countries of Western Europe. In Finland, Sweden, France, Italy and Switzerland survival was ≥80%. England, Scotland, Wales, Denmark, Malta and Portugal had 5-year age-standardised survival just above 70%. Particularly low breast cancer survival was seen in Eastern Europe (Estonia, Poland, Slovakia and Slovenia) with 5-year relative survival rate between 60 and 67% (Sant et al, 2003).

Relative survival for breast cancer improved steadily in all European countries, but at different rates (data not showed). Improvements were more marked for Western Europe than in the Nordic countries, where survival rates were already high for patients diagnosed in the 1980s. As a result, the range of breast cancer survival rates between the Nordic countries and Western Europe has greatly reduced. There is some evidence of a more rapid improvement in survival in the UK, with a gradual reduction of the survival deficit relative to other Western European countries. Conversely, improvements in survival were less evident in Eastern European countries; actually , the gap between Eastern and Western European countries has increased (Coleman et al, 2003).

 

Figure 5.3.33. Female breast cancer (ICD9 174) age-standardized 5-year relative survival. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999

 

5-year relative survival for cervical cancer was lower in Poland (48%) and higher in Sweden (70%) (Figure 5.3.34) (Sant et al, 2003). Survival has improved steadily in most countries, but not in Eastern European countries, where it has remained low (data not showed). Even though the survival of women with cervical cancer in Northern and Western European countries with effective cervical screening programmes tends to reflect the more aggressive cancers for which screening has failed, survival in these countries is still higher than in Eastern European countries where there are no organised cervical screening programmes. This suggests differences in the availability of effective treatment (Coleman et al, 2003).

 

Figure 5.3.34.            Cervical cancer (ICD9 180) age-standardized 5-year relative survival. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999

 

EUROCARE-3 found that the overall European relative survival for prostate cancer 5 years after diagnosis stood at 67% (Figure 5.3.35). 5-year relative survival rates for prostate cancer differed greatly from one country to another . Austria, France, Germany and Iceland had the highest survival (≥75%), while the Czech Republic, Denmark, England, Estonia, Malta, Poland, Portugal, Scotland, Slovakia, Slovenia and Wales had particularly low survival (<55%) (Sant et al, 2003). European 5-year relative survival increased from 55% in the period 1983–1985 to 68% in 1992–1994. Increased survival with time was observed in most countries (data not showed). The main exceptions were Denmark, where estimates remained at the low level of ~42% for the entire period, and Poland and Slovakia where survival actually decreased. Exceptional increases in 5-year relative survival for prostate cancer were seen in Estonia (from 33% to 57%) and Italy (from 43% to 68%). The low survival in Denmark and the UK occurred in the context of relatively low incidence levels, whereas the European countries with the highest survival had high incidence levels (Sant et al, 2003; Coleman et al, 2003).

 

Figure 5.3.35.            Prostate cancer (ICD9 185) age-standardized 5-year relative survival. Patients diagnosed between 1990 and 1994 and followed up to 31st December 1999

 

Patients diagnosed in 1995-1999

Berrino et al (2007) analysed data from 83 cancer registries in 23 European countries on 2 699 086 adult cancer cases that were diagnosed in 1995–99 and followed up to December, 2003.

Age-adjusted 5-year relative survival for colorectal (European mean: 54%), lung (European mean: 12%), breast (European mean: 79%), prostate (European mean: 76%) cancer was higher in Nordic countries (except Denmark) and central Europe, intermediate in Southern Europe, lower in the UK and Denmark, and worse in Eastern Europe. All-cancer survival correlated with total national expenditure on health (TNEH) for most countries. Denmark and UK had lower all-cancer survival than countries with similar TNEH; Finland had high all-cancer survival, but moderate TNEH. Data for 1990–94 and 1995–99 showed a survival increase for colorectal and breast cancers.

Increases in survival and decreases in geographic differences over time, which are mainly due to improvements in health-care services in countries with poor survival, might indicate better cancer care. Wealthy countries with high TNEH generally had good cancer outcomes, but those with conspicuously worse outcomes than those with similar TNEH might not be efficiently allocating their health resources.

 

Patients diagnosed in 2000-2002

Verdecchia et al (2007) analysed survival data for patients diagnosed with cancer in 2000–02, collected from 47 of the European cancer registries participating in the EUROCARE-4 study. 5-year period relative survival for patients diagnosed in 2000–02 was estimated.

For all cancers, age-adjusted 5-year period survival improved for patients diagnosed in 2000–02, especially for patients with colorectal, breast, prostate cancers. The European mean 5-year relative survival was 79% for female breast cancer, 25% for stomach cancer and 11% for lung cancer. Survival for patients diagnosed in 2000–02 was generally higher in Northern European countries and lower in Eastern European countries, although, patients in Eastern Europe had the highest improvement in survival for major cancer sites during 1991–2002 (colorectal cancer passed from 30% to 45%; breast cancer from 60% to 74%; prostate cancer from 40% to 68%).

Cancer-service infrastructure, prevention and screening programmes, access to diagnostic and treatment facilities, tumour-site-specific protocols, multidisciplinary management, application of evidence-based clinical guidelines, and recruitment to clinical trials probably account for most of the differences noticed in outcomes.