Elsevier

The Lancet Oncology

Volume 8, Issue 9, September 2007, Pages 784-796
The Lancet Oncology

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Recent cancer survival in Europe: a 2000–02 period analysis of EUROCARE-4 data

https://doi.org/10.1016/S1470-2045(07)70246-2Get rights and content

Summary

Background

Traditional cancer-survival analyses provide data on cancer management at the beginning of a study period, and are often not relevant to current practice because they refer to survival of patients treated with older regimens that might no longer be used. Therefore, shortening the delay in providing survival estimates is desirable. Period analysis can estimate cancer survival by the use of recent data. We aimed to apply the period-analysis method to data that were collected by European cancer registries to estimate recent survival by country and cancer site, and to assess survival changes in Europe. We also compared our findings with data on cancer survival in the USA from the US SEER (Surveillance, Epidemiology, and End Results) programme.

Methods

We 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 as the product of interval-specific relative survival values of cohorts with different lengths of follow-up. 5-year survival profiles for patients diagnosed in 2000–02 were estimated for the European mean and for five European regions, and findings were compared with US SEER registry data for patients diagnosed in 2000–02. A 5-year survival profile for patients diagnosed in 1991–2002 and a 10-year survival profile for patients diagnosed in 1997–2002 were also estimated by the period method for all malignancies, by geographical area, and by cancer site.

Findings

For all cancers, age-adjusted 5-year period survival improved for patients diagnosed in 2000–02, especially for patients with colorectal, breast, prostate, and thyroid cancer, Hodgkin's disease, and non-Hodgkin lymphoma. The European mean age-adjusted 5-year survival calculated by the period method for 2000–02 was high for testicular cancer (97·3% [95% CI 96·4–98·2]), melanoma (86·1% [84·3–88·0]), thyroid cancer (83·2% [80·9–85·6]), Hodgkin's disease (81·4% [78·9–84·1]), female breast cancer (79·0% [78·1–80·0]), corpus uteri (78·0% [76·2–79·9]), and prostate cancer (77·5% [76·5–78·6]); and low for stomach cancer (24·9% [23·7–26·2]), chronic myeloid leukaemia (32·2% [29·0–35·7]), acute myeloid leukaemia (14·8% [13·4–16·4]), and lung cancer (10·9% [10·5–11·4]). Survival for patients diagnosed in 2000–02 was generally highest for those in northern European countries and lowest for those in eastern European countries, although, patients in eastern European had the highest improvement in survival for major cancer sites during 1991–2002 (colorectal cancer from 30·3% [28·3–32·5] to 44·7% [42·8–46·7]; breast cancer from 60% [57·2–63·0] to 73·9% [71·7–76·2]; for prostate cancer from 39·5% [35·0–44·6] to 68·0% [64·2–72·1]). For all solid tumours, with the exception of stomach, testicular, and soft-tissue cancers, survival for patients diagnosed in 2000–02 was higher in the US SEER registries than for the European mean. For haematological malignancies, data from US SEER registries and the European mean were comparable in 2000–02, except for non-Hodgkin lymphoma.

Interpretation

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 that we noted in outcomes.

Introduction

The crude annual incidence of cancer in Europe has been estimated at 338 per 100 000 population for eastern Europe and 447 per 100 000 population in western Europe.1 To measure the overall effect of the management of cancer, data on population-based survival are important. According to the EUROCARE studies,2, 3, 4, 5, 6, 7 survival varies greatly across Europe for common and rare malignancies. These variations can be explained by a number of factors, including differences in the quality of cancer-treatment facilities, in screening programmes, in evidence-based best-practice guidelines, in facilities for radiotherapy, and in access to new anticancer drugs. The results of the EUROCARE studies have encouraged governments in European Union (EU) member states to improve cancer services by increasing their organisation and investments, developing screening programmes, and providing more rapid access to state-of-the-art diagnostic facilities and treatment.8, 9

One of the limitations of long-term survival estimates derived from conventional survival analyses is that they refer to cohorts of individuals diagnosed many years before and not to patients diagnosed more recently; therefore, time trends in survival cannot be detected early (eg, the effects that earlier diagnosis or treatment might have on survival patterns). To address this limitation, period survival analysis has been used.10 Unlike traditional cohort analyses of survival, period analysis provides long-term survival estimates that also take into consideration survival of more recently diagnosed patients.

In the current study, we applied the period-analysis method to data, collected by the European cancer registries, of patients diagnosed from 1978 to 2002 to estimate recent survival by country and cancer site, and to assess survival changes in Europe. Survival 5 years after diagnosis was used as the indicator of outcome. We also compared our findings with data on cancer survival in the USA from the US SEER (Surveillance, Epidemiology, and End Results) programme.

Section snippets

Data sources and procedures

The data source for this analysis was the EUROCARE-4 study database, which includes data on the incidence of cancer and follow-up information on patients with cancer who were diagnosed from Jan 1, 1978, to Dec 31, 2002, collected by 83 cancer registries throughout Europe. This included the 47 cancer registries that had collected data in a more recent period (1996–2002) and followed patients until Dec 31, 2003 (table 1). These registries consisted of 12 national registries that had 100% national

Results

Since 2002, about 6·7 million patients from 21 countries with incident cancer, who were grouped into five geographical areas, were included in the European pool (table 1). The first year that the registries began to record incidence of cancer varied between 1978 and 1997. The percentage of invalid records was 0·1% overall and ranged from 0% to 0·9 % for individual registries. When data from the periods 1996–99 and 2000–02 were compared, the total percentage of microscopically confirmed patients

Discussion

Overall survival has improved for all cancers and for the major cancer sites. Survival for patients treated in 2000–02 was highest generally for countries in northern Europe and lowest in countries in eastern Europe—although the eastern European countries had the largest improvements.

The use of period analysis allowed us to estimate survival within a few years of diagnosis and to acquire recent estimates (ie, for 2000–02) for Europe. Consequently, survival and time trends can be interpreted in

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