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

Research output: Contribution to journalArticle

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. © 2018 Elsevier Ltd
Original languageEnglish
Pages (from-to)127-137
Number of pages11
JournalEuropean journal of cancer
Volume93
DOIs
Publication statusPublished - 2018

Fingerprint

Eastern Europe
Survival
Neoplasms
Registries
Estonia
Lithuania
Slovenia
Bulgaria
Slovakia
Croatia
Austria
Delayed Diagnosis
Poland
Norway
Switzerland
Ireland
Netherlands
Spain
Italy
France

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

Cite this

Is low survival for cancer in Eastern Europe due principally to late stage at diagnosis? / Minicozzi, P.; Walsh, P.M.; Sánchez, M.-J.; Trama, A.; Innos, K.; Marcos-Gragera, R.; Dimitrova, N.; Botta, L.; Johannesen, T.B.; Rossi, S.; Sant, M.; Group, EUROCARE-5 Working; De Angelis, Roberta; Caldora, Massimiliano; Carrani, Eugenio; Francisci, Silvia; Mallone, Sandra; Pierannunzio, Daniela; Roazzi, Paolo; Rossi, Silvia; Santaquilani, Mariano; tavilla, andrea.

In: European journal of cancer, Vol. 93, 2018, p. 127-137.

Research output: Contribution to journalArticle

Minicozzi, P, Walsh, PM, Sánchez, M-J, Trama, A, Innos, K, Marcos-Gragera, R, Dimitrova, N, Botta, L, Johannesen, TB, Rossi, S, Sant, M, Group, EUROCAREW, De Angelis, R, Caldora, M, Carrani, E, Francisci, S, Mallone, S, Pierannunzio, D, Roazzi, P, Rossi, S, Santaquilani, M & tavilla, A 2018, 'Is low survival for cancer in Eastern Europe due principally to late stage at diagnosis?', European journal of cancer, vol. 93, pp. 127-137. https://doi.org/10.1016/j.ejca.2018.01.084
Minicozzi, P. ; Walsh, P.M. ; Sánchez, M.-J. ; Trama, A. ; Innos, K. ; Marcos-Gragera, R. ; Dimitrova, N. ; Botta, L. ; Johannesen, T.B. ; Rossi, S. ; Sant, M. ; Group, EUROCARE-5 Working ; De Angelis, Roberta ; Caldora, Massimiliano ; Carrani, Eugenio ; Francisci, Silvia ; Mallone, Sandra ; Pierannunzio, Daniela ; Roazzi, Paolo ; Rossi, Silvia ; Santaquilani, Mariano ; tavilla, andrea. / Is low survival for cancer in Eastern Europe due principally to late stage at diagnosis?. In: European journal of cancer. 2018 ; Vol. 93. pp. 127-137.
@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. {\circledC} 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-Žakelj, 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 ‘standard care’ 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",

}

TY - JOUR

T1 - Is low survival for cancer in Eastern Europe due principally to late stage at diagnosis?

AU - Minicozzi, P.

AU - Walsh, P.M.

AU - Sánchez, M.-J.

AU - Trama, A.

AU - Innos, K.

AU - Marcos-Gragera, R.

AU - Dimitrova, N.

AU - Botta, L.

AU - Johannesen, T.B.

AU - Rossi, S.

AU - Sant, M.

AU - Group, EUROCARE-5 Working

AU - De Angelis, Roberta

AU - Caldora, Massimiliano

AU - Carrani, Eugenio

AU - Francisci, Silvia

AU - Mallone, Sandra

AU - Pierannunzio, Daniela

AU - Roazzi, Paolo

AU - Rossi, Silvia

AU - Santaquilani, Mariano

AU - tavilla, andrea

N1 - 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-Žakelj, 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 ‘standard care’ 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., Sánchez, 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., Lönnberga, 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 Saúde Pública, 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

PY - 2018

Y1 - 2018

N2 - 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

AB - 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

KW - Cancer

KW - Europe

KW - Population-based study

KW - Stage at diagnosis

KW - Survival

KW - aged

KW - Article

KW - Austria

KW - breast cancer

KW - Bulgaria

KW - cancer diagnosis

KW - cancer mortality

KW - cancer registry

KW - cancer risk

KW - cancer staging

KW - cancer survival

KW - colon cancer

KW - controlled study

KW - Croatia

KW - Eastern Europe

KW - Estonia

KW - female

KW - France

KW - Germany

KW - human

KW - Italy

KW - Lithuania

KW - lung cancer

KW - major clinical study

KW - male

KW - malignant neoplasm

KW - melanoma

KW - Netherlands

KW - observational study

KW - Poland

KW - priority journal

KW - rectum cancer

KW - retrospective study

KW - Slovenia

KW - Southern Europe

KW - Spain

KW - stomach cancer

KW - Switzerland

KW - thyroid cancer

KW - adolescent

KW - adult

KW - age

KW - delayed diagnosis

KW - follow up

KW - middle aged

KW - mortality

KW - neoplasm

KW - pathology

KW - register

KW - statistics and numerical data

KW - survival rate

KW - very elderly

KW - young adult

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Delayed Diagnosis

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasm Staging

KW - Neoplasms

KW - Registries

KW - Retrospective Studies

KW - Survival Rate

KW - Young Adult

U2 - 10.1016/j.ejca.2018.01.084

DO - 10.1016/j.ejca.2018.01.084

M3 - Article

VL - 93

SP - 127

EP - 137

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0014-2964

ER -