EUROCARE-5 reveals cancer survival trends

Results show 5-year adult and childhood cancer survival rates across Europe for 2000 to 2007

medwireNews: Results from EUROCARE-5 show that survival from both adult and childhood cancers has increased in European patients in recent years.

But the findings, published in The Lancet Oncology, also show a significant discrepancy in survival rates between European regions, as well as significant variation in survival trends between tumour types.

The adult study used data from over 10 million patients included in 107 registries of 29 countries in northern, central, southern and eastern Europe, and UK and Ireland, who were diagnosed between 2000 and 2007, and followed up until 2008.

The greatest increases in 5-year survival from 1999–2001 to 2005–2007 were for prostate cancer (73.4 to 81.7%), non-Hodgkin lymphoma (NHL, 53.8 to 60.4%), rectal cancer (52.1 to 57.6%), report Roberta De Angelis, from the Istituto Superiore di Sanità in Rome, Italy, and co-authors.

“The most likely reasons for improved survival for NHL and rectal cancer are more effective drugs and better surgical techniques, whilst earlier diagnosis, as well as detection of indolent cancers and over-diagnosis, owing to the increasing use of prostate-specific Antigen… testing, explains the dramatic increase in numbers of patients surviving prostate cancer,” commented Roberta De Angelis in a press release.

The disparity in survival between patients in Bulgaria, Estonia, Latvia, Lithuania, Poland, and Slovakia versus those living in the Nordic, central and southern European countries with the best survival rates narrowed for some diagnoses, such as breast cancer. Nevertheless, survival rates remained below average in eastern Europe, especially for tumours with good or intermediate prognoses.

Patients in the UK and Ireland had intermediate survival rates for breast, prostate, and rectal cancers, skin melanoma, and NHL, but, of concern, lower than average survival for cancers affecting the lung, colon, ovaries, kidneys, and stomach.

Meanwhile, a second study reporting EUROCARE-5 data for 59,579 children showed that overall 5- year survival for all cancer had increased significantly, from 76.1% for children diagnosed in 1999–2001 to 79.1% for those diagnosed in 2005–2007.

Although eastern Europe had the greatest improvement in the overall 5-year survival rate over this period, from 65.2% to 70.2%, the rate remained the lowest in Europe and showed significant disparity with the highest rate of 82.1% found in southern Europe, say Gemma Gatta of the Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy and co-authors.

Five-year survival improved for some childhood malignancies, including leukaemia and NHL, but was not significantly changed for other diseases, such as Wilm’s tumour, Ewing’s sarcoma, or central nervous system tumours.

The authors of the two reports suggest that lack of healthcare resources, delayed diagnosis, treatment choices, and drug supply may contribute to poor outcomes for adults and children, and hypothesise that cross-border care and collaborative programmes could reduce regional disparities.

In an accompanying comment, however, Alastair Munro, from the University of Dundee in the UK, notes that interpretation of EUROCARE data is hampered by limitations such as the absence of national cancer registries in some countries and the inability to determine the impact of migration.

“Registries should record more sociodemographic information and more details about investigation, staging, treatment, recurrences, and second-line treatment,” he recommends.

“Investigators should actively seek information about long-term consequences of treatment and precise information about causes of death.”

References

De Angelis R, Sant M, Coleman M, et al. Cancer survival in Europe 1999—2007 by country and age: results of EUROCARE-5—a population-based study. Lancet Oncol, Early Online Publication, 5 December 2013. doi:10.1016/S1470-2045(13)70546-1

Gatta G, Botta G, Rossi S, et al. Childhood cancer survival in Europe 1999—2007: results of EUROCARE-5—a population-based study. Lancet Oncol, Early Online Publication, 5 December 2013. doi:10.1016/S1470-2045(13)70548-5.

Munro AJ. Interpretation of EUROCARE-5. Lancet Oncol, Early Online Publication, 5 December 2013. doi:10.1016/S1470-2045(13)70566-7

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