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The European Journal of Public Health Advance Access originally published online on April 15, 2008
The European Journal of Public Health 2008 18(5):527-532; doi:10.1093/eurpub/ckn022
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© The Author 2008. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Mortality

Patient survival for all cancers combined as indicator of cancer control in Europe

Arduino Verdecchia1, Paolo Baili2, Alberto Quaglia3, Ian Kunkler4, Roberta Ciampichini2, Franco Berrino5 and Andrea Micheli2

1 Center for Epidemiology, Health Surveillance and Promotion, Istituto Superiore di Sanità, Rome, Italy
2 Descriptive Epidemiology and Health Planning Unit, Fondazione IRCCS ‘Istituto Nazionale dei Tumori’, Milan, Italy
3 Liguria Region Cancer Registry, Descriptive Epidemiology Unit, National Cancer Research Institute, Genoa, Italy
4 Department of Oncology, University of Edinburgh, Edinburgh, Scotland, UK
5 Etiologic Epidemiology and Prevention Unit, Fondazione IRCCS ‘Istituto Nazionale dei Tumori’, Milan, Italy

Correspondence: Dott. Andrea Micheli, Descriptive Epidemiology and Health Planning Unit, Fondazione IRCCS ‘Istituto Nazionale dei Tumori’, Via Venezian, 1, 20133 Milan, Italy, tel: +39 02 23902867/3526, fax: +39 02 23903528, e-mail: andrea.micheli{at}istitutotumori.mi.it

Received September 19, 2007 , accepted March 13, 2008

Background: EUROCARE found marked differences in cancer survival across European populations, provoking extensive discussion as to the cause. We investigated the influence of socioeconomic indicators on survival, making use of the indicator population-based age-standardized and cancer site-standardized relative survival for all cancers combined (all cancer survival). Methods: Bivariate correlation and multivariate regression analyses investigated relations between 1995 socioeconomic variables and all cancer survival in EUROCARE-3 patients from 19 European countries diagnosed 1990–94 and followed to 1999. Results: Gross domestic product (GDP) and total national expenditure on health (TNEH) correlated highly with all cancer survival. Wealthy northern and western European countries had high survival; eastern European countries had low all cancer survival. GDP, TNEH, and number of computed tomography scanners per million—proxy of technological investment in cancer care—explained most survival differences. Low all cancer survival in the UK and Denmark compared to countries of similar wealth was closely related to fewer computed tomography scanners. Low all cancer survival in Poland compared to countries of similar wealth was also related to low TNEH. Conclusions: All cancer survival appears a useful and important indicator for monitoring countries’ performance in cancer control. The most direct way for poorer European countries to improve all cancer survival would be to get richer; for richer countries more investment in health technology is important. However the sharply increasing costs of cancer care may render this impossible suggesting the need to radically rethink cancer control strategies.

Keywords: cancer survival, cancer indicator, cancer control, EUROCARE, EUROCHIP


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