When is a cancer patient cured? (Results from the EUROCARE-5 study)

Abstract Background Although heterogenous risks of recurrence or late effects according to cancer type and host factors exist, increasing evidence of cure has emerged for some cancers. This leads, among other important topics, to the so-called “right to be forgotten” law, adopted in France and Belgium to help cancer survivors access loans and insurance. The aim of the study was to estimate population-based indicators of cancer cure in Europe by type, sex, age, and period. Methods Data from 7.2 million cancer patients, aged 15-74 years, from 42 population-based cancer registries in 17 countries were extracted from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: a) median life expectancy of fatal cases (LEF); b) cure fraction (CF) as a proportion of patients with death rates similar to the general population; and c) time to cure (TTC) as the time to reach five-year conditional relative survival (CRS)>95%. Results LEF ranged from 10 years for patients with chronic lymphocytic leukemia to < 6 months for those with liver, pancreas, brain, gallbladder, and lung cancers. The CF was 94% for testis, 87% for thyroid cancer in women (70% in men), 86% for skin melanoma in women (76% in men), 66% for breast, 63% for prostate, and <10% for liver, lung, and pancreatic cancers. TTC was <5 years for testis and thyroid cancer patients diagnosed below age 55 years, and <10 years for stomach, colorectal, corpus uteri, and melanoma patients of all ages. For breast and prostate cancers, a small excess remained for at least 15 years. Conclusions In a context of increasing number of people living after a cancer diagnosis, these results may help to reduce unneeded medicalization (e.g., follow-up) and resources needed for their care, and they further document that there is already a cure for some cancers. Fundings This work was supported by the Italian Association of Cancer Research (AIRC) and the European Commission (IPAAC). Key messages Cancer cure indicators are provided for European patients and 32 cancer type. Recognizing cancer patients as cured has relevant clinical and social implications.

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Cancer cure for 32 cancer types: results from the EUROCARE-5 study

International Journal of Epidemiology ◽

10.1093/ije/dyaa128 ◽

2020 ◽

Vol 49 (5) ◽

pp. 1517-1525

Author(s):

Luigino Dal Maso ◽

Chiara Panato ◽

Andrea Tavilla ◽

Stefano Guzzinati ◽

Diego Serraino ◽

...

Keyword(s):

Thyroid Cancer ◽

Cancer Patients ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Lung Cancers ◽

Pancreatic Cancers ◽

Corpus Uteri ◽

Cure Fraction ◽

Prostate Cancers

Abstract Background Few studies have estimated the probability of being cured for cancer patients. This study aims to estimate population-based indicators of cancer cure in Europe by type, sex, age and period. Methods 7.2 million cancer patients (42 population-based cancer registries in 17 European countries) diagnosed at ages 15–74 years in 1990–2007 with follow-up to 2008 were selected from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: (i) life expectancy of fatal cases (LEF); (ii) cure fraction (CF) as proportion of patients with same death rates as the general population; (iii) time to cure (TTC) as time to reach 5-year conditional relative survival (CRS) >95%. Results LEF ranged from 10 years for chronic lymphocytic leukaemia patients to <6 months for those with liver, pancreas, brain, gallbladder and lung cancers. It was 7.7 years for patients with prostate cancer at age 65–74 years and >5 years for women with breast cancer. The CF was 94% for testis, 87% for thyroid cancer in women and 70% in men, 86% for skin melanoma in women and 76% in men, 66% for breast, 63% for prostate and <10% for liver, lung and pancreatic cancers. TTC was <5 years for testis and thyroid cancer patients diagnosed below age 55 years, and <10 years for stomach, colorectal, corpus uteri and melanoma patients of all ages. For breast and prostate cancers, a small excess (CRS < 95%) remained for at least 15 years. Conclusions Estimates from this analysis should help to reduce unneeded medicalization and costs. They represent an opportunity to improve patients’ quality of life.

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Variations in the Survival of Adult Cancer Patients in Italy

Tumori Journal ◽

10.1177/030089169708300112 ◽

1997 ◽

Vol 83 (1) ◽

pp. 497-504 ◽

Cited By ~ 24

Author(s):

Gemma Gatta ◽

Eva Buiatti ◽

Ettore Conti ◽

Vincenzo De Lisi ◽

Fabio Falcini ◽

...

Keyword(s):

Cancer Patients ◽

Geographical Area ◽

Central Italy ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Italian Population ◽

Age Class ◽

General Survival ◽

General Improvement

Aims As part of the ITACARE project, the present study analyzed and compared population-based data on the survival of adult cancer patients in Italy, according to sex, age, period of diagnosis and geographical area. Methods Nine Italian population-based cancer registries provided data on all their cancer patients (total 90,431 cases) followed for at least 5 years and diagnosed during the period 1978–1989. About 10% of the Italian population is covered by these registries. The data was analyzed by means of a multivariate model. Results The major findings were that there was a general improvement in 5-year relative survival over the study period (from 33% to 39%) and that there were significant differences in survival between different areas of the country, particularly for cancer sites which respond well to treatment. In general, the area covered by the Ragusa (Sicily) registry was characterized by significantly worse survival than other registry populations. Other important findings were that for all malignant cancer sites 5-year relative survival decreased with age from 50% for the youngest age class (15–44 years) to 27% for the oldest age class (75+ years) and that women have a better prognosis for most cancer sites (overall 5-year relative survival in women 48% vs 32% in men). Conclusions The significant regional differences in survival may reflect unequal provision of care, particularly between northern-central Italy and the south. The reasons for the general survival improvement with time are not completely understood, whereas the marked overall sex difference is related to the fact that the commonest cancer in women (breast cancer) is eminently more treatable than the commonest malignancy in men (lung cancer). The unfavorable trend with increasing age may be due to increasing difficulty in applying complete therapy protocols as general health declines, sometimes in relation to an advanced cancer stage at diagnosis.

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Studying Survival of Cancer Patients in Different Populations: Its Potential and Role

Tumori Journal ◽

10.1177/030089169708300104 ◽

1997 ◽

Vol 83 (1) ◽

pp. 3-8 ◽

Cited By ~ 15

Author(s):

Andrea Micheli ◽

Gemma Gatta ◽

Arduino Verdecchia

Keyword(s):

Cancer Patients ◽

Health Expenditure ◽

Cancer Survival ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Malignant Neoplasms ◽

Regional Health ◽

Italian Regions ◽

Different Populations

Rationale Survival figures from a population-based study incorporate the overall practice in diagnosis, cure and clinical follow-up for a specific disease within a given health care system. Being the outcome of a number of individual, social and economical aspects, population-based survival may be thought as index for measuring the level of a country's development. Data The EUROCARE project, a European Cancer Registries (CR) concerted action, provided reliable information on survival for more than 800,000 cancer patients from 11 European countries. A great deal of epidemiologic information has derived from EUROCARE. Women had a longer survival than men for all studied tumour sites, except for the colon. European survival variability was fairly high for several cancers, but it was lower for cancers with a relatively good prognosis and those sensitive to treatment. The ranking of populations of cancer survival tended to be fairly stable for many cancers: CR of Switzerland and Finland ranked high and Polish CR low. Denmark, Italian and France CR did not substantially differ from the European survival average. For most cancers, prognosis improved during the studied period (years of diagnosis: 1978–1985). Survival figures for colon (r = 0.74, males; r = 0.73, women) and female breast cancer (r = 0.57) well correlated with the national health expenditure of different participating countries. The ITACARE study, a new Italian Cancer Registries collaborative project involving more than 100,000 cancer patients, was set up to study survival differences within the country. Survival of cancer patients was not homogeneous in 7 studied Italian regions (the estimated 5-year relative survival for all malignant neoplasms combined ranked from 37.8% in CR of Sicily to 42.1% in those of Emilia-Romagna). The lowest levels of regional health expenditures were accompanied by the lowest levels of prognosis for overall cancers. However, a relatively low correlation among patient cancer survival and the regional health expenditure (r = 0.21) was found, suggesting that other factors such as different efficiency in managing cancer may play a role in explaining the intracountry differences. Conclusions Population-based survival figures may be used to study epidemiologic aspects, comparing different health systems, and may be interpreted as indexes for discussing inequalities in health in different populations.

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Survival in Adult Italian Cancer Patients, 1978–1989

Tumori Journal ◽

10.1177/030089169708300109 ◽

1997 ◽

Vol 83 (1) ◽

pp. 39-425 ◽

Cited By ~ 23

Author(s):

Arduino Verdecchia ◽

Riccardo Capocaccia ◽

Roberta De Angelis ◽

Fulvia Valente ◽

...

Keyword(s):

Cancer Patient ◽

Cancer Patients ◽

Patient Survival ◽

National Level ◽

International Comparisons ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Cancer Site ◽

Malignant Neoplasms

Aims To present a systematic analysis of population-based cancer patient survival in Italy. Methods Population-based survival data have been made available from 10 Italian cancer registries within the ITACARE project. Data, collected and validated using a common protocol, included over 100,000 patients with cancer diagnosed between 1978 and 1989. Multivariate weighted analysis was used to provide relative survival estimates attributable to Italy at national level. Results Results are presented, according to a systematic frame, as the main object of the ITACARE study, involving crude and relative survival figures for adult Italian cancer patients, by age, sex, period of diagnosis and registry area. An estimate with reference to Italy as a whole is also presented by cancer site and for all malignant neoplasms combined. Age-standardized relative survival figures are presented to allow comparisons between Italian registries and also to give a basis for international comparisons with countries involved in the EUROCARE study. Conclusions For the fist time, population-based survival of cancer patients is made available in Italy on a large scale analysis of data from all the Italian cancer registries in a combined action. Estimates of cancer patient survival at a national level in Italy allow proper international comparisons with European countries and give elements of evaluation and discussion on the performance of the Italian health care system.

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The Itacare Study

Tumori Journal ◽

10.1177/030089169708300106 ◽

1997 ◽

Vol 83 (1) ◽

pp. 17-24 ◽

Cited By ~ 10

Author(s):

Milena Sant ◽

Gemma Gatta ◽

Fulvia Valente ◽

Alessandro Barchielli ◽

Valerio Ramazzotti ◽

...

Keyword(s):

Cancer Patients ◽

Survival Data ◽

Collaborative Study ◽

Transitional Cell ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Italian Population ◽

Breast Cancer Patients

ITACARE is a collaborative study on the survival of Italian cancer patients diagnosed in the period 1978–1989. The study involves 11 Italian population-based cancer registries (CRs) (Firenze, Forlì-Ravenna, Genova, Latina, Modena, Parma, Ragusa, Torino, Varese, the childhood CR of Piedmont and the colorectal CR of Modena), and its principal aim is to identify and analyze possible differences between the areas covered by the CRs. This article describes the ITACARE database. Ten percent of the Italian population is covered by the participating CRs, most of which are located in the northern part of the country. All malignant cancer sites (classified by ICD-9) except skin cancers were included. For bladder cancers, papillomas and transitional cell tumours grade 1 and 2 were also included. Survival data on over 100,000 cases were collected. The principal information variables were sex, date of birth, diagnosis and end of follow-up, life status, ICD-9 code for tumour site, diagnosis modality (clinical, cytologic confirmation, histologic confirmation), ICD-0 morphology code, and tumour stage (grouped into broad categories). Follow-up is active in all registries. All cases were checked systematically for errors and inconsistencies, following which about 0.2% of cases were excluded from the analyses. The percentage of cases microscopically verified, which is an indicator of diagnostic accuracy and data reliability, was higher among patients under 65 years of age (90%), breast cancer patients (92%) and cases covered by the Varese, Torino and Forlì-Ravenna CRs (more than 82%). The percentage of cases known by death certificate only (an indicator of the completeness and quality of registration) was about 3% of total cases and was higher among older patients (4%). Province-specific mortality, used to compute relative survival from cancer (i.e., survival adjusted for competing causes of death), varied according to period of diagnosis, sex and area: the highest mortality was among women of the Ragusa CR (Sicily) and men in northern CRs. Overall mortality decreased during the period, more markedly in the north and among women.

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DYNAMICS OF OBSERVED AND RELATIVE SURVIVAL OF COLON CANCER PATIENTS IN ST. PETERSBURG AND THE REPUBLIC OF BELARUS (ACCORDING TO POPULATION-BASED CANCER REGISTRIES)

Problems in oncology ◽

10.37469/0507-3758-2017-63-3-394-405 ◽

2017 ◽

Vol 63 (3) ◽

pp. 394-405

Author(s):

Vakhtang Merabishvili ◽

Aleksey Okeanov ◽

Alesya Yevmenenko

Keyword(s):

Colon Cancer ◽

Cancer Patients ◽

Survival Rates ◽

Cancer Control ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Problem Analysis ◽

The Republic ◽

Analysis Of Dynamics

Actuality of problem. Analysis of observed and relative survival is related to important criteria for evaluation of cancer control at the population-based level covering all patients on the administrative territory as well as the group of treated patients. Comparison of the effectiveness of treatment of patients in different countries allows revealing more adequate methods of complex anti-cancer activities. In this paper such study was carried out with respect to colon cancer according to population-based cancer registries of the Republic of Belarus and St. Petersburg. Purpose of study is to compare dynamics of observed and relative survival rates in colon cancer patients in the Republic of Belarus and St. Petersburg. Materials and methods. In the basis of the study there were taken databases of population-based cancer registries of the Republic of Belarus and St. Petersburg and also there was used standard methodology by constructing expectancy tables and estimating the significance of differences in rates. Analysis of obtained data. There was performed in-depth comparative analysis of dynamics of survival rates by sex, age and histological tumor types. Conclusion. Conducted comparative study of survival colon cancer patients in the Republic of Belarus and St. Petersburg showed significant growth of rates however relative survival in Europe was much higher than in the Republic of Belarus and western regions of Russia.

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Clinical Relevance of Conditional Survival of Cancer Patients in Europe: Age-Specific Analyses of 13 Cancers

Journal of Clinical Oncology ◽

10.1200/jco.2009.25.9697 ◽

2010 ◽

Vol 28 (15) ◽

pp. 2520-2528 ◽

Cited By ~ 100

Author(s):

Maryska L.G. Janssen-Heijnen ◽

Adam Gondos ◽

Freddie Bray ◽

Timo Hakulinen ◽

David H. Brewster ◽

...

Keyword(s):

Cancer Survivors ◽

Excess Mortality ◽

Age Groups ◽

Relative Survival ◽

Cancer Registries ◽

Initial Diagnosis ◽

Accurate Information ◽

Testis Cancer ◽

Corpus Uteri

Purpose When cancer survivors wish to receive accurate information on their current prognosis during follow-up, conditional 5-year relative survival may be most suitable. We have estimated conditional 5-year relative survival for 13 cancers using a large European database—European Network for Indicators on Cancer (EUNICE)—of 10 dedicated long-standing cancer registries across Europe. Patients and Methods Patients age 15 years and older diagnosed between 1985 and 2004 were included. Conditional 5-year relative survival for each age group was computed for every additional year survived up to 10 years. Period analysis with follow-up period 2000 to 2004 was used. Results All patients with cutaneous melanoma or colorectal, endometrial, or testis cancer and younger patients with stomach, glottis, cervix, ovary, or thyroid cancer or non-Hodgkin's lymphoma exhibited hardly any excess mortality (conditional 5-year relative survival > 95%) given that they were alive at a defined time point within 10 years of initial diagnosis. However, patients with supraglottis, lung, breast, and kidney cancer, as well as older patients with most cancers exhibited substantial excess mortality (conditional 5-year relative survival < 90%). Initial differences in relative survival at diagnosis between age groups largely disappeared with time since initial diagnosis for melanoma, or stomach, colorectal, corpus uteri, or testicular cancer but persisted for patients diagnosed with other tumors. Differences between stage groups became smaller over time or disappeared. Conclusion Conditional relative survival shows clinically relevant variations according to time since diagnosis, type of cancer, and age, and can help serve as a guide for cancer survivors in planning for their future and for doctors in planning schedules for surveillance.

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