Original ResearchIs low survival for cancer in Eastern Europe due principally to late stage at diagnosis?
Introduction
EUROCARE, the continuing population-based investigation of European cancer survival, found that the well-known between-country differences in 5-year relative survival (RS) persisted for patients diagnosed in 2000–2007 [1], [2], latest period for which data are available. Survival was confirmed as low for Eastern European and UK/Ireland patients and high for Northern and Central European patients. Differences in cancer biology, intensity of screening, extent of diagnostic workup, quality of care, and organisation of care delivery contribute to these inequalities [1], but stage at diagnosis is also important [3], as shown by analyses of the influence of diagnostic work-up, stage, and treatments on survival in random samples of cancer registry (CR) cases (collecting clinical data on all cases is too resource-intensive) [4], [5], [6].
The present retrospective observational study provides the first Europe-wide population-based estimates of stage distribution at diagnosis and stage-specific RS for selected cancers and CRs, for which the stage information sent to EUROCARE-5 was considered to be of sufficiently high quality.
Section snippets
Materials and methods
The EUROCARE-5 protocol [7] asked CRs to send data—specifically including stage at diagnosis, on adult (≥15 years) patients diagnosed with 15 types of cancer in 2000–2007 and followed to the end of 2008.
Although stage is an essential element of CR data [8], not all European CRs collect it, and many experience difficulties in accessing and coding it [9], [10]. The protocol therefore requested stage be provided in one or more of 3 forms [7]: TNM (most detailed), condensed TNM, and (summary)
Results
Over 900,000 primary invasive cancers were analysed (Table 1): 39% breast, 22% colon, 18% lung, 11% rectum, 5% stomach, and 2% each for thyroid and melanoma. Patients with lung, colon, rectum and stomach cancers were generally older than those with the other cancers (26–40% versus 9–20% ≥ 75 years; 10–15% versus 33–55% < 55 years). Age distribution varied somewhere between regions, with Eastern European patients tending to be younger. For cancers of rectum, stomach, and lung, >55% of cases were
Discussion
Our main findings are that Eastern European cancer patients were not only diagnosed at a more advanced stage than patients in other parts of Europe but also had worse stage-specific RS, and a greater RER of cancer death (except lung cancer death) than European cancer patients in general, even after adjusting for age, sex and stage. Worse stage-specific RS combined with greater risk of cancer death strongly suggests less effective care as a major cause of poorer outcomes in Eastern Europe.
‘Less
Funding
This work was supported by the Compagnia di San Paolo, the Cariplo Foundation, the European Commission [grant number 20102202, European Action Against Cancer, EPAAC Joint Action], and the Italian Ministry of Health [grant number 1529710, Ricerca Finalizzata 2009, RF-2009].
Role of funding sources
The funding sources had no role in study design, the collection, analysis or interpretation of data, the writing of the report or the decision to submit the article for publication.
Conflict of interest statement
None declared.
Acknowledgements
The authors thank Chiara Margutti and Simone Bonfarnuzzo for their assistance, and Don Ward for help with the English.
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