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Survival rates of Czech cancer patients have improved

Earlier this year, two studies analysing survival rates of cancer patients in the Czech Republic and across Europe were published [12]. Survival rates of cancer patients belong to key parameters in terms of evaluation of cancer care outcomes, and of fulfilling the National Cancer Control Programme. The good news from both studies is that outcomes of the Czech cancer care have improved in most diagnoses: both in terms of time trends, and when compared to other European countries. However, there is much space for improvements in cancer prevention efforts as well as early diagnosis of less advanced stages; and last but not least, the availability of cancer diagnosis and treatment in individual regions of the Czech Republic needs to be further improved.


EUROCARE-5 study: the Czech Republic now ranks better in Europe

The EUROCARE-5 study [1] analysed data from cancer registries from 29 countries in order to compare 5-year relative survival rates of more than 9 million cancer patients in the period between 2000 and 2007. Considering the fact that the source datasets from the involved countries varies greatly as regards their structure and quality, it is only possible to perform such comparisons in a limited number of cancer types, and without any differentiation between clinical stages.

5-year relative survival
5-year relative survival rates describe the percentage of patients with a disease that are alive five years after their disease is diagnosed divided by the percentage of the general population of corresponding sex and age that are alive after five years.

Results of the EUROCARE-5 study documented a general trend accross Europe, which is an improvement in survival rates of cancer patients; that can be largely attributed to modern therapies, better diagnostic methods, and even cancer screening programmes in some cases. However, there are significant differences among individual countries and regions in terms of reported survival rates. In most cancer diagnoses, Nordic countries and Central European countries achieved the best result, while the survival rates of the former Eastern Europe continue to lag behind those of the former Western Europe. In this respect, the Czech Republic is an exception: in a majority of diagnoses, the 5-year relative survival of Czech cancer patients is getting close to the European average, and significantly exceeds the Eastern European average. Among the 10 cancer types which were analysed, this applies to malignant melanoma of skin, ovarian cancer and kidney cancer, in particular.

Better survival rates for breast cancer patients when compared with the Eastern European average is another excellent result speaking in favour of the Czech cancer care: 5-year relative survival for breast cancer in the Czech Republic is 78.0%, while the European average is 81.8%, and the Eastern European average only amounts to 73.7%. Improvements in this statistics can be largely attributed to the organised programme of breast cancer screening. In general, it is obvious that a timely diagnosis of cancer in less advanced stages is the most important factor contributing to improvements in survival rates in the entire population (regardless of clinical stage of the disease at the time of diagnosis). Apart of the above-mentioned breast cancer in women, prostate cancer and malignant melanoma of skin are other examples of this phenomenon.

Figure 1 shows the results of the EUROCARE-5 study for individual diagnoses.

Figure 1. Survival rates of cancer patients in European countries according to the EUROCARE-5 study [1]: ten common cancers, analysed period 2000-2007.

Czech national study: early diagnosis is of key importance for a better survival

Figure 2. Survival rates of Czech cancer patients according to the Czech national study [2]: various diagnoses, without differentiation among clinical stages, analysed periods 2000-2004 and 2005-2008.

Data describing survival rates of Czech cancer patients was published by a team of leading Czech oncologists and analysts at the beginning of 2014 [2]. The analyses were based on data from the Czech National Cancer Registry. Unlike the EUROCARE-5 study, the Czech study evaluated survival rates of cancer patients with respect to the stage at which the tumour was diagnosed. Analysis of Czech data is therefore more detailed than that performed in the European study; on top of that, the Czech study provides a comparison between long-term time trends. Results of the Czech study again confirmed a well-known fact that an earlier diagnosis results into a longer survival. Figures 2 and 3 document statistically significant improvements in survival rates over time, which were observed even when comparing two relatively recent periods of 2000–2004 and 2005–2008.

The unified methodology makes it possible to compare 5-year relative survival rates of Czech cancer patients between the periods 2000–2007 (as presented in the EUROCARE-5 study) and 2005–2008 (as presented in the Czech national study). Table 1 shows a slight increase in survival rates even when comparing those two partly ovelapping periods. 

Figure 3. Survival rates of Czech cancer patients according to the Czech national study [2]: various diagnoses, differentiation among clinical stages, periods 2000-2004 and 2005-2008.

Table 1: Comparison of age-standardised 5-year relative survival rates of Czech cancer patients: EUROCARE-5 study (2000-2007) and analysis of CNCR data performed by IBA MU (2005-2008).

Diagnosis EUROCARE-5 study [1]
Evaluated period: 2000-2007
Czech national study [2]
Evaluated period: 2005-2008
5-year relative survival
95% confidence interval
5-year relative survival
95% confidence interval
stomach cancer 22.0 (21.1-23.0) 22.5 (20.0-25.0)
colon cancer 52.5 (51.8-53.2) 53.1 (51.5-54.7)
rectal cancer 48.7 (47.9-49.6) * *
lung cancer 11.5 (11.0-11.9) 11.1 (9.9-12.3)
skin melanoma 83.4 (82.4-84.3) 84.7 (82.2-87.2)
breast cancer (women)

78.0

(77.3-78.7) 79.8 (78.2-81.4)
ovarian cancer 36.3 (35.0-37.6) 38.4 (35.3-41.5)
prostate cancer 78.2 (77.1-79.2) 82.2 (78.5-85.9)
kidney cancer 59.9 (58.9-60.9) 62.7 (60.2-65.2)
non-Hodgkin lymphoma 57.3 (56.0-58.5) ** **

* The Czech study evaluated colorectal cancer as a whole.
** The Czech study did not evaluate blood cancers.

Conclusion

International and Czech analyses of national data have proved statistically significant improvements in survival rates of Czech cancer patients over time, particularly in diagnoses where a detection at less advanced stages substantially contributes to a better survival (breast cancer, prostate cancer, skin melanoma etc.). When compared with the rest of Europe, the Czech Republic now exceeds survival rates observed in Eastern European countries, and catches up with developed Central European countries. However, these good news do not imply that there is not much space for further improvements. Many European countries, notably the Nordic ones, have regularly achieved even better results. Making every effort to diagnose cancer patients at the earliest stages possible, effective promotion of ongoing cancer screening programmes, a reasonable degree of centralisation of cancer care (necessarily linked to a thorough quality control), and the support for a timely and correct availabilty of innovative procedures and medicinal products for patients - all these are key measures potentially leading to further improvements in the Czech Cancer care, as recommended by an OECD expert panel evaluating the cancer care in detail [3].

References

  1. De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, et al. EUROCARE-5 Working Group. Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE-5-a population-based study. Lancet Oncol 2014; 15(1): 23-34.
  2. Pavlík T, Májek O, Büchler T, Vyzula R, Petera J, Ryska M, Ryška A, Cibula D, Babjuk M, Abrahámová J, Vorlíček J, Mužík J, Dušek L. Trends in stage-specific population-based survival of cancer patients in the Czech Republic in the period 2000-2008. Cancer Epidemiol 2014; 38(1):28-34.
  3. OECD. Health Policy Studies - Cancer Care: Assuring Quality to Improve Survival. Country note: Czech Republic [online]. Available from WWW: http://www.oecd.org/els/health-systems/Cancer-Care-Czech-Republic-2013.pdf.

 

Authors: Jakub Gregor, Tomáš Pavlík, Ondřej Májek, Lenka Šnajdrová, Ladislav Dušek (IBA MU)

13. 4. 2014 IBA MU


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