I have made much about how lousy the UK five year survival rates are relative to the US. A researcher comes up with a statistical explanation for why the survival rates -- while bad -- may not be as bad as Poland's:
This is all from a Financial Times article entitled: "Why the UK's Cancer Survival Rates Look Bad"
www.ifpma.org/PressReviewEmail/PressReviewDetail.aspx
"Of the 20-plus countries in the Eurocare survey, only 10 look at the entire population. In 1998, the starting point for the latest five-year figures, Germany's figures covered just 1 per cent of the population, the Czech Republic 8 per cent, Poland 9 per cent and Spain and France 16 and 17 per cent respectively.
Prof Richards says that for instance in Italy, the figures cover only 28 per cent of the population, mainly in the affluent north "so it is almost certain their figures overestimate survival rates".
That's the good news. And Professor Richard's makes a fair point if he can prove that the smaller slice of cancer patients surveyed are more likely to be over-represented by people who are more likely to survive. Gee, that's just like infant mortality rates where some countries only count babies as alive if they live for 30 days while in the US we count them from the time they leave the womb.
Now the bad:
The UK has 100 per cent coverage, as do the Nordic countries. "Sweden, Norway and Finland do have appreciably better survival rates than we do, while Denmark looks remarkably like the UK across a whole range of factors," he says. "There is a real gap between us and the Nordic countries, and our task is to narrow that."
While the UK is slower than some other European countries to adopt newer cancer drugs, late diagnosis seems to be the real culprit. "Most of it is accounted for by our one-year survival rates," Professor Richards says. "If you get past that, our survival rates look much more like the European average. And one-year survival is most often correlated with advanced disease. There are relatively few cancers that will kill you in a year if they are diagnosed early". Smaller-scale studies also suggest that when patients in the UK seek help their disease is more advanced.
Does anyone have any idea why UK patients get help later when new drugs are less effective? Anyone?
Prof. Richard suggests:
Some of that may be cultural: stoical Britons may delay seeing a doctor. The government's cancer plan aims to tackle that through better education and better screening, backed by large investments in radiotherapy.
Stoical? Hardly. Resigned and outraged is more like it. But Richards also believes the Eurocare survey understates advances in survival because it is based on old data:
'Prof Richards believes that the reason Britain's figures are not better, despite the huge resources ploughed into tackling the problem, is that the numbers used for international comparisons are out of date, relating to cancers diagnosed in 1999 and 2000. "They predate the UK's big surge in spending after 1999, and any impact from the national cancer plan. We have a problem, but we are tackling it. I am pretty sure we are narrowing the gap".
In fact, many of the methodological problems with the Eurocare survey have been addressed in other articles, notably by Dr. Franco Berrino who took note of them in earlier surveys and adjusted for both over and under estimation of survival by weighting five year survival rates of all countries studies based on limitations deriving from the quality of registry data. Berrino, et al also use period analysis instead of the traditional cohort analysis provides long-term survival estimates that also take into consideration survival of more recently diagnosed patients. By every measure the UK lags behind Western health systems in Europe and the US in particular which has more heterogeneity in its cancer population.
www.thelancet.com/journals/lanonc/article/PIIS1470204507702462/fulltext
This is all from a Financial Times article entitled: "Why the UK's Cancer Survival Rates Look Bad"
www.ifpma.org/PressReviewEmail/PressReviewDetail.aspx
"Of the 20-plus countries in the Eurocare survey, only 10 look at the entire population. In 1998, the starting point for the latest five-year figures, Germany's figures covered just 1 per cent of the population, the Czech Republic 8 per cent, Poland 9 per cent and Spain and France 16 and 17 per cent respectively.
Prof Richards says that for instance in Italy, the figures cover only 28 per cent of the population, mainly in the affluent north "so it is almost certain their figures overestimate survival rates".
That's the good news. And Professor Richard's makes a fair point if he can prove that the smaller slice of cancer patients surveyed are more likely to be over-represented by people who are more likely to survive. Gee, that's just like infant mortality rates where some countries only count babies as alive if they live for 30 days while in the US we count them from the time they leave the womb.
Now the bad:
The UK has 100 per cent coverage, as do the Nordic countries. "Sweden, Norway and Finland do have appreciably better survival rates than we do, while Denmark looks remarkably like the UK across a whole range of factors," he says. "There is a real gap between us and the Nordic countries, and our task is to narrow that."
While the UK is slower than some other European countries to adopt newer cancer drugs, late diagnosis seems to be the real culprit. "Most of it is accounted for by our one-year survival rates," Professor Richards says. "If you get past that, our survival rates look much more like the European average. And one-year survival is most often correlated with advanced disease. There are relatively few cancers that will kill you in a year if they are diagnosed early". Smaller-scale studies also suggest that when patients in the UK seek help their disease is more advanced.
Does anyone have any idea why UK patients get help later when new drugs are less effective? Anyone?
Prof. Richard suggests:
Some of that may be cultural: stoical Britons may delay seeing a doctor. The government's cancer plan aims to tackle that through better education and better screening, backed by large investments in radiotherapy.
Stoical? Hardly. Resigned and outraged is more like it. But Richards also believes the Eurocare survey understates advances in survival because it is based on old data:
'Prof Richards believes that the reason Britain's figures are not better, despite the huge resources ploughed into tackling the problem, is that the numbers used for international comparisons are out of date, relating to cancers diagnosed in 1999 and 2000. "They predate the UK's big surge in spending after 1999, and any impact from the national cancer plan. We have a problem, but we are tackling it. I am pretty sure we are narrowing the gap".
In fact, many of the methodological problems with the Eurocare survey have been addressed in other articles, notably by Dr. Franco Berrino who took note of them in earlier surveys and adjusted for both over and under estimation of survival by weighting five year survival rates of all countries studies based on limitations deriving from the quality of registry data. Berrino, et al also use period analysis instead of the traditional cohort analysis provides long-term survival estimates that also take into consideration survival of more recently diagnosed patients. By every measure the UK lags behind Western health systems in Europe and the US in particular which has more heterogeneity in its cancer population.
www.thelancet.com/journals/lanonc/article/PIIS1470204507702462/fulltext
