Is low survival for cancer in Eastern Europe due principally to late stage at diagnosis?

P. Minicozzi, P.M. Walsh, M.-J. Sánchez, A. Trama, K. Innos, R. Marcos-Gragera, N. Dimitrova, L. Botta, T.B. Johannesen, S. Rossi, M. Sant, EUROCARE-5 Working Group, Roberta De Angelis, Massimiliano Caldora, Eugenio Carrani, Silvia Francisci, Sandra Mallone, Daniela Pierannunzio, Paolo Roazzi, Silvia RossiMariano Santaquilani, andrea tavilla

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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. © 2018 Elsevier Ltd
Original languageEnglish
Pages (from-to)127-137
Number of pages11
JournalEuropean journal of cancer
Publication statusPublished - 2018


  • 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


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