Will the world ever be cancer free?

Cancer: Survival Rates in International Comparison

December 4th, 2019 - The chance of surviving cancer continues to increase in countries with higher incomes. This is shown by a study published in the journal The Lancet. What is surprising, however, are the sometimes considerable differences between the countries being compared: How high the cancer survival rate is also depends on which country you live in.

In Denmark they do it differently. Because the small country had significantly higher cancer mortality rates than many other comparable western countries, it was decided in 2007 to take up the fight against cancer more strategically. So-called Cancer Patient Pathways (CPP) were introduced. The goal: an earlier, faster diagnosis. The rule of thumb is that for every second cancer patient who presents themselves to their general practitioner, the symptoms are either severe, but not directly indicative of cancer, or are not severe but only vague. And that demonstrably leads to delayed diagnoses.

The problem is, time is something that cancer patients don't have.

A patient with vague findings waited an average of 2.5 months longer for a diagnosis than someone whose diagnosis leaves no doubt from the outset. With the introduction of CPPs - how they work is described here - doctors have the opportunity to refer their patients with poor and unclear findings directly to specialized centers. This evaluation proves the success of the strategy:

  • Across all cancer types, the three-year relative survival in Denmark increased from 45 to 54 percent (based on data that were evaluated between 2004 and 2010).
  • Even more clear: in gynecological cancer patients it even rose from 58 to 75 percent.
  • 16.2 percent of patients with severe but unspecific symptoms were found to actually have cancer - they could be treated accordingly.
  • After the introduction of CPPs, the waiting time for diagnosis decreased by 17 days (from 49 to 35 days).

No wonder the Danes stand out in the SURVMARK-2 study published in the Lancet in September 2019. The study analyzed data from nearly four million cancer patients from seven countries: Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK. Cancers of the esophagus, stomach, intestines and colon, pancreas, lungs and ovaries were taken into account.

The highest cancer survival rates: Australia, Canada, Norway

The long-term observation shows that cancer survival rates in the seven countries studied have increased continuously since 1995. This is particularly true - at least in relative terms - of the types of cancer for which the prognosis for the patient is worst (esophagus, stomach, lungs and pancreas), and especially for those who are younger than 75 years of age when diagnosed. In the country comparison, Australia, Canada and Norway performed best across all cancer types examined.

However, the differences between the countries are sometimes considerable, depending on the type of cancer: In the study period 2010 to 2014, the five-year survival rate for pancreatic cancer in Australia, at 14.6 percent, is almost twice as high as in Great Britain (7.9 percent). Even with stomach cancer, patients in Australia have a significantly better chance of surviving five years with 32.8 percent than the British with 20.8 percent - the difference is at least 12 percentage points. In the types of cancer examined, the chances of survival are highest in the intestine and colon: in Australia, five years after diagnosis, 70.8 percent of those affected are still alive. Here, too, the British are at the bottom again (with 58.9 and 62.1 percent, respectively).

Higher cancer survival rates through health policy decisions

Although the Danes are in the middle of this international comparison, they have increased considerably since the mid-1990s. The five-year survival rate for esophageal cancer grew from 5.1 percent (1990-1999) to 14.7 percent (2010-2014) - a threefold increase. It is noticeable that the highest rates of increase occur in the period after the introduction of the CPPs. Thanks to this health policy reform, the country has managed to catch up.

An overview of the so-called age-standardized five-year survival rates per country and type of cancer - broken down by observation period - can be found in Table 2 of the study.

"The improvements in cancer survival rates," the study's authors write, "are likely a direct consequence of major health sector reforms and technological advances that have made earlier diagnoses, more effective and targeted therapies, and better patient management possible." the greater accuracy of targeted therapies that are used on the basis of molecular biomarkers "probably has a part in this."

For the differences, which are sometimes considerable in an international comparison, there is still further research need for the scientists. B. the stage of the disease at diagnosis - that is, the question of how good a health system is at detecting cancer at an early stage. Or the extent of the accompanying illnesses or comorbidities - and thus the question of how healthy a population is in general. Or the speed with which the affected people have access to effective drugs - in other words, the question of how much time passes before a drug approved in Europe actually arrives in everyday healthcare.

Cancer drug: Four years later in the UK than in Germany

This example shows how great the differences can be in the access of seriously ill patients to drug innovations in Europe: In May 2019, the British organization Cancer Research UK celebrated that patients with multiple myeloma, a cancer of the blood-forming system, were now combined with the immunomodulator lenalidomide can be treated with dexamethasone. This is "fantastic news" for the patients and their relatives. And not just because studies have shown that the therapy significantly extends progression-free survival - i.e. the time from the start of therapy to the point at which the disease status worsens again - as well as overall survival. It is also an important therapy option when other medications lose their effectiveness and the treating physicians are dependent on alternatives.

The bitter thing is: The decision for the therapy comes four years after the corresponding approval in Europe. That doesn't happen in Germany. Because a Europe-wide approved drug can be prescribed there immediately. Its availability does not depend on the result of a benefit assessment procedure and pricing - this process is downstream and only needs to be completed in the first twelve months after approval. This principle of "We-treat-now-and-talk-later" is a blessing, especially for seriously ill people. For example, patients in Germany already have access to the next advances in therapy in this indication, which will once again significantly extend overall survival.

It is likely that such differences in health policy frameworks contribute to the fact that countries with a similar standard of living stand so differently in terms of cancer survival rates.