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

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]. 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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 -