Age and case mix-standardised survival for all cancer patients in Europe 1999–2007: Results of EUROCARE-5, a population-based study
Introduction
Population-based cancer registries (CRs) began to operate in Europe from the 1940s onwards, mainly providing indicators of risk, prognosis and burden of cancer [1]. Over the years increasing numbers of CRs have run studies on survival, in evaluation service of clinical practice and of mass screening programmes, aetiological research [1] and survivorship studies [2], [3], [4]. The role of cancer registration is strongly recognised, and CRs are considered a pillar of cancer control by the World Cancer Declaration of the Union for International Cancer Control (UICC) [5] and European Commission [6], [7].
In general, clinicians tend to underuse the findings of population-based survival studies and rely more on studies of selected patient groups in randomised clinical trials or outcome studies from hospitals (or groups of hospitals) [8]. However, population-based survival data can provide essential information for administrators and policy makers. For instance, in 2000, cancer action plans were implemented in Denmark and the United Kingdom (UK) with the aim of improving cancer treatment and outcomes, following the discovery of unexpectedly poor cancer survival in these countries by the EUROCARE [8]. Cancer registry data have also been widely used for evaluations and monitoring the impact of action plans [9]. Although some countries have used cancer survival statistics to set priorities for the provision of cancer care, the economic and social implications of changes in cancer survival are not widely appreciated [8].
These considerations are especially appropriate if we consider the measure of survival for all cancers combined. Epidemiologists and clinicians acknowledge that the complex mixture of different cancer types and subtypes with different risk factors, diagnostic methods, therapies and prognosis makes it problematic to base conclusions on overall measures (incidence, survival and mortality) [10]. However, the general public, journalists, politicians and administrators often prefer summary measures (such as survival for all cancers combined) as they offer a broad picture of cancer burden and serve to evaluate the impact of cancer control plans [10]. Population-based relative survival for all cancers has been proposed as a useful indicator for monitoring cancer control across countries [11].
The present paper illustrates the results of survival analyses for all cancers combined for each country participating in EUROCARE-5 [12]. Survival data must be comparable, in order to deliver a correct benchmark across administrative borders (e.g. among countries). Cancer survival statistics are usually considered comparable if the original data are: (a) collected in a standardised way (EUROCARE-5 data originate from CRs working to standardised data collection and coding rules), (b) estimated by the same methods (the EUROCARE-5 methods are described elsewhere [12]) and (c) if the results presented are age-standardised [13]. In presenting data for all cancers combined, it is also essential to consider the differing case-mixes of cancers in different countries, and to eliminate the confounding effect if, for example, the incidence of highly lethal cancers is higher in one country than in another. Here, therefore, we present the population-based age-standardised and cancer site-standardised relative survival for all cancers combined correlating it with economic variables so to interpret any differences [11].
Section snippets
Materials and methods
EUROCARE-5 materials and methods are fully described elsewhere [12]. We shall just summarise the features used in estimating survival for all cancers combined.
Ninety-nine CRs, collecting data for adult (⩾15 years) cancer patients, contributed to the EUROCARE-5 study. For analyses of all cancers combined, 12 registries were excluded as they only gathered data for specific cancer sites [12].
We present analyses of three different datasets: (a) analysis on cancer patients diagnosed in 2000–2007 in
Results
Table 1 shows the case-mix weights applied for ACRS estimates by sex, and the range of different weights across Europe (weights are associated with the frequency with which each cancer appears in a given country cancer site distribution). Several sites showed a four-fold ratio between max and minimum. Large ranges were for male lung cancer (8% points in Sweden to 26% points in Poland), female lung cancer (3% in Malta to 15% in Scotland), female breast cancer (21% in Lithuania to 37% in
Discussion
We analysed over 7.5 million cancer cases from the European CRs participating in the EUROCARE-5 project, and conducted a comprehensive survival analysis on all cancer cases, in 29 European countries. Most of the CRs had participated in the European Network of Cancer Registries survey in 2010–2012 [1]. We focused on survival for all cancers combined and in this general indicator we did not analyse the role of different cancer sites, as survival for specific cancer sites is dealt with in other
Conclusion
The EUROCARE-5 data suggest that on a clinical level cancer survival depends on the widespread application of effective diagnosis and treatment modalities, and can be correlated with macro-economic determinants, in particular investment in the health care system. Our data, together with those of clinical registries [48], could be used by clinicians too, to engage local governments in discussions on the relevance of ACRS differences across Europe and to seek long-term effects of treatments and
Role of funding sources
The study was funded by the Compagnia di San Paolo, Fondazione Cariplo Italy, Italian Ministry of Health (Ricerca Finalizzata 2009, RF-2009-1529710) and the European Commission (European Action Against Cancer, EPAAC, Joint Action No. 20102202). The funding sources had no role in study design, data collection, analysis or interpretation, the writing of the report or the decision to submit the article for publication.
Conflict of interest statement
None declared.
Acknowledgements
Thanks to Chiara Margutti, Simone Bonfarnuzzo and Camilla Amati for their assistance.
References (48)
- et al.
Uses of cancer registries for public health and clinical research in Europe: results of the European Network of Cancer Registries survey among 161 population-based cancer registries during 2010–2012
Eur J Cancer
(2015) - et al.
Cancer rehabilitation indicators for Europe
Eur J Cancer
(2013) - et al.
Improving cancer control in the European Union: conclusions from the Lisbon round-table under the Portuguese EU Presidency, 2007
Eur J Cancer
(2008) - et al.
Comparative cancer survival information in Europe
Eur J Cancer
(2009) - et al.
The EUROCARE-5 study on cancer survival in Europe: database, quality checks and methods of statistical analysis
Eur J Cancer
(2015) - et al.
Standard cancer patient population for age standardising survival ratios
Eur J Cancer
(2004) - et al.
Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: a population-based study
Eur J Cancer
(2015) - et al.
Survival for oesophageal, stomach and small intestine cancers: results from EUROCARE-5
Eur J Cancer
(2015) - et al.
On-going improvement and persistent differences in the survival of patients with colon and rectum cancer across Europe – Results from the EUROCARE-5 study
Eur J Cancer
(2015) - et al.
Survival in patients with primary liver cancer, gallbladder and extra hepatic biliary tract cancer and pancreatic cancer in Europe 1999–2007: results of EUROCARE-5
Eur J Cancer
(2015)
Survival for skin melanoma in Europe: results of the EUROCARE-5 study
Eur J Cancer
Survival of women with cancers of breast and genital organs: results of the EUROCARE-5 study
Eur J Cancer
Survival of male genital cancers (prostate, testis and penis) in Europe: results from the EUROCARE-5 study
Eur J Cancer
Urinary tract cancer survival in Europe: results of the population-based study EUROCARE-5
Eur J Cancer
Survival of primary malignant brain tumours in adults in Europe; results of the EUROCARE-5 study
Eur J Cancer
Survival patterns in lung and pleura cancer in Europe: results from the Eurocare-5 study
Eur J Cancer
Survival variations by country and age for lymphoid and myeloid malignancies in Europe 2000–2007: results of a EUROCARE-5 population-based study
Eur J Cancer
Interpreting international comparisons of cancer survival: the effects of incomplete registration and the presence of death certificate only cases on survival estimates
Eur J Cancer
Cancer registration, public health and the reform of the European data protection framework: abandoning or improving European public health research?
Eur J Cancer
Cancer mortality in Europe, 2005–2009, and an overview of trends since 1980
Ann Oncol
Socio-economic inequalities: a review of methodological issues and the relationships with cancer survival
Crit Rev Oncol Hematol
Cancer survival in the elderly: effects of socio-economic factors and health care system features (ELDCARE project)
Eur J Cancer
Socio-economic factors and health care system characteristics related to cancer survival in the elderly. A population-based analysis in 16 European countries (ELDCARE project)
Crit Rev Oncol Hematol
European health systems and cancer care
Ann Oncol
Cited by (63)
Survival of breast cancer patients in German-Danish border regions – A registry-based cohort study
2021, Cancer EpidemiologyCenters of excellence or excellence networks: The surgical challenge and quality issues in rare cancers
2019, European Journal of Surgical OncologyRevisiting Cancer Diagnosis in Scotland: Further Insights from the Second Scottish National Cancer Diagnosis Audit
2024, European Journal of Cancer Care