Survival of European adolescents and young adults diagnosed with cancer in 2010-2014

BACKGROUND

We used the comprehensive definition of AYA (age 15 to 39 years) to update 5-year relative survival (RS) estimates for AYAs in Europe and across countries and to evaluate improvements in survival over time.

METHODS

We used data from EUROCARE-6. We analysed 700,000 AYAs with cancer diagnosed in 2000-2013 (follow-up to 2014). We focused the analyses on the 12 most common cancers in AYA. We used period analysis to estimate 5-year RS in Europe and 5-year RS differences in 29 countries (2010-2014 period estimate) and over time (2004-06 vs. 2010-14 period estimates).

FINDINGS

5-year RS for all AYA tumours was 84%, ranging from 70% to 90% for most of the 12 tumours analysed. The exceptions were acute lymphoblastic leukaemia, acute myeloid leukaemia, and central nervous system tumours, presenting survival of 59%, 61%, and 62%, respectively. Differences in survival were observed among European countries for all cancers, except thyroid cancers and ovarian germ-cell tumours. Survival improved over time for most cancers in the 15- to 39-year-old age group, but for fewer cancers in adolescents and 20- to 29-year-olds.

INTERPRETATION

This is the most comprehensive study to report the survival of 12 cancers in AYAs in 29 European countries. We showed variability in survival among countries most likely due to differences in stage at diagnosis, access to treatment, and lack of referral to expert centres. Survival has improved especially for haematological cancers. Further efforts are needed to improve survival for other cancers as well, especially in adolescents.

Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

Survival in men diagnosed with prostate cancer in Poland in the years 2000 - 2014 compared to European Countries based on Concord-3

Background

Wealthy countries have observed in recent decades a fast-growing number of prostate patients, who require treatment and long-term cancer care. This trend seems to be connected with some demographic changes such as aging societies, better access to diagnostic methods with high sensitivity as well as large-scale secondary prevention (prostate cancer screening at early stage before clinical manifestation). Secondary prevention is becoming more accessible and widely applied. The expected effect of prevention is to improve overall survival while the mortality trend is decreasing. The prevention success requires highly effective healthcare system that must manage additional burden which is a consequence of the need to provide optimal treatment and healthcare in a big group of cancer patients diagnosed in effective prevention programms. According to the National Cancer Registry (NCR) the number of incidence from year 1980 - 1731 cases rose in year 2013 to 12 162 cases. Apart from incidence and mortality rates, the 5-year survival is a significant factor for the assessment of a population healthcare and healthcare system efficiency. The prognosis related to prostate incidence is 22 344 men in year 2025 in comparison to 12 162 in year 2013 - that would be a double rise in incidence. CONCORD-2 results (years 1995-2009) showed, among the others, that cancer curability for some cancers, including prostate cancer improved. In year 2018 the results of CONCORD-3 were published (years 2000-2014) showing a rising trend in improvement in prostate cancer curability in Poland.

Objective

The objective was to analyse the 5-year survival in prostate cancer patients in Poland, and in each of 16 voivodships, with the focus on changes in years 2000 - 2014 in comparison to European trends.

Material and Methods

The analysis was based on the 5-year net survival (estimated in CONCORD-3) in prostate cancer patients diagnosed in Poland (NCR national data) and in all Polish voivodships. The 5-year survival of prostate cancer patients and its changes in years 2000 - 2014 compared between 16 voivodships, Poland in total and 28 European countries.

Results

In Poland in years 2010 - 2014 the 5-year survival in prostate cancer patients was 78.1%, and compared to years 2000 - 2004 rose by 9.3 percentage points. Despite a systematic improvement in survival the differences between individual voivodships in Poland remained. In 6 voivodships the survival was higher than average for Poland and ranged from 80 to 82%. The lowest survival was in Opolskie voivodship - 72.3%. On a European scale, the curability of prostate cancer at that time was over 90% (9 countries), while Poland was among 5 countries whose total survival rate was less than 80% (from 72.3% - Opolskie voivodship to 83.6% -- Pomeranian voivodship).

Conclusions

The 5-year survival in prostate cancer patients in years 2010 - 2014 in Poland was significantly lower in comparison to Western Europe countries, and favourable trends on a regional level in Poland were too slow to overcome high differentiation in Europe. It is expected that changing the structure and organisation of cancer care in Poland into a modern National Oncology Network Comprehensive Cancer Care Network, together with the use of the experiences from European projects, including iPAAC and better financing will contribute to improvement in prostate cancer treatment in Poland.

Comorbidities, timing of treatments, and chemotherapy use influence outcomes in stage III colon cancer: A population-based European study

INTRODUCTION

For stage III colon cancer (CC), surgery followed by chemotherapy is the main curative approach, although optimum times between diagnosis and surgery, and surgery and chemotherapy, have not been established.

MATERIALS AND METHODS

We analysed a population-based sample of 1912 stage III CC cases diagnosed in eight European countries in 2009-2013 aiming to estimate: (i) odds of receiving postoperative chemotherapy, overall and within eight weeks of surgery; (ii) risks of death/relapse, according to treatment, Charlson Comorbidity Index, time from diagnosis to surgery for emergency and elective cases, and time from surgery to chemotherapy; and (iii) time-trends in chemotherapy use.

RESULTS

Overall, 97% of cases received surgery and 65% postoperative chemotherapy, with 71% of these receiving chemotherapy within eight weeks of surgery. Risks of death and relapse were higher for cases starting chemotherapy with delay, but better than for cases not given chemotherapy. Fewer patients with high comorbidities received chemotherapy than those with low (P < 0.001). Chemotherapy timing did not vary (P = 0.250) between high and low comorbidity cases. Electively-operated cases with low comorbidities received surgery more promptly than high comorbidity cases. Risks of death and relapse were lower for elective cases given surgery after four weeks than cases given surgery within a week. High comorbidities were always independently associated with poorer outcomes. Chemotherapy use increased over time.

CONCLUSIONS

Our data indicate that promptly-administered postoperative chemotherapy maximizes its benefit, and that careful assessment of comorbidities is important before treatment. The survival benefit associated with slightly delayed elective surgery deserves further investigation.

Reasons for low cervical cancer survival in new accession European Union countries: a EUROCARE-5 study

PURPOSE

With better access to early diagnosis and appropriate treatment, cervical cancer (CC) burden decreased in several European countries. In Eastern European (EE) countries, which accessed European Union in 2004, CC survival was worse than in the rest of Europe. The present study investigates CC survival differences across five European regions, considering stage at diagnosis (local, regional and metastatic), morphology (mainly squamous versus glandular tumours) and patients' age.

METHODS

We analysed 101,714 CC women diagnosed in 2000-2007 and followed-up to December 2008. Age-standardised 5-year relative survival (RS) and the excess risks of cancer death in the 5 years after diagnosis were computed.

RESULTS

EE women were older and less commonly diagnosed with glandular tumours. Proportions of local stage cancers were similar across Europe, while morphology- and stage-specific RS (especially for non-metastatic disease) were lower in Eastern Europe. Adjusting for age and morphology, excess risk of local stage CC death for EE patients remained higher than that for other European women.

CONCLUSION

Stage, age and morphology alone do not explain worse survival in Eastern Europe: less effective care may play a role, probably partly due to fewer or inadequate resources being allocated to health care in this area, compared to the rest of Europe.

Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer

Survival for breast cancer (BC) is lower in eastern than northern/central Europe, and in older than younger women. We analysed how comorbidities at diagnosis affected whether selected standard treatments (STs) were given, across Europe and over time, also assessing consequences for survival/relapse. We analysed 7581 stage I/IIA cases diagnosed in 9 European countries in 2009-2013, and 4 STs: surgery; breast-conserving surgery plus radiotherapy (BCS + RT); reconstruction after mastectomy; and prompt treatment (≤6 weeks after diagnosis). Covariate-adjusted models estimated odds of receiving STs and risks of death/relapse, according to comorbidities. Pearson's R assessed correlations between odds and risks. The z-test assessed the significance of time-trends. Most women received surgery: 72% BCS; 24% mastectomy. Mastectomied patients were older with more comorbidities than BCS patients (p < 0.001). Women given breast reconstruction (25% of mastectomies) were younger with fewer comorbidities than those without reconstruction (p < 0.001). Women treated promptly (45%) were younger than those treated later (p = 0.001), and more often without comorbidities (p < 0.001). Receiving surgery/BCS + RT correlated strongly (R = -0.9), but prompt treatment weakly (R = -0.01/-0.02), with reduced death/relapse risks. The proportion receiving BCS + RT increased significantly (p < 0.001) with time in most countries. This appears to be the first analysis of the influence of comorbidities on receiving STs, and of consequences for outcomes. Increase in BCS + RT with time is encouraging. Although women without comorbidities usually received STs, elderly patients often received non-standard less prompt treatments, irrespective of comorbidities, with increased risk of mortality/relapse. All women, particularly the elderly, should receive ST wherever possible to maximise the benefits of modern evidence-based treatments.

Analysis of changes in cancer health care system in Poland since the socio-economic transformation in 1989

BACKGROUND

The transformation period in Poland is associated with a set of factors seen as ‘socio-economic stress’, which unfavourably influenced cancer treatment and slowed down the progress of the Polish cancer care in the 90’s. These outcomes in many aspects of cancer care may be experienced till today. The results of the international EUROCARE and CONCORD studies based on European data prove evidence that there is a substantial potential for improvement of low 5-year survival rates in Poland. Since high survivals are related to notably efficient health care system, therefore, to improve organization and treatment methods seems to be one of the most important directions of change in the Polish health care system. Till today, cancer care in Poland is based on a network outlined by Professor Koszarowski in the middle of the last century, and is a solid foundation for the contemporary project of the Comprehensive Cancer Care Network (CCCN) proposed in the frame of CanCon Project.

OBJECTIVE

Analysis of the structure of health care system and the changes introduced within the network of oncology in Poland since the beginning of the post-commuinist socio-economic transformation in 1989.

MATERIALS AND METHODS

This study was conducted based on the CanCon methods aimed at reviewing specialist literature and collecting meaningful experiences of European countries in cancer care, including the main legal regulations.

RESULTS

The analysis provided evidence that the political situation and the economic crisis of the Transformation period disintegrated the cancer care and resulted in low 5-year survival rates. A step forward in increasing efficiency of the cancer treatment care was a proposal of the ’Quick Oncological Therapy’ together with one more attempt to organize a CCCN. With this paper the Authors contribute to the CanCon Project by exploration, analysis and discussion of the cancer network in Poland as an example of existing net-like structures in Europe as well as by preparation of guidelines for constructing a contemporary CCCN.

CONCLUSIONS

(1) ‘Socio-economic’ stress adversely affected the efficiency of oncological treatment, both by reducing safety and slowing down the development of modern oncology. (2) Changing the current system into the contemporary form - CCCN could be an important step forward to optimise the oncological health care in Poland. (3) Introduction of the mandatory monitoring of organizational changes with the use of health standardized indicators could allow for the assessment of the effectiveness of implemented solutions and their impact on better prognosis for cancer patients. (4) Optimising the organization of the health care system is possible only by implementing necessary legislative corrections.

Survival of women with cancers of breast and genital organs in Europe 1999-2007: Results of the EUROCARE-5 study

BACKGROUND

Survival differences across Europe for patients with cancers of breast, uterus, cervix, ovary, vagina and vulva have been documented by previous EUROCARE studies. In the present EUROCARE-5 study we update survival estimates and investigate changes in country-specific and over time survival, discussing their relationship with incidence and mortality dynamics for cancers for which organised screening programs are ongoing.

METHODS

We analysed cases archived in over 80 population-based cancer registries in 29 countries grouped into five European regions. We used the cohort approach to estimate 5-year relative survival (RS) for adult (⩾15years) women diagnosed 2000-2007, by age, country and region; and the period approach to estimate time trends (1999-2007) in RS for breast and cervical cancers.

RESULTS

In 2000-2007, 5-year RS was 57% overall, 82% for women diagnosed with breast, 76% with corpus uteri, 62% with cervical, 38% with ovarian, 40% with vaginal and 62% with vulvar cancer. Survival was low for patients resident in Eastern Europe (34% ovary-74% breast) and Ireland and the United Kingdom [Ireland/UK] (31-79%) and high for those resident in Northern Europe (41-85%) except Denmark. Survival decreased with advancing age: markedly for women with ovarian (71% 15-44years; 20% ⩾75years) and breast (86%; 72%) cancers. Survival for patients with breast and cervical cancers increased from 1999-2001 to 2005-2007, remarkably for those resident in countries with initially low survival.

CONCLUSIONS

Despite increases over time, survival for women's cancers remained poor in Eastern Europe, likely due to advanced stage at diagnosis and/or suboptimum access to adequate care. Low survival for women living in Ireland/UK and Denmark could indicate late detection, possibly related also to referral delay. Poor survival for ovarian cancer across the continent and over time suggests the need for a major research effort to improve prognosis for this common cancer.

Survival in patients with primary liver cancer, gallbladder and extrahepatic biliary tract cancer and pancreatic cancer in Europe 1999-2007: Results of EUROCARE-5

BACKGROUND

The EUROCARE study collects and analyses survival data from population-based cancer registries (CRs) in Europe in order to provide data on between-country differences in survival and time trends in survival.

METHODS

This study analyses data on liver cancer, gallbladder and extrahepatic biliary tract cancers ("biliary tract cancers"), and pancreatic cancer diagnosed in 2000-2007 from 88 CRs in 29 countries. Relative survival (RS) was estimated overall, by region, sex, age and period of diagnosis using the complete approach. Time trends in 5-year RS over 1999-2007 were also analysed using the period approach.

RESULTS

The prognosis of the studied cancers was poor. Age-standardised 5-year RS was 12% for liver cancer, 17% for biliary tract cancers and 7% for pancreatic cancer. There were some between-country differences in survival. In general, RS was low in Eastern Europe and high in Central and Southern Europe. For all sites, 5-year RS was similar in men and women and decreased with advancing age. No substantial changes in survival were reported for pancreatic cancer over the period 1999-2007. On average, there was a crude increase in 5-year RS of 3 percentage points between the periods 1999-2001 and 2005-2007 for liver cancer and biliary tract cancers.

CONCLUSIONS

The major changes in imaging techniques over the study period for the diagnosis of the three studied cancers did not result in an improvement in the prognosis of these cancers. In the near future, new innovative treatments might be the best way to improve the prognosis in these cancers.

Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND

Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control.

METHODS

Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights.

FINDINGS

5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease.

INTERPRETATION

International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems.

FUNDING

Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).

Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE--5-a population-based study

BACKGROUND

Cancer survival is a key measure of the effectiveness of health-care systems. EUROCARE-the largest cooperative study of population-based cancer survival in Europe-has shown persistent differences between countries for cancer survival, although in general, cancer survival is improving. Major changes in cancer diagnosis, treatment, and rehabilitation occurred in the early 2000s. EUROCARE-5 assesses their effect on cancer survival in 29 European countries.

METHODS

In this retrospective observational study, we analysed data from 107 cancer registries for more than 10 million patients with cancer diagnosed up to 2007 and followed up to 2008. Uniform quality control procedures were applied to all datasets. For patients diagnosed 2000-07, we calculated 5-year relative survival for 46 cancers weighted by age and country. We also calculated country-specific and age-specific survival for ten common cancers, together with survival differences between time periods (for 1999-2001, 2002-04, and 2005-07).

FINDINGS

5-year relative survival generally increased steadily over time for all European regions. The largest increases from 1999-2001 to 2005-07 were for prostate cancer (73.4% [95% CI 72.9-73.9] vs 81.7% [81.3-82.1]), non-Hodgkin lymphoma (53.8% [53.3-54.4] vs 60.4% [60.0-60.9]), and rectal cancer (52.1% [51.6-52.6] vs 57.6% [57.1-58.1]). Survival in eastern Europe was generally low and below the European mean, particularly for cancers with good or intermediate prognosis. Survival was highest for northern, central, and southern Europe. Survival in the UK and Ireland was intermediate for rectal cancer, breast cancer, prostate cancer, skin melanoma, and non-Hodgkin lymphoma, but low for kidney, stomach, ovarian, colon, and lung cancers. Survival for lung cancer in the UK and Ireland was much lower than for other regions for all periods, although results for lung cancer in some regions (central and eastern Europe) might be affected by overestimation. Survival usually decreased with age, although to different degrees depending on region and cancer type.

INTERPRETATION

The major advances in cancer management that occurred up to 2007 seem to have resulted in improved survival in Europe. Likely explanations of differences in survival between countries include: differences in stage at diagnosis and accessibility to good care, different diagnostic intensity and screening approaches, and differences in cancer biology. Variations in socioeconomic, lifestyle, and general health between populations might also have a role. Further studies are needed to fully interpret these findings and how to remedy disparities.

FUNDING

Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation, Cariplo Foundation.

Childhood cancer survival in Europe 1999-2007: results of EUROCARE-5--a population-based study

BACKGROUND

Survival and cure rates for childhood cancers in Europe have greatly improved over the past 40 years and are mostly good, although not in all European countries. The EUROCARE-5 survival study estimates survival of children diagnosed with cancer between 2000 and 2007, assesses whether survival differences among European countries have changed, and investigates changes from 1999 to 2007.

METHODS

We analysed survival data for 157,499 children (age 0-14 years) diagnosed between Jan 1, 1978 and Dec 31, 2007. They came from 74 population-based cancer registries in 29 countries. We calculated observed, country-weighted 1-year, 3-year, and 5-year survival for major cancers and all cancers combined. For comparison between countries, we used the corrected group prognosis method to provide survival probabilities adjusted for multiple confounders (sex, age, period of diagnosis, and, for all cancers combined without CNS cancers, casemix). Age-adjusted survival differences by area and calendar period were calculated with period analysis and were given for all cancers combined and the major cancers.

FINDINGS

We analysed 59,579 cases. For all cancers combined for children diagnosed in 2000-07, 1-year survival was 90.6% (95% CI 90.2-90.9), 3-year survival was 81.0 % (95% CI 80.5-81.4), and 5-year survival was 77.9% (95% CI 77.4-78.3). For all cancers combined, 5-year survival rose from 76.1% (74.4-77.7) for 1999-2001, to 79.1% (77.3-80.7) for 2005-07 (hazard ratio 0.973, 95% CI 0.965-0.982, p<0.0001). The greatest improvements were in eastern Europe, where 5-year survival rose from 65.2% (95% CI 63.1-67.3) in 1999-2001, to 70.2% (67.9-72.3) in 2005-07. Europe-wide average yearly change in mortality (hazard ratio) was 0.939 (95% CI 0.919-0.960) for acute lymphoid leukaemia, 0.959 (0.933-0.986) for acute myeloid leukaemia, and 0.940 (0.897-0.984) for non-Hodgkin lymphoma. Mortality for all of Europe did not change significantly for Hodgkin's lymphoma, Burkitt's lymphoma, CNS tumours, neuroblastoma, Wilms' tumour, Ewing's sarcoma, osteosarcoma, and rhabdomyosarcoma. Disparities for 5-year survival persisted between countries and regions, ranging from 70% to 82% (for 2005-07).

INTERPRETATION

Several reasons might explain persisting inequalities. The lack of health-care resources is probably most important, especially in some eastern European countries with limited drug supply, lack of specialised centres with multidisciplinary teams, delayed diagnosis and treatment, poor management of treatment, and drug toxicity. In the short term, cross-border care and collaborative programmes could help to narrow the survival gaps in Europe.

FUNDING

Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation.

Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study

OBJECTIVES

To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe.

DESIGN

A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis.

SETTING AND PARTICIPANTS

21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998.

OUTCOME MEASURES

Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models.

RESULTS

The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours.

CONCLUSIONS

The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.

Breast cancer survival in the US and Europe: a CONCORD high-resolution study

Breast cancer survival is reportedly higher in the US than in Europe. The first worldwide study (CONCORD) found wide international differences in age-standardized survival. The aim of this study is to explain these survival differences. Population-based data on stage at diagnosis, diagnostic procedures, treatment and follow-up were collected for about 20,000 women diagnosed with breast cancer aged 15-99 years during 1996-98 in 7 US states and 12 European countries. Age-standardized net survival and the excess hazard of death up to 5 years after diagnosis were estimated by jurisdiction (registry, country, European region), age and stage with flexible parametric models. Breast cancers were generally less advanced in the US than in Europe. Stage also varied less between US states than between European jurisdictions. Early, node-negative tumors were more frequent in the US (39%) than in Europe (32%), while locally advanced tumors were twice as frequent in Europe (8%), and metastatic tumors of similar frequency (5-6%). Net survival in Northern, Western and Southern Europe (81-84%) was similar to that in the US (84%), but lower in Eastern Europe (69%). For the first 3 years after diagnosis the mean excess hazard was higher in Eastern Europe than elsewhere: the difference was most marked for women aged 70-99 years, and mainly confined to women with locally advanced or metastatic tumors. Differences in breast cancer survival between Europe and the US in the late 1990s were mainly explained by lower survival in Eastern Europe, where low healthcare expenditure may have constrained the quality of treatment.

Premature mortality due to cancer in Swietokrzyskie Province (Poland) in 1999-2010

THE PURPOSE OF THE STUDY

The purpose of the study was to analyze the level and the trends of premature mortality caused by selected cancers in Swietokrzyskie Province in years 1999-2010.

MATERIAL AND METHODS

The material for the study was the data published in the Swietokrzyskie Cancer Registry on the number of deaths caused by cancers as well as the information from the Central Statistical Office on the number of deaths due to general death causes in Swietokrzyskie Province in years 1999-2010. The premature mortality analysis was conducted with the use of PYLL indicator (PYLL - potential years of life lost). PYLL rate was calculated according to the method proposed by J. Romeder, according to which the premature mortality was defined as death before the age of 70. Time trends of PYLL rate and the average annual percent change (APC - annual percent change) were assessed usingjointpoint models as well as the Jointpoint Regression Program (Version 4.0.1 - January 2013).

RESULTS

In year 2010 cancers were responsible for 18.3% of PYLL in men and 48.1% in women. In years 1999-2010 PYLL rate in men decreased due to lung cancer (APC=0.75%) and stomach cancer (APC=1.2%). The increase in rate of PYLL was noted for colorectal cancer (APC=3.3%, p<0.05) and prostate cancer (APC=1.6%). In women, rate of PYLL increased due to lung cancer (APC=6.2%, p<0.05), colorectal cancer (APC=2.9%), breast cancer (APC=1.8%) and ovarian cancer (APC=0.15%). Rate of PYLL decreased due to cervical cancer (APC=4.3%, p<0.05) and stomach cancer (APC=1.5%).

SUMMARY AND CONCLUSIONS

During the analysed period the highest increase of premature mortality was observed in colorectal cancer in both sexes and lung cancer in women, a slightly smaller increase was noted for breast cancer and prostate cancer. What is particularly important is the trend and a slight decrease of premature mortality rate caused by lung cancer in men and its significant decrease for cervical cancer as well as stomach cancer in both sexes.

Trends of premature mortality in Swietokrzyskie Province (Poland), years 2002-2010

BACKGROUND

Premature mortality in younger age groups influences the society as far as social and economic aspects are concerned. Therefore, it is important to come up with a tool which will allow to assess them, and will enable to implement only these health care measures that bring tangible benefits. That is the reason for introducing PYLL rate (PYLL - potential years of life lost), which is an addition to the analysis of premature mortality as it includes the number of deaths due to a particular cause and the age at death.

OBJECTIVE

The purpose of this study was to analyse the level and trends of PYLL rate according to death causes in years 2002 -2010 in Swietokrzyskie Province.

MATERIAL AND METHODS

The material for the analysis was the information from the Central Statistical Office on the number of deaths due to all causes registered among the inhabitants of Swiytokrzyskie Province in years 2002-2010. Causes of death were coded according to the 10th revision of the International Classification of Diseases. The analysis of premature mortality was carried out with the use of PYLL rate. PYLL rate was calculated according to the method proposed by Romeder, according to which the premature mortality was defined as death before the age of 70. The analysis of time trends of PYLL rate and the APC (annual percent change) of the PYLL rate were calculated using jointpoint model as well as the Jointpoint Regression Program (Version 4.0.1 - January 2013).

RESULTS

In men, in years 2002 - 2007 PYLL rate increased by 1.5% per year (p<0.05). From year 2007 the trend went downward and PYLL rate decreased on average by 3.1% per year till year 2010. External causes of death, cardiovascular diseases and cancers in years 2002 - 2010 were the reason for almost 74.0% PYLL in men. In year 2010 PYLL rate due to all death causes amounted to 8913.8/105 and was three times higher than in women (2975.5/10(5)). In women, however, during the analysed period PYLL rate did not change significantly, and was dominated by cancers, cardiovascular diseases and external death causes. Similarly to men, those three groups of death causes were responsible for an average 76.0% PYLL.

CONCLUSIONS

The analysis of the causes of premature mortality in Swietokrzyskie Province shows that in the majority of cases it is due to preventable deaths, which calls for the necessity of more intensive measures in primary and secondary prevention as well as the improvement in treatment standards, mainly of cardiovascular diseases, cancers, injuries and accidents.

Differences in results of breast cancer curative treatment between urban/rural female population in Podlaskie Voivodship of Poland before introduction of the National Cancer Control Programme

The aim of the study was to evaluate differences in the results of the curative treatment received by women with breast cancer in urban and rural area in Podlaskie Voivodship in 2001-2002 before the introduction of the National Cancer Control Programme. The analysis was based on 449 women with breast cancer, who received curative treatment in years 2001-2002. Relative 5-year survival rates as function of age and stage among urban and rural women population were calculated. The results showed that survival rates in Podlaskie Voivodship among curatively treated women with breast cancer were 81.9% but they differed between urban and rural areas. Patients living in rural areas had much lower survivals than those living in urban areas at local and regional stage of disease. In all age groups considered in the study survivals in rural areas were lower than in urban ones in which survivals were higher in 55-64 age group. These results indicated the necessity intervention in order to increase the access to the health care system and effectiveness of early detection and also improved treatment standards for more disadvantaged rural areas. These results should be also considered in monitoring of the National Cancer Control Programme introduction in Poland in 2006.

Waiting time for treatment of women with breast cancer in Podlaskie Voivodeship (Poland) in view of place of residence. A population study

INTRODUCTION

Treatment delay is a major problem of contemporary oncology. Knowing the time interval between diagnosis and initiation of treatment, together with monitoring this adverse prognostic factor, is an important element of the treatment planning process in the population and can contribute to the improvement of patients' curability.

OBJECTIVE

To assess the waiting time for first treatment of women diagnosed with breast cancer in 2001-2002 in Podlaskie Voivodeship.

MATERIALS AND METHODS

During 2001-2002, there were 709 cases of women with breast cancer who reported to the Voivodeship Cancer Registry in Bialystok. 659 women were diagnosed with a primary invasive breast tumour. A cohort of 499 women who were treated with a curative intent was selected from this group. The waiting time in the created cohort was calculated as the number of days between the date of the breast cancer diagnosis and date of the first treatment.

RESULTS

The average time between the date of diagnosis and date of the first treatment was 38 days. The median was 14 days. 28.6% of patients from the selected cohort waited longer than 28 days. The treatment of rural women was initiated faster than the treatment of urban patients.

The breast-conserving surgery of women with breast cancer in Podlaskie Voivodeship (Poland). Population study

INTRODUCTION

The results of breast cancer treatment depend mainly on better detection in mammography screening and, consequently, a higher proportion of women with early stage of the disease. They depend also on a better access to health care services and the effectiveness of oncological treatment. One of the methods of breast cancer control is a breast-conserving surgery. With a proper patients' classification for the treatment, the results of the breast-conserving surgery do not differ in relation to mastectomy. That's why, the availability of breast-conserving surgical methods is particularly important, especially in a population in which a population screening is conducted.

OBJECTIVE

The analysis of the selected aspects of the breast cancer treatment's standard in Podlaskie Voivodeship.

PATIENTS AND METHODS

In years 2001-2002, 709 cases of women with breast cancer were reported to the Voivodeship Cancer Registry in Bialystok. 659 women were diagnosed with a primary invasive breast cancer. Based on a cohort of 499 women treated with radical methods the following indicators, recommended by WHO for the evaluation of the breast-conserving surgery's availability, were calculated: a percentage of patients with whom breast-conserving surgery was used, a proportion of breast cancer cases receiving post-operative breast radiotherapy after breast-conserving surgery and a proportion of breast-conserving surgery in pT1 cases.

RESULTS

The breast-conserving surgery has been used much less frequently in Podlaskie Voivodeship than in Western Europe, but more frequently than in Poland in general.

CONCLUSION

It should be aimed to provide a surgical treatment with the use of breast-conserving surgical methods to the highest possible percentage of patients. The increase of the percentage of patients treated with breast-conserving surgery methods can be a result of an effective screening realisation.

Survival for ovarian cancer in Europe: the across-country variation did not shrink in the past decade

BACKGROUND

Survival for ovarian cancer is the poorest of all gynaecological cancer sites. Our aim was to present the most up-to-date survival estimate for ovarian cancer by age and morphology and to answer the question whether survival for ovarian cancer improved in Europe during the 1990s.

MATERIAL AND METHODS

This analysis was performed with data from the EUROCARE database. We considered all adult women diagnosed with ovarian cancer between 1995 and 2002 and life status followed up until the end of 2003. A total of 97 691 cases were contributed by 72 European cancer registries in 24 countries. We estimated the most up-to-date relative survival for a mean of 23 661 patients followed up in 2000-2003 using the period hybrid approach and described the relative survival trends from the beginning of 1990s.

RESULTS AND CONCLUSION

Overall, the European age-standardised one-year, five-year and five-year conditional on surviving one-year relative survival were 67.2% (95% CI 66.6-67.8), 36.1% (95% CI 35.4-36.8) and 53.7% (95% CI 52.8-54.7), respectively. Five-year relative survival was 58.6% (95% CI 57.4-59.8), 37.1% (95% CI 36.1-38.1) and 20.5% (95% CI 19.1-21.9) in women aged 15-54, 55-74 and 75-99 years, respectively. The age-standardised five-year relative survival was 38.1% (95% CI 36.9-39.3) for serous tumours and 51.9% (95% CI 49.0-54.9) for mucinous cancers and the crude five-year relative survival was 85.6% (95% CI 81.2-90.0) for germ cell cancers. Overall, the age-standardised five-year relative survival increased from 32.4% (95% CI 31.7-33.2) in 1991-1993 to 36.3% (95% CI 35.5-37.0) in 2000-2003. There is a need to better understand the reasons for the wide variation in survival of ovarian cancer in Europe. Actions aiming to harmonise the protocols for therapy should contribute to narrowing the wide gap in survival and research on screening and early detection of ovarian cancer should be enforced.

Carcinoma of endocrine organs: results of the RARECARE project

The rarity or the asymptomatic character of endocrine tumours results in a lack of epidemiological studies on their incidence and survival patterns. The aim of this study was to describe the incidence, prevalence and survival of endocrine tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002, registered in 89 population-based cancer registries (CRs) with follow-up until 31st December 2003. These data give an unique overview of the burden of endocrine carcinomas in Europe. A list of tumour entities based on the third International Classification of Diseases for Oncology was provided by the project Surveillance of rare cancer in Europe (RARECARE) project. Over 33,594 cases of endocrine carcinomas were analysed in this study. Incidence rates increased with age and were highest in patients 65 years of age or older. In 2003, more than 315,000 persons in the EU (27 countries) were alive with a past diagnosis of a carcinoma of endocrine organs. The incidence of pituitary carcinoma equalled four per 1,000,000 person years and showed the strongest decline in survival with increasing age. Thyroid cancer showed the highest crude incidence rates (four per 100,000 person years) and was the only entity with a gender difference: (female-to-male ratio: 2:9). Parathyroid carcinoma was the rarest endocrine entity with two new cases per 10,000,000 person years. For adrenal carcinoma, the most remarkable observations were a higher survival for women compared to men (40% compared to 32%, respectively) and a particularly low relative survival of 24% in patients 65 years of age or older. More high quality studies on rare cancers, with additional information, e.g. on stage and therapeutic approach, are needed and may be of help in partly explaining the observed variation in survival.

[The role of science in policy making--EuSANH-ISA project, framework for science advice for health]

Governments and other authorities (including MPs) should be well informed on issues of science and technology. This is particularly important in the era of evidence-based practice. This implies the need to get expert advice. The process by which scientific knowledge is transmitted, along with proposals how to solve the problem, is called science advice. The main aim of the article is to discuss the issue of science advice--definitions, interaction between science and policymaking, and its position in contemporary policies. The second aim is to present European Science Advisory Network for Health (EuSANH), EuSANH-ISA project, and framework for science advice for health which was developed by participants. Furthermore, the role of civil society in decision-making process and science advice is also discussed. Interaction between scientists and policy-makers are described in terms of science-push approach (technocratic model), policy-pull (decisionistic) and simultaneous push-pull approach (pragmatic). The position of science advice is described in historical perspective from the 50s, especially in the last two decades. Description relies to USA, Canada and UK. Principles of scientific advice to government (Government Office for Science, UK) are quoted. Some important documents related to science advice in EU and UN are mentioned. EuSANH network is described as well as EuSANH-ISA project, with its objectives and outcomes. According to findings of this project, the process of science advice for health should follow some steps: framing the issue to be covered; planning entire process leading to the conclusion; drafting the report; reviewing the report and revision; publishing report and assessing the impact on policy.

Patterns of care for European colorectal cancer patients diagnosed 1996-1998: a EUROCARE high resolution study

OBJECTIVE

To identify disparities in the management of colon and rectal cancer across Europe by assessing population-based information from 12 European cancer registries (CR) participating in EUROCARE, together with additional information obtained from individual clinical records.

METHODS AND PATIENTS

We considered five indicators: (a) resection with curative intent; (b) post-operative mortality; (c) proportion of stage II/III colon cancer cases given adjuvant chemotherapy; (d) proportion of rectal cancer cases receiving radiotherapy; and (e) proportion of curative intent resections with 12 or more lymph nodes examined.

RESULTS

A total of 6 871 colorectal cancer patients, diagnosed between 1996-1998, were examined. Overall 71% of patients received resection with curative intent, range 44-86% by CR; 46% of stage III colon cancer cases (range 24-73% by CR) and 22% of stage II cases (not then recommended) received adjuvant chemotherapy; 12% of rectal cancer cases received adjuvant radiotherapy, range < or =2% in five CRs to >51% in two CRs. For only 29% of curative intent resections were 12 or more lymph nodes examined.

CONCLUSIONS

This study reveals that, although most patients received surgery with curative intent, disparities in treatment for colorectal cancer across Europe in the late 1990s were unexpectedly large, with many patients not receiving treatments indicated by published clinical trials. Consensus guidelines for CRC management are now becoming available and should be adopted across Europe. It is hoped that dissemination of guidelines will improve the use of scientifically proven treatments for the disease, but this should be monitored by further population-based studies.

Variation in 'standard care' for breast cancer across Europe: a EUROCARE-3 high resolution study

On a population-based sample of 13,500 European breast cancer patients mostly diagnosed in 1996-1998 and archived by 26 cancer registries, we used logistic regression to estimate odds of conservative surgery plus radiotherapy (BCS+RT) versus other surgery, in T1N0M0 cases by country, adjusted for age and tumour size. We also examined: BCS+RT in relation to total national expenditure on health (TNEH); chemotherapy use in N+ patients; tamoxifen use in oestrogen-positive patients; and whether 10 nodes were examined in lymphadenectomies. Stage, diagnostic examinations and treatments were obtained from clinical records. T1N0M0 cases were 33.0% of the total. 55.0% of T1N0M0 received BCS+RT, range 9.0% (Estonia) to 78.0% (France). Compared to France, odds of BCS+RT were lower in all other countries, even after adjusting for covariates. Women of 70-99 years had 67% lower odds of BCS+RT than women of 15-39 years. BCS+RT was 20% in low TNEH, 58% in medium TNEH, and 64% in high TNEH countries. Chemotherapy was given to 63.0% of N+ and 90.7% of premenopausal N+ (15-49 years), with marked variation by country, mainly in post-menopause (50-99 years). Hormonal therapy was given to 55.5% of oestrogen-positive cases, 44.6% at 15-49 years and 58.8% at 50-99 years; with marked variation across countries especially in premenopause. The variation in breast cancer care across Europe prior to the development of European guidelines was striking; older women received BCS+RT much less than younger women; and adherence to 'standard care' varied even among countries with medium/high TNEH, suggesting sub-optimal resource allocation.

Breast cancer survival gap between urban and rural female population in Podlaskie Voivodship, Poland, in 2001–2002. Population study

The aim of the study was to evaluate differences in breast cancer 5-year relative survival rates between the urban and rural female population in Podlaskie Voivodship in 2001-2002, before the introduction of the Population Screening Programme in 2006. The analysis was based on 659 breast cancer cases diagnosed in 2001-2002 and registered in CR in Białystok (Voivodship Cancer Registry). Relative survival and relative excess of risk of death after 5 years of diagnosis as function of age and stage among urban and rural women population were calculated. The results showed that survival rates in Podlaskie Voivodship were low (69.4%) in comparison to the European average (79.4%), and they differed between urban and rural areas. Patients living in rural areas had a much lower survival rate than those living in urban areas at local and regional stage of disease, whereas survivals were higher at the metastatic stage. In all age groups considered in the study, the survivals in rural areas were lower than in urban areas. The multivariate analysis confirmed that both the cancer stage and place of residence are independent prognostic factors. Relationship with age was not confirmed. The research results indicate low curability of breast cancer in Podlaskie Voivodship, and significant differences between urban and rural areas. These results need to be considered in the planning and monitoring of further intervention in order to increase the effectiveness of prevention and treatment standards for more disadvantaged rural areas. It is particularly significant when implementing the National Cancer Control Programme.

[Breast cancer risk factors--possibilities of primary prevention]

In the article were presented the important breast cancer risk factors: genetic factors, family history, age, procreation behaviors, women's physiology (menarche, menopause), obesity, low physical activity, alcohol intake, oral contraceptive and menopausal hormonal replacement therapy. Possibilities of primary prevention and methods of calculation of individual breast cancer risk were also described. The value of the secondary prevention of the disease was emphasized. The primary and secondary prevention could substantially reduce burden of the breast cancer.

Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study

BACKGROUND

EUROCARE is the largest population-based cooperative study on survival of patients with cancer. The EUROCARE project aims to regularly monitor, analyse, and explain survival trends and between-country differences in survival. This report (EUROCARE-4) presents survival data for eight selected cancer sites and for all cancers combined, diagnosed in adult (aged >/=15 years) Europeans in 1995-99 and followed up until the end of 2003.

METHODS

We analysed data from 83 cancer registries in 23 European countries on 2 699 086 adult cancer cases that were diagnosed in 1995-99 and followed up to December, 2003. We calculated country-specific and mean-weighted age-adjusted 5-year relative survival for eight major cancers. Additionally, case-mix-adjusted 5-year survival for all cancers combined was calculated by countries ranked by total national expenditure on health (TNEH). Changes to survival were analysed relative to cases diagnosed in 1990-94.

FINDINGS

Mean age-adjusted 5-year relative survival for colorectal (53.8% [95% CI 53.3-54.1]), lung (12.3% [12.1-12.5]), breast (78.9% [78.6-79.2]), prostate (75.7% [75.2-76.2]), and ovarian (36.3% [35.7-37.0]) cancer was highest in Nordic countries (except Denmark) and central Europe, intermediate in southern Europe, lower in the UK and Ireland, and worst in eastern Europe. Survival for melanoma (81.6% [81.0-82.3]), cancer of the testis (94.2% [93.4-95.0]), and Hodgkin's disease (80.0% [79.0-81.0]) varied little with geography. All-cancer survival correlated with TNEH for most countries. Denmark and UK had lower all-cancer survival than countries with similar TNEH; Finland had high all-cancer survival, but moderate TNEH. Survival increased and intercountry survival differences narrowed between the data for 1990-94 and 1995-99 for, notably, Hodgkin's disease (range 66.1-82.9 [IQR 72.2-78.6] vs 74.0-83.9 [78.6-81.9]), colorectal (29.4-56.7 [45.8-54.1] vs 38.8-59.7 [50.7-57.5]), and breast (61.7-82.7 [72.3-78.3] vs 69.3-87.6 [76.6-82.7]) sites.

INTERPRETATION

Increases in survival and decreases in geographic differences over time, which are mainly due to improvements in health-care services in countries with poor survival, might indicate better cancer care. Wealthy countries with high TNEH generally had good cancer outcomes, but those with conspicuously worse outcomes than those with similar TNEH might not be allocating health resources efficiently.

Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study

BACKGROUND

EUROCARE is the largest population-based cooperative study on survival of patients with cancer. The EUROCARE project aims to regularly monitor, analyse, and explain survival trends and between-country differences in survival. This report (EUROCARE-4) presents survival data for eight selected cancer sites and for all cancers combined, diagnosed in adult (aged >/=15 years) Europeans in 1995-99 and followed up until the end of 2003.

METHODS

We analysed data from 83 cancer registries in 23 European countries on 2 699 086 adult cancer cases that were diagnosed in 1995-99 and followed up to December, 2003. We calculated country-specific and mean-weighted age-adjusted 5-year relative survival for eight major cancers. Additionally, case-mix-adjusted 5-year survival for all cancers combined was calculated by countries ranked by total national expenditure on health (TNEH). Changes to survival were analysed relative to cases diagnosed in 1990-94.

FINDINGS

Mean age-adjusted 5-year relative survival for colorectal (53.8% [95% CI 53.3-54.1]), lung (12.3% [12.1-12.5]), breast (78.9% [78.6-79.2]), prostate (75.7% [75.2-76.2]), and ovarian (36.3% [35.7-37.0]) cancer was highest in Nordic countries (except Denmark) and central Europe, intermediate in southern Europe, lower in the UK and Ireland, and worst in eastern Europe. Survival for melanoma (81.6% [81.0-82.3]), cancer of the testis (94.2% [93.4-95.0]), and Hodgkin's disease (80.0% [79.0-81.0]) varied little with geography. All-cancer survival correlated with TNEH for most countries. Denmark and UK had lower all-cancer survival than countries with similar TNEH; Finland had high all-cancer survival, but moderate TNEH. Survival increased and intercountry survival differences narrowed between the data for 1990-94 and 1995-99 for, notably, Hodgkin's disease (range 66.1-82.9 [IQR 72.2-78.6] vs 74.0-83.9 [78.6-81.9]), colorectal (29.4-56.7 [45.8-54.1] vs 38.8-59.7 [50.7-57.5]), and breast (61.7-82.7 [72.3-78.3] vs 69.3-87.6 [76.6-82.7]) sites.

INTERPRETATION

Increases in survival and decreases in geographic differences over time, which are mainly due to improvements in health-care services in countries with poor survival, might indicate better cancer care. Wealthy countries with high TNEH generally had good cancer outcomes, but those with conspicuously worse outcomes than those with similar TNEH might not be allocating health resources efficiently.

Trends in cervical cancer survival in Europe, 1983–1994: A population-based study

OBJECTIVE

To evaluate trends in survival from cervical cancer in Europe and in European countries participating in the EUROCARE study as a function of age, morphology and stage at diagnosis.

METHODS

Relative survival and relative excess risk of death within 5 years of diagnosis, as a function of age, morphology and stage, among 73,022 women aged 15-99 years diagnosed during 1983-1994 and followed up to 1999 in each of 18 European countries participating in the EUROCARE study, using data from 34 population-based cancer registries.

RESULTS

Overall five-year relative survival was 62%, rising by 2% during the period 1983-1994. The highest survival occurred in Northern and Western Europe and the lowest in Central Europe. Survival falls with age at diagnosis, but mainly for localised disease. Survival is higher for adenocarcinoma in younger women, but higher for squamous cell carcinoma in older women. The proportions of younger women, localised cancer and adenocarcinoma all increased. The main improvements in survival were for women under 65, and for metastatic disease.

CONCLUSIONS

Survival in Europe has improved slowly but steadily, but the trend is not geographically uniform. Central European countries and the UK saw little or no improvement, and survival in those countries remains the lowest among participating countries in Europe. Further reduction of cervical cancer mortality in Europe may be expected from expansion of screening, and improvement in the treatment of older women, and of metastatic disease.

An international prospective study of the EORTC cancer in-patient satisfaction with care measure (EORTC IN-PATSAT32)

Little is known about patients' satisfaction with care in oncology hospitals across cultural contexts. Within the EORTC, we developed a 32-item satisfaction with care questionnaire to measure patients' appraisal of hospital doctors and nurses, as well as aspects of care organisation and services. This study assessed the psychometric characteristics of the questionnaire, the EORTC IN-PATSAT32, in a large, international sample of patients with cancer. Patients discharged from a surgery or medical oncology ward in nine countries were invited to complete at home the EORTC IN-PATSAT32 as well as other instruments for psychometric testing. Of 762 eligible patients recruited, 15% failed to return the questionnaire. Of the 647 compliant patients, 63% completed the questionnaires within 15 min and 82% required no help in its completion. Multitrait scaling analysis revealed excellent internal consistency and convergent validity, although some scales within the IN-PATSAT32 were relatively highly correlated. Test-retest data on 113 patients showed high reliability for most scales. Scales of the IN-PATSAT32 and of the QLQ-C30 were not significantly correlated, suggesting that the two questionnaires are assessing quite distinct concepts. The scales of the IN-PATSAT32 were able to discriminate clearly between patients with differing care expectations and differing intentions to recommend their hospital to others. This study supports the acceptability to patients, and the psychometric robustness of the EORTC IN-PATSAT32 questionnaire. Further studies are needed to assess the responsiveness of the questionnaire to changes in the structure and process of care over time.

[Significance of medical data availability for the assessment of prognostic factors in cancer patients. Analysis based on a study of cervical cancer population]

The aim of this study was to estimate the availability of medical records (MR) in population study based on Cancer Registries (CR) data, and to investigate weather the availability of MR correlates with favourable prognostic factors in cervical cancer patients. The cohort consisted of 1386 patients diagnosed between 1993 and 1996 and registered at CR in three Polish cities: Kielce, Opole and Warsaw. Population of these areas covers about 10% of Polish population. The data became amended with information from MR on stage, histopathology and first treatment. The place of living and availability of MR were also considered as prognostic factors. Chi square test was used to compare the differentiation of distribution of prognostic factors between two groups: patients for whom MR were available and remaining group with information available from CR only. A multivariate regression analysis was applied for the evaluation of prognostic factors. MR, available for 75,4% patients, combined with CR data, formed the high quality database allowing analysis of prognostic factors. The availability of MR correlated with more favourable prognostic factors (p<0.0001): earlier stage of disease, younger age and category of microscopic diagnosis. Multivariate analysis confirmed the prognostic meaning of the stage of disease, place of living and availability of MR, however, the last factor was not significant. The analysis confirmed the necessity of including selected clinical prognostic factors into routinely collected data by population CR to allow monitoring of effectiveness of any cancer control project and evaluation of cancer health indicators as recommended by IARC/WHO in EUROCHIP Project.

Cervical cancer in Poland: awareness, survival and therapy. Population based studies

For the purpose of finding the reasons for the slow changes in the mortality trend among cervical cancer patients, the awareness, survival and therapy were studied. After 26 years of observation, Polish women's knowledge of secondary prevention in cervical cancer has improved in a significant way. The behaviour of women has also slightly improved. Above finding and the low 5-year survivals, large proportion of unfavourable clinical stages on the first diagnosis, the small number of cancer cases eligible for radical treatment and the delays in radiotherapy found in epidemiological and clinical studies, offers some explanation for the observed slow change in the mortality trend.

[Survival of cervical cancer patients in selected regions of Poland in 1990-1996, in relation to some prognostic factors]

To evaluate whether cervical cancer patients in selected regions of Poland show similar 5-year survival rates and if they are different from European average and, also, to evaluate the effect of selected prognostic factors. The analysis based on a cohort of 1386 cervical cancer cases identified by population-based Cancer Registries collecting data from Kieleckie and Opolskie voivodships and from the City of Warsaw in 1990-96. These data become complete by adding information from medical records. The 5-year relative survival rates were calculated using the life tables method, and, a multivariant regression analysis was applied for evaluation of prognostic factors. The regions differed significantly in stage distribution (p<0.001), however, they were similar in age groups and histological diagnosis. The age-standardized relative 5-year overall survival rate was 52.2%, and was among lowest rates in Europe. The rate in Kieleckie was 60.7%; in Opolskie--43.3%, and in Warsaw--51.9%. The rates for Stage I in those regions were comparable at over 80%, but were different for Stage II and higher stages. The multivariant analysis showed a significant risk increase related to stage advancement (p<0.0001) as well as to the place of living in Opolskie (p=0.02) and to the adenocarcinoma diagnosis (p=0.05). However, the analysis did not confirm the effect of age of diagnosis as a prognostic factor. The overall, age-standardised 5-year relative survival rates of cervical cancer patients are one of the lowest in Europe, though diversified in the regions. They are almost satisfactory and close to European average in Kieleckie where prevention was effective, but poor in the other regions. The low survivals overall are basically due to the unsatisfactory proportion of the early stage of disease. The uneven survivals of patients with Stage II and higher stages of cancer in the selected regions of Poland suggest different standards of treatment.

European health systems and cancer care

INTRODUCTION

Data on the survival of all incident cases collected by population-based cancer registries make it possible to evaluate the overall performance of diagnostic and therapeutic actions on cancer in those populations. EUROCARE-3 is the third round of the EUROCARE project, the largest cancer registry population based collaborative study on survival in European cancer patients. The EUROCARE-3 study analysed the survival of cancer patients diagnosed from 1990 to 1994 and followed-up to 1999. Sixty-seven cancer registries of 22 European countries characterised by differing health systems participated in the study. This paper includes essays providing brief overviews of the state and evolution of the health systems of the considered countries and comments on the relation between cancer survival in Europe and some European macro-economic and health system indicators, in the 1990s.

OVERVIEW OF THE EUROPEAN HEALTH SYSTEMS

The European health systems underwent a great deal of reorganisation in the last decade; a general tendency being to facilitate expanding involvement of the private sector in health care, a process which occurred mainly in the eastern countries (i.e. the Czech Republic, Estonia, Poland, Slovakia and Slovenia). In contrast, organisational changes in the northern European countries (i.e. Denmark, Iceland, Finland and Sweden) tended to confirm the established public sector systems. Other countries, including the UK and some southern European countries (i.e. England, Scotland, Wales, Malta and Italy) have reduced the public role while the systems remain basically public, at least at present. Our findings clearly suggest that cancer survival (all cancer combined) is related to macro-economic variables such as the gross domestic product (GDP), the total national (public and private) expenditure on health (TNEH) and the total public expenditure on health (TPEH). We found, however, that survival is related to wealth (GDP), but only up to a certain level, after which survival continues to be related to the level of health investment (both TNEH and TPEH). According to the Organisation for Economic Co-operation and Development (OECD), the TNEH increased during the 1990s in all EUROCARE-3 countries, while the ratio of TPEH to TNEH reduced in all countries except Portugal.

CONCLUSIONS

Cancer survival depends on the widespread application of effective diagnosis and treatment modalities, but our enquiry suggests that the availability of these depends on macro-economic determinants, including health and public health investment. Analysis of the relationship between health system organisation and cancer outcome is complicated and requires more information than is at present available. To describe cancer and cancer management in Europe, the European Cancer Health Indicator Project (EUROCHIP) has proposed a list of indicators that have to be adopted to evaluate the effects on outcome of proposed health system modifications.

[Breast cancer prevention--awareness and health behavior changes in women in 1998-2002]

AIM

To find changes in the proportion of women who declared they were aware of breast self examination (BSE) and performed it regularly in 1998 and in 2002, as well as in the proportion of those who declared health behaviour connected with secondary prevention of breast cancer. Also to define the groups of women who especially need health education and prophylactic intervention.

METHODS

The results of two breast cancer prevention surveys on representative samples of Polish women aged over 18 + years were compared. The data were analysed in groups of women categorised according to selected demographic and social factors.

RESULTS

The substantial increase in the proportion of women who declared that they performed mammography in 2002 in relation to 1998. The percent of women who declared other prophylactic behaviours in 2002 did not change or was even lower in some groups. The decrease of doctors' activity in the field of secondary prevention of cancer was also observed.

CONCLUSIONS

1. It is important to continue educational work and intervention measures concerning breast cancer prevention, with special attention to the most neglected groups of women. 2. It would be important to continue educating doctors in prophylactic breast examination and establish some obligatory rules in this area. 3. It would be beneficial to introduce breast cancer screening in Poland on the national scale. A model of such screening has already been implemented.

[Cervical cancer prevention - awareness and health behavior changes of women in 1976, 1986, 1990 and 1998]

AIM

To find the changes in the proportion of women who declared knowledge about cytological tests and underwent that test in the years 1976, 1986, 1990 and 1998, as well as in the proportion of those who declared showing up at the gynaecologist during the last year. To assess the number of women taking part in the secondary prevention of cervical cancer. To correct health education intervention targeted at women.

METHODS

The results of four cervical prevention surveys on representative samples of Polish women aged over 18 years were compared.

RESULTS

The substantial (58%) increase in the proportion of women who declared awareness of cytological tests was shown. As expected, smaller favourable changes were found in the field of women's health related to secondary prevention. The percent of women who declared yearly visits at the gynaecologists increased by 12% and those who declared having cytological tests done during last three years by 7%. The lowest level of awareness and the lowest frequency of using prevention services were declared among women aged over 60, represented the lowest education level and resided in rural areas.

CONCLUSIONS

It is important to continue educational work and intervention measures concerning cervical cancer prevention, with special attention to the most neglected groups of women.