New studies published online in The Lancet Oncology this week show that cancer survival in Europe is improving and the large gap between nations could be on the verge of closing. But cancer survival in the UK is below the European average and almost on a par with Eastern European countries that spend less than one third on healthcare per head than the UK.

The best performing countries reported in the studies are the Nordic countries, like Norway and Sweden, plus central European countries.

These were followed by Southern European countries, then the UK, closely followed by Eastern European countries.

The UK’s cancer “tsar”, Prof Mike Richards earlier this year said reform of the UK’s national health service’s (NHS) provision for cancer must be speeded up. In a Comment in the same issue of The Lancet Oncology he said he welcomed the news of improvements in Europe’s performance on cancer survival, but he said more lives would be saved if all countries performed as well as the best, and that the UK would do better if more emphasis were placed on earlier diagnosis.

“The poor results from the UK were attributable mainly to patients having more advanced disease at diagnosis than patients in other European countries,” said Richards.

An accompanying editorial concluded that the studies may lead to a “fundamental reassessment” of how the NHS is organized, such as divorcing it from “political control and short-term political gains”.

The two papers relate to a large European project called EUROCARE which analyses data on cancer survival from 83 registries in 23 countries. EUROCARE is the largest international population based analysis of cancer survival.

Previous EUROCARE studies were published in 1995, 1999 and 2003. These showed that cancer survival rates varied widely in Europe, for both common and rarer forms of the disease.

The first of the two studies was conducted by Franco Berrino of the Fondazione Istituto Nazionale dei Tumori, Milan, Italy, and colleagues. They examined survival data from 2.7 million adult cancer patients with 8 common, major, or potentially curable cancers (breast, colorectal, lung, melanoma, ovarian, prostate, testicular, and Hodgkin’s).

Berrino and colleagues compared the data from patients diagnosed between 1995 and 1999 with those diagnosed in 1990 to 1994. They also calculated the 5 year relative survival rate for all the cancers combined and compared them to each country’s total national expenditure on health (TNEH).

They found that the highest survival rate for ovarian cancer and the four most common cancers (colorectal, lung, breast, and prostate), was in Nordic countries (except Denmark) and central Europe. The next highest survival rate for these five cancers was in Southern Europe, then UK and Ireland, and the lowest was in Eastern Europe.

Not surprisingly, countries with higher TNEH in the most part had higher all cancer survival rates. The exceptions were the UK and Denmark, they had lower all cancer survival rates than countries with a similar TNEH. This contrasted with Finland that had a moderate national health expenditure but a high all cancer survival rate.

The good news is that in countries that in previous study results had shown a low all cancer survival rate, the rate had increased. The result is that the gap between countries appears to be closing, suggesting a significant improvement in cancer care in countries with poor survival.

However, as the authors point out, despite these improvements, differences in survival remain between European countries and regions fro individual cancers, and that:

“If all countries attained the mean survival (57 per cent) of Norway, Sweden, and Finland (countries with high survival and medium-to-high TNEH), about 12 per cent fewer cancer deaths (about 150 000) would occur in the five years after diagnosis.”

The second of the two studies in The Lancet Oncology was carried out by Arduino Verdecchia from the Istituto Superiore di Santià, Rome, Italy and colleagues. They looked at survival of cancer patients diagnosed during 2000 to 2002. They analysed the data according to country and type of cancer, looking in particular at how survival in Europe is changing and how it compares with the same period in the USA.

They found that the overall survival has improved for all the major cancers. Survival rates for cancers diagnosed in this time frame was generally highest in Northern Europe, and in Sweden in particular. The rates were lowest in Eastern Europe (the Czech Republic and Poland) but patients in this region had the largest improvement in survival rates, which means the gap between Eastern Europe and the rest of Europe is closing.

For patients diagnosed with solid tumours in 2000 to 2002, the survival rate was lower in Europe than the USA. 5 year survival for all cancers in the USA was 66.3 per cent for men and 62.9 per cent for women. These figures are significantly better than the European cancer survival rates for the same period: 47.3 per cent for men and 55.8 per cent for women.

The authors suggested a number of reasons for the disparity in survival rates between Europe and USA. Organization and training, healthcare professional skills, and use of evidence based guidelines as well as clinical factors such as tumour stage and biology were cited.

The authors said the EU had an opportunity to improve the situation:

“In the EU, the organisation of cancer services is the sole responsibility of member states. Sharing the dividends of successful national cancer plans between European policymakers, and in the long-term, developing a pan-European cancer plan could assist in the adoption of modern diagnostic and treatment facilities and the establishment of evidence-based clinical practice in all European countries.”

“Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study.”
Franco Berrino, Roberta De Angelis, Milena Sant, Stefano Rosso, Magdalena B Lasota, Jan W Coebergh and Mariano Santaquilani.
The Lancet Oncology, In Press, Corrected Proof, Available online 21 August 2007.

Click here for Abstract.

“Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data.”
Arduino Verdecchia, Silvia Francisci, Hermann Brenner, Gemma Gatta, Andrea Micheli, Lucia Mangone and Ian Kunkler.
The Lancet Oncology, In Press, Corrected Proof, Available online 21 August 2007.

Click here for Abstract.

Written by: Catharine Paddock