Matt Kaiser
Posted by
Matt Kaiser

Is cancer survival the "worst in Europe"?

Matt Kaiser
Posted by
Matt Kaiser
11 Dec 2013

Dear Sir/Madam,

Your article “Cancer survival in Britain the worst in Europe” (5th Dec 2013) has an alarming but misleading headline. This is not what is shown in the study on which the article is based (The Lancet Oncology, 5 December 2013, doi:10.1016/S1470-2045(13)70546-1). For many cancers, Britain has lower five-year survival rates than the mean European average, but that does not necessarily mean it is the worst. The study actually shows that for the majority of cancers analysed, the five-year survival rates in eastern Europe are the worst. The article also offers little scrutiny of the size of differences of survival rates, which in many instances are within a few percentage points – in fact, the researchers themselves note that for some common cancers, "survival in the UK and Ireland was close to the European mean".

Furthermore, given the potential discrepancies in data quality across the countries, such as registration coverage, quality of diagnostic and prognostic information, level of national coordination, and consistency of data collection and follow-up reporting, the cross-country comparisons may be subject to biases and large variances. The authors of the study addressed and mitigated these potential issues, as one would expect, but were unable to eliminate them altogether.

Whilst none of this undermines the validity of the results or denies that there are between-country discrepancies to address, it means that a more nuanced and measured interpretation is needed and that differences may be less disconcerting than the sensational tone of the article suggests.

There is also a positive note to the study – alluded to by Sean Duffy [National Clinical Director for Cancer for NHS England] whose quote was squeezed in at the end of your article – that five-year cancer survival rates have, on the whole, been getting better over time across Europe. This positive message, which has been the result of coordinated and sustained research efforts plus improvements in symptom awareness and screening programmes, is at least as important as the serious message that the UK needs to keep pace with some of our European neighbours. It is important for people reading the article that they are aware that, thanks to publicly supported research and healthcare programmes, someone diagnosed with cancer today will never have had a better chance of long-term survival.

In summary, we are doing well but could be doing better.


Photo courtesy of Flickr user: hang_in_there [licence: CC BY 2.0]



Thank you for the comment on the data Matthew. A couple of points if I may. You mention the potential discrepancies in data quality across the countries as being an issue, but as these errors are the same across the board one might suggest that these would have cancelled themselves out leaving a fairly balanced report.
There appears to be little doubt that Germany, Sweden, Norway etc, the best performers, are achieving better results than we are. Indeed one must ask given the choice where would you or someone you love prefer to be treated? In the best in Europe or in the average group?
Indeed my daughter who had lymphoma was treated on a trial through a German University hospital who were said to be the best in Europe in treating lymphoma. They were superb and in fairness the UK hospital they were learning along the way from the Germans. Well done EU.
Cancer Research UK in their comments on the study were defensive, stating that the study used data that was now five or so years old and that we have improved our cancer survival performance. This may be the case but, have the best performers not improved as well? Is the gap between best, worst and average now even bigger? I have to be honest and say that the stakes are so high with this illness that should the need arise I would choose to be treated by the best in Europe rather than the by average performer. I do not know why we are so relatively poor, we have well paid Dr.'s and Consultants and are spending millions on research, we have some brilliant minds at work on the problem, but still we remain mid table. I do not think we should be defensive, there is no such thing as failure, only results! and ours were poor. Now is not the time for blame and obfuscation, but the time for our leaders, communities, scientists and clinicians to ask the questions: Why? How? And who,has the vision and leadership to take us to the top of the premier league! I
In so doing help alleviate so much suffering which is what this is all about.

In so doing to help alleviate suffering.