Kathrin Strasser-Weippl1st Medical Department

Wilhelminen Hospital, Vienna

Cancer Care in Europe

Cancer in Europe

• Cancer is the 2nd most common cause of death in Europe• 2 mio. people are diagnosed with cancer/year• 1 out of 3 people will be diagnosed with cancer during their lifetime• 1 out of 4 people in the EU die of cancer

Cancer Incidence in Europe

• Cancer incidence in Europe is on the increase

• Difference in cancer incidence between different parts of Europe

differences in lifestyle and associated risk factors, e.g. smoking, diet, reproductive behaviour

unknown factors

Cancer mortality in Europe

• Cancer mortality is different according to country and region in Europe

different incidence of tumour types

other reasons?

Incidence versus Mortality : Males 2002Mortality (ASR)Mortality (ASR)Incidence (ASR)Incidence (ASR)

Incidence versus Mortality: Females 2002

Incidence (ASR)Incidence (ASR) Mortality (ASRMortality (ASR)

• Difference in mortality is NOT solely due to difference in cancer incidence• Other reasons?

- stage at diagnosis?- organizational?- availability of cancer drugs?- patient advocacy groups?

Cancer Survival in Europe

• Difference in Mortaliy is NOT solely due to difference in cancer incidence

Other reasons?

- stage at diagnosis?- organizational?- availability of cancer drugs?- patient advocacy groups?

Cancer Survival in Europe

Stage at diagnosis: Breast cancer, Slovenia 1973-2002

Cancer Registry of SloveniaCancer Registry of Slovenia

Stage at diagnosis

• Difference in mortality between NW and CE Europe is explained by differences in incidence/stage at diagnosis for:

- Breast cancer

- Colorectal cancer

- Female reproductive tract

effective screening measures in NW Europe: pap smear screening for cervical cancer precursors starting not later than the age of 30; mammography screening for breast cancer in women aged 50-69 in accordance with European guidelines on quality assurance in mammography faecal occult blood screening for colorectal cancer in men and women age 50‑74. EUROCARE 3 study

• screening measures lead to diagnosis earlier in the disease process increase in cancer incidence

• Lead-time bias! - Early diagnosis falsely appears to prolong survival

• BUT: early diagnosis also facilitates earlier treatment and potentially saves lifes

Cancer Diagnosis and Follow-Up

• Difference in Mortaliy is NOT solely due to difference in cancer incidence

Other reasons?- stage at diagnosis?

- organizational (cancer centres, money, education)?

- availability of cancer drugs?- patient advocacy groups?

Cancer Survival in Europe

• Patients with breast cancer have 9% better survival at five years and 8% better survival at 10 years when cared for by specialist surgeons

• A reduction in risk of dying of 16% (6-25%) was found after adjustment for the prognostic factors of age, tumor size socioeconomic status, and

nodal involvement

Cancer care by specialists

Gillis CR, Hole DJ 1996

•proportion of gross domestic product devoted to health care in Europe varies:

- Poland: 6%- Germany: 10.6%

• not all countries have National Cancer Registries and National Cancer Plans – quality control

• decentralisation of healthcare structure in CEE countries has lead to regional inequities

• 25% of the difference in mortality rates between NW and CE Europe are due to inadequacies in healthcare

Organizational Issues: NW vs CE Europe

Institute des Sciences de la Sante 2004

• medical education strongly correlates with research efforts

•in 2002/03 1.43 billion Euro were spent on cancer research in Europe

• 93% of total funding came from EU countries, and >50% from the former EU-15

• 9 NW European countries spend > 10 mio. Euro on cancer research/year

• 10 European countries spend < 1 mio. Euro on cancer research/year

Cancer Education in Europe

Wilking, Jöngsson Karolinska Institutet 2005

• Difference in Mortaliy is NOT solely due to difference in cancer incidence

Other reasons?- stage at diagnosis?- organizational?

- availability of cancer drugs?- patient advocacy groups?

Cancer Survival in Europe

Availibility of Cancer Drugs

Wilking, Jöngsson Karolinska Institutet 2005

• the median time for approval of new cancer drugs in Europe is 418 days

• the target time for approval set by the EU is 90 days!

•Austria, Spain, Switzerland are above average in terms of adoption of new cancer drugs

• Czech Republic, Hungary, Norway, Poland and UK are below average

Availibility of Cancer Drugs

Wilking, Jöngsson Karolinska Institutet 2005

Availibility of Cancer Drugs: Drugs approved 2000-2004

Wilking, Jöngsson Karolinska Institutet 2005

Country % Of Drugs Time delay (days)

Austria 69 82

Czech Rep. 62 389

Estonia 41 131

Germany 82 0

France 55 431

Hungary 20 214

Poland 106 2190

Slovakia 40 453

UK 86 0

USA 100 0

Availibility of Cancer Drugs

Wilking, Jöngsson Karolinska Institutet 2005

• there is strong inequality in the uptake of new cancer drugs throughout Europe (except for

Imatinib)

• the ability of cancer patients to access new drugs depends on where they live

• uptake of new cancer drugs is generally slower in CEE countries

Availibility of Cancer Drugs

F. Lichtenberg 2005

• the increase in the number of cancer drugs in 1975-95 in the US accounted for 50% of the increase in survival 6 years after diagnosis

• it accounted for >10% of the increase of US life expectancy

the number of available cancer drugs is associated with 1-year and 5-year survival rates

• Difference in Mortaliy is NOT solely due to difference in cancer incidence

Other reasons?- stage at diagnosis?- organizational?- availability of cancer drugs?

- patient advocacy groups?

Cancer Survival in Europe

• European Cancer Patient Coalition: 153 members

• none of the founding member organizations from CEE countries

• by 2005 only 9/153 member organizations from CEE countries

• association between quality of cancer care and work of patient advocacy groups??

• EU funds for new member countries make work of lobbies very important

Patient Advocacy Groups

ECPC Website

• There is a gap in cancer survival between NW and CEE countries

• lead-time-bias

• however, part of this gap is due to inequalities in cancer care in Europe

• availability of cancer drugs is hampered in CEE countries

• structure of healthcare often leads to regional inequalities in CEE countries

Cancer Care in Europe – Conclusion (1)

• funding for research is less in CEE countries than in NW Europe (and less in NW Europe than in the US)

• EU structural funds for new members may help to reduce the health gap between NW and CE Europe

lobby work of patient advocacy groups to apply for and adequately direct EU funds is very important

Patient advocacy groups play a major role in improving cancer care in Europe

Cancer Care in Europe – Conclusion (2)