@article{52429faefd864167a5a83726d71333f3,
title = "Is low survival for cancer in Eastern Europe due principally to late stage at diagnosis?",
abstract = "Background: Cancer survival has persistently been shown to be worse for Eastern European and UK/Ireland patients than those of other European regions. This is often attributed to later stage at diagnosis. However, few stage-specific survival comparisons are available, so it is unclear whether poorer quality treatment or other factors also contribute. For the first time, European cancer registries have provided stage-at-diagnosis data to EUROCARE, enabling population-based stage-specific survival estimates across Europe. Data and methods: In this retrospective observational study, stage at diagnosis (as TNM, condensed TNM, or Extent of Disease) was analysed for patients (≥15 years) from 15 countries grouped into 4 regions (Northern Europe: Norway; Central Europe: Austria, France, Germany, Switzerland, The Netherlands; Southern Europe: Croatia, Italy, Slovenia, and Spain; and Eastern Europe: Bulgaria, Estonia, Lithuania, Poland, and Slovakia), diagnosed with 7 malignant cancers in 2000–2007, and followed to end of 2008. A new variable (reconstructed stage) was created which used all available stage information. Age-standardised 5-year relative survival (RS) by reconstructed stage was estimated and compared between regions. Excess risks of cancer death in the 5 years after diagnosis were also estimated, taking age, sex and stage into account. Results: Low proportions of Eastern European patients were diagnosed with local stage cancers and high proportions with metastatic stage cancers. Stage-specific RS (especially for non-metastatic disease) was generally lower for Eastern European patients. After adjusting for age, sex, and stage, excess risks of death remained higher for Eastern European patients than for European patients in general. Conclusions: Late diagnosis alone does not explain worse cancer survival in Eastern Europe: greater risk of cancer death together with worse stage-specific survival suggest less effective care, probably in part because fewer resources are allocated to health care than in the rest of Europe. We recommend that Eastern European cancer registries and other involved bodies to draw attention to poor cancer survival, so as to stimulate research and inform policies to improve outcomes. {\textcopyright} 2018 Elsevier Ltd",
keywords = "Cancer, Europe, Population-based study, Stage at diagnosis, Survival, aged, Article, Austria, breast cancer, Bulgaria, cancer diagnosis, cancer mortality, cancer registry, cancer risk, cancer staging, cancer survival, colon cancer, controlled study, Croatia, Eastern Europe, Estonia, female, France, Germany, human, Italy, Lithuania, lung cancer, major clinical study, male, malignant neoplasm, melanoma, Netherlands, observational study, Poland, priority journal, rectum cancer, retrospective study, Slovenia, Southern Europe, Spain, stomach cancer, Switzerland, thyroid cancer, adolescent, adult, age, delayed diagnosis, follow up, middle aged, mortality, neoplasm, pathology, register, statistics and numerical data, survival rate, very elderly, young adult, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Delayed Diagnosis, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Staging, Neoplasms, Registries, Retrospective Studies, Survival Rate, Young Adult",
author = "P. Minicozzi and P.M. Walsh and M.-J. S{\'a}nchez and A. Trama and K. Innos and R. Marcos-Gragera and N. Dimitrova and L. Botta and T.B. Johannesen and S. Rossi and M. Sant and Group, {EUROCARE-5 Working} and {De Angelis}, Roberta and Massimiliano Caldora and Eugenio Carrani and Silvia Francisci and Sandra Mallone and Daniela Pierannunzio and Paolo Roazzi and Silvia Rossi and Mariano Santaquilani and andrea tavilla",
note = "Cited By :2 Export Date: 11 April 2019 CODEN: EJCAE Correspondence Address: Minicozzi, P.; Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Italy; email: pamela.minicozzi@istitutotumori.mi.it Funding details: Compagnia di San Paolo Funding details: European Commission, 20102202 Funding details: Fondazione Cariplo Funding details: 1529710, RF-2009 Funding text 1: 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]. References: Minicozzi, P., Otter, R., Primic-{\v Z}akelj, M., Francisci, S., , 51. , Survival of cancer patients in Europe, 1999–2007: the EUROCARE-5 study, Eur J Cancer, 2015, 2099–2268; De Angelis, R., Sant, M., Coleman, M.P., Francisci, S., Baili, P., Pierannunzio, D., Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE–5-a population-based study (2014) Lancet Oncol, 15, pp. 23-34; Visser, O., van Leeuwen, F.E., Stage-specific survival of epithelial cancers in North-Holland/Flevoland, The Netherlands (2005) Eur J Cancer, 41, pp. 2321-2330; (2017) High resolution studies, , http://www.hrstudies.eu, [Accessed 16 January 2018]; Allemani, C., Storm, H., Voogd, A.C., Holli, K., Izarzugaza, I., Torrella-Ramos, A., Variation in {\textquoteleft}standard care{\textquoteright} for breast cancer across Europe: a EUROCARE-3 high resolution study (2010) Eur J Cancer, 46, pp. 1528-1536; Minicozzi, P., Bouvier, A.M., Faivre, J., Sant, M., Management of rectal cancers in relation to treatment guidelines: a population-based study comparing Italian and French patients (2014) Dig Liver Dis, 46, pp. 645-651; EUROCARE, Survival of cancer patients in Europe (2017), http://www.eurocare.it, [Accessed 16 January 2018]; Parkin, D.M., The evolution of the population-based cancer registry (2006) Nat Rev Cancer, 6, pp. 603-612; Siesling, S., Louwman, W.J., Kwast, A., van den Hurk, C., O'Callaghan, M., Rosso, S., Uses of cancer registries for public health and clinical research in Europe: results of the European Network of Cancer Registries survey among the 161 population-based cancer registries during 2010–2012 (2015) Eur J Cancer, 51, pp. 1039-1049; Minicozzi, P., Innos, K., S{\'a}nchez, M.-J., Trama, A., Walsh, P.M., Marcos-Gragera, R., Quality analysis of population-based information on cancer stage at diagnosis across Europe, with presentation of stage-specific cancer survival estimates: a EUROCARE-5 study (2017) Eur J Cancer, 84, pp. 335-353; Institute, N.C., http://training.seer.cancer.gov/ss2k/staging/, 2017 [Accessed 16 January 2018]; Rossi, S., Baili, P., Capocaccia, R., Caldora, M., Carrani, E., Minicozzi, P., The EUROCARE-5 study on cancer survival in Europe 1999-2007: database, quality checks and statistical analysis methods (2015) Eur J Cancer, 51, pp. 2104-2119; Dickman, P.W., Sloggett, A., Hills, Hakulinen, T., Regression models for relative survival (2004) Stat Med, 23, pp. 51-64; Menard, S.W., Applied logistic regression analysis (2002), 2nd ed. SAGE Thousand Oaks; StataCorp, Stata statistical software: release 12 (2011), StataCorp LP Texas: College Station; Ambrosini, V., Nicolini, S., Caroli, P., Nanni, C., Massaro, A., Marzola, M.C., PET/CT imaging in different types of lung cancer: an overview (2012) Eur J Radiol, 81, pp. 988-1001; Eurostat, Healthcare resource statistics – technical resources and medical technology (2017), http://ec.europa.eu/eurostat/statistics-explained/index.php/Healthcare_resource_statistics_-_technical_resources_and_medical_technology, [Accessed 16 January 2018]; Baburin, A., Aareleid, T., Padrik, P., Valvere, V., Innos, K., Time trends in population-based breast cancer survival in Estonia: analysis by age and stage (2014) Acta Oncol, 53, pp. 226-234; Grau, C., Defourny, N., Malicki, J., Dunscombe, P., Borras, J.M., Coffey, M., Radiotherapy equipment and departments in the European countries: final results from the ESTRO-HERO survey (2014) Radiother Oncol, 112, pp. 155-164; Dimitrova, N., Gavrilov, I., Effect of adherence to breast cancer standards for care in Bulgaria (2013) Clinical management of breast cancer, pp. 219-235. , D. Kalev Varna: Art Tracer; Anttila, A., L{\"o}nnberga, S., Pontic, A., Suonio, E., Villain, P., Coebergh, J.W., Towards better implementation of cancer screening in Europe through improved monitoring and evaluation and greater engagement of cancer registries (2015) Eur J Cancer, 51, pp. 241-251; Kalager, M., Haldorsen, T., Bretthauer, M., Hoff, G., Thoresen, S.O., Adami, H.O., Improved breast cancer survival following introduction of an organized mammography screening program among both screened and unscreened women: a population-based cohort study (2009) Breast Cancer Res, 11, p. R44; Stratigos, A.J., Forsea, A.M., van der Leest, R.J., de Vries, E., Nagore, E., Bulliard, J.L., Euromelanoma: a dermatology-led European campaign against nonmelanoma skin cancer and cutaneous melanoma. Past, present and future (2012) Br J Dermatol, 167, pp. 99-104; Padrik, P., Valter, A., Valter, E., Baburin, A., Innos, K., Trends in incidence and survival of cutaneous malignant melanoma in Estonia: a population-based study (2017) Acta Oncol, 56, pp. 52-58; Sormani, M.P., The Will Rogers phenomenon: the effect of different diagnostic criteria (2009) J Neurol Sci, 287, pp. S46-S49; Crocetti, E., Mallone, S., Robsahm, T.E., Gavin, A., Agius, D., Ardanaz, E., Survival of patients with skin melanoma in Europe increases further: results of the EUROCARE-5 study (2015) Eur J Cancer, 51, pp. 2179-2190; Dal Maso, L., Tavilla, A., Pacini, F., Serraino, D., van Dijk, B.A.C., Chirlaque, M.D., Survival of 86,690 patients with thyroid cancer: a population-based study in 29 European countries from EUROCARE-5 (2017) Eur J Cancer, 77, pp. 140-152; (2017) National guidelines for treatment of thyroid cancer in Norway [under revision], , http://legeforeningen.no/PageFiles/54916/Nasjonale%20retningslinjer%20for%20cancer%20thyroideae.pdf, [Accessed 16 January 2018]; Pelizzo, M.R., Rubello, D., Bernardia, C., Gemo, G., Bertazza, L., Schievano, E., Thyroid surgical practices shaping thyroid cancer incidence in North-Eastern Italy (2014) Biomed Pharmacother, 68, pp. 39-43; Walters, S., Maringe, C., Butler, J., Rachet, B., Barrett-Lee, P., Bergh, J., Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: a population-based study (2013) Br J Cancer, 108, pp. 1195-1208; Maringe, C., Walters, S., Rachet, B., Butler, J., Fields, T., Finan, P., Stage at diagnosis and colorectal cancer survival in six high-income countries: a population-based study of patients diagnosed during 2000-2007 (2013) Acta Oncol, 52, pp. 919-932; Walters, S., Maringe, C., Coleman, M.P., Peake, M.D., Butler, J., Young, N., Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004–2007 (2013) Thorax, 68, pp. 551-564; Saadatmand, S., Bretveld, R., Siesling, S., Tilanus-Linthorst, M.M., Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173,797 patients (2015) BMJ, 351, p. h4901; Gerlinger, T., Schmucker, R., Transnational migration of health professionals in the European Union (2007) Cad Sa{\'u}de P{\'u}blica, 23, pp. S184-S192; Wismar, M., Maier, C.B., Glinos, I.A., Dussault, G., Figueras, J., Health professional mobility and health systems: evidence from 17 European countries (2011), World Health Organization Copenhagen; Starkiene, L., Macijauskiene, J., Riklikiene, O., Stricka, M., Padaiga, Z., Retaining physicians in Lithuania: integrating research and health policy (2013) Health Pol, 110, pp. 39-48; European Commission, Cancer control joint action – policy papers (2017), https://cancercontrol.eu/archived/uploads/PolicyPapers27032017/Policy_Paper_2_NCCP.pdf, [Accessed 16 January 2018]; http://ec.europa.eu/chafea/health/actions.html, European Commission. Call 2017: Joint actions,; 2017 [Accessed 16 January 2018]; Coebergh, J.W., van den Hurk, C., Louwman, M., Comber, H., Rosso, S., Zanetti, R., EUROCOURSE recipe for cancer surveillance by visible population-based cancer RegisTrees in Europe: from roots to fruits (2015) Eur J Cancer, 51, pp. 1050-1063; Navarro, C., Martos, C., Ardanaz, E., Galceran, J., Izarzugaza, I., Peris-Bonet, R., Population-based cancer registries in Spain and their role in cancer control (2010) Ann Oncol, 21 (3), pp. 3-13; Arndt, V., Population-based cancer registration and research in Switzerland: examples, limitations and perspectives (2016) Schweizer Krebsbulletin, 2, pp. 161-168; Coebergh, J.W., van der Hurk, C., Rosso, S., Comber, H., Storm, H., Zanetti, R., EUROCOURSE lessons learned from and for population-based cancer registries in Europe and their programme owners: improving performance by research programming for public health and clinical evaluation (2015) Eur J Cancer, 51, pp. 997-1017; Thomson, S., Figueras, J., Evetovits, T., Jowett, M., Mladovsky, P., Maresso, A., Economic crisis, health systems and health in Europe: impact and implications for policy (2014), World Health Organization Copenhagen; Thomson, S., Figueras, J., Evetovits, T., Jowett, M., Mladovsky, P., Maresso, A., Economic crisis, health systems and health in Europe: impact and implications for policy – policy summary 12 (2014), World Health Organization CopenhagenUR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85043284574&doi=10.1016%2fj.ejca.2018.01.084&partnerID=40&md5=2c279d061ef881fcc1221a8c99c2ee26",
year = "2018",
doi = "10.1016/j.ejca.2018.01.084",
language = "English",
volume = "93",
pages = "127--137",
journal = "European Journal of Cancer",
issn = "0014-2964",
publisher = "Elsevier Ltd",
}