Cancer survival rates are on the up in most of Europe, according to a couple of new studies, but the UK, despite its considerable healthcare budget is languishing near the bottom of the table.
The Eurocare-4 study, which includes data from 83 cancer registries in 23 countries covering some 2.7 million patients diagnosed between 1995 and 1999, has been published in The Lancet Oncology. Franco Berrino of the National Cancer Institute in Milan wrote that "increases in survival and decreases in geographic differences over time, which are mainly due to improvements in healthcare services in countries with poor survival, might indicate better cancer care". However the UK is a glaring exception to that view.
The Eurocare study reveals that survival for the four most common cancers – colorectal, lung, breast and prostate – as well as ovarian cancer was best in central Europe and most Nordic states, excluding Denmark. Southern Europe was in the middle, followed by the UK and Ireland and then eastern Europe. The researchers argued that if all countries had the mean survival rate of 57% of Norway, Sweden and Finland, there would be about 150,000, or 12%, fewer deaths in the five years after diagnosis.
However, the study’s view that the more a country spends on healthcare, the greater its survival rates, shudders to a halt when the UK experience is taken into account. In Britain, the five-year survival rate was about 42% for men and 52% for women, versus the European average of about 45% and 55%, respectively, slightly better than Slovenia, Poland and the Czech Republic.
Fundamental reassessment needed in UK
If survival in one country is substantially lower than that in other countries, especially those of a similar wealth, the health system is probably not functioning as it should," the researchers wrote and an editorial in The Lancet Oncology noted that "overall, survival for all cancers combined in the UK as a whole is not only below the European average, it is also noticeably similar to some eastern European countries that spend less than one third of the UK's per capita healthcare budget”. It adds that the problem would require "fundamental reassessment of the ways in which the NHS operates".
Arduino Verdecchia at the Istituo Superiore di Santia in Rome, Italy, found similar results in a related study and noted that the outlook for Europeans diagnosed with cancer is brighter than before but they still lag behind their counterparts in the USA. The five-year survival rate in the latter was 66% in men and 63% in women, versus 47% and 56%, he wrote and Dr Verdecchia’s colleagues suggested that the difference is due to better skills and training of health workers in the USA as well as higher investment in facilities and other treatment services.
A co-researcher of Dr Berrino, Ian Kunkler from the Western General Hospital in Edinburgh, Scotland, said that in the UK there has been a substantial investment in radiotherapy facilities, but “there is still a shortfall". He added that “we have good evidence that survival for lung cancer has been compromised by long waiting lists for radiotherapy treatment."
Prof Kunkler went on to say that the research shows that survival rates are improving overall particularly for colorectal, breast, thyroid and prostate cancers but within the UK “if you look at breast cancer there's still a difference of 8.5% of five-year survival rates compared with Sweden”. Still he claimed that the effect of the NHS Cancer Plan, introduced in 2000, is unlikely to be seen in this particular study, although an accompanying editorial argued that the plan is not working. “Our concerns illustrate the considerable challenges that now face the UK government if it is to make the NHS work efficiently and effectively," it stated.
Richard Sullivan, Cancer Research UK's director of clinical programmes, said that the papers show encouraging improvements for the UK but “while there are genuine differences in the early diagnosis and treatment of cancer patients between the UK and other European countries, the degree of that difference remains uncertain. Comparisons between countries are difficult because survival data are not collected in the same way in all places”.
"Partly as a result of the political impetus provided by the first Eurocare study,” he added, the NHS Cancer Plan was published “to reorganise, standardise and rejuvenate cancer services. Although these figures don't cover much time since the Cancer Plan was introduced, they show how it had already begun to make a difference”.
Prof Sullivan concluded that "cancer is still not being diagnosed early enough in all cases” and “we need to ensure that patients have access to the best surgery, radiotherapy and other treatments. This study shows that cancer is certainly not a 'ticked box'. We need a sustained effort to beat the disease".