Differences in treatment likely to be behind differing survival rates for blood cancers between regions within Europe

July 14, 2014, Lancet

Failure to get the best treatment and variations in the quality of care are the most likely reasons why survival for blood cancer patients still varies widely between regions within Europe, according to the largest population-based study of survival in European adults to date, published in The Lancet Oncology.

"The good news is that 5-year survival for most cancers of the blood has increased over the past 11 years, most likely reflecting the approval of new targeted drugs in the early 2000s such as rituximab for non-Hodgkin lymphoma and imatinib for chronic myeloid leukaemia", explains study leader Dr Milena Sant from the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy.

"But there continue to be persistent differences between regions. For example, the uptake and use of new technologies and effective treatments has been far slower in eastern Europe than other regions. This might have contributed to the large differences in the management and outcomes of patients."*

The EUROCARE study analysed data from 30 cancer registries* covering all patients diagnosed in 20 European countries to compare changes in 5-year survival for more than 560 400 adults (aged 15 years and older) diagnosed with 11 lymphoid and myeloid cancers between 1997 and 2008, and followed up to the end of 2008.

Some blood cancers have shown particularly large increases in survival between 1997 and 2008—eg, follicular lymphoma (59% to 74%), diffuse large B-cell lymphoma (42% to 55%), chronic myeloid leukaemia (32% to 54%), and acute promyelocytic leukaemia (50% to 62%).

The greatest improvements in survival during 1997-2008 have been in northern, central, and eastern Europe, even though adults in eastern Europe (where survival in 1997 was the lowest) continue to have lower survival for most than elsewhere.

But survival gains have been lower in southern Europe and the UK. For example, improvements in 5-year chronic myeloid leukaemia survival in northern (29% to 60%) and central Europe (34% to 65%) have been persistently higher than in the UK (35% to 56%) and southern Europe (37% to 55%). For more detailed findings for all cancers by European area see table 4 on page 6 and figure 2 on page 6.

The risk of death within 5 years from diagnosis fell significantly for all malignancies except myelodysplastic syndromes between 1997 and 2008. But not all regions have seen such improvements. For example, compared with the UK, the excess risk of death was significantly higher in eastern Europe than in other regions for most of the cancers investigated, but significantly lower in northern Europe. For more detailed findings for all cancers by European area and age see table 5 on page 7.

The authors suggest that the most likely reasons for continuing geographical differences in survival are inequalities in the provision of care and in the availability and use of new treatments.

"We know that rituximab, imatinib, thalidomide, and bortezomib were first made available for general use in Europe in 1997, 2001, 1998, and 2003, respectively. The years following general release of these drugs coincided with large increases in survival for chronic myeloid leukaemia, diffuse large B-cell lymphoma, and ; with a smaller but still significant survival increase for multiple myeloma plasmacytoma.", say the authors.

However, they point out that uptake and use of these drugs has not been uniform across Europe. For example, market uptake of rituximab, imatinib, and bortezomib was lower in eastern Europe than elsewhere and might explain the consistently lower survival in this region.

According to Sant, "High resolution studies that use clinical records to collect detailed clinical information for representative samples of cancer registry cases can more directly link treatments and clinical characteristics to survival."

Writing in a linked Comment, Alastair Munro from the University of Dundee Medical School in Scotland questions whether these improvements in survival can just be attributed to the drugs, saying that, "Better understanding of the conclusions from EUROCARE-5 requires additional information about changes over time (and space) affecting: according to the broad categories of disease (Hodgkin's lymphoma, non-Hodgkin lymphoma, leukaemias, myeloma, and other myeloid malignancies); the distribution of histological subtypes and their relation with the age distribution of the population; the distribution of stages at diagnosis; and the timing of active intervention for indolent tumours. …When making comparisons, whether across time or space, one should consider the effect of potential confounders. Is it all about the drugs? The answer is, not entirely."

Explore further: Large differences in cancer survival between European countries still remain despite major improvements in cancer diagno

More information: The Lancet Oncology, www.thelancet.com/journals/lan … (14)70282-7/abstract

*Northern Europe (Denmark, Iceland, and Norway), the UK (England, Northern Ireland, Scotland, and Wales), central Europe (Austria, Côte d'Or haematological, Saarland, Basel, Geneva, Grisons, St Gallen, Valais, and Netherlands), eastern Europe (Bulgaria, Estonia, Lithuania, Kielce, and Slovakia), and southern Europe (Ferrara, Modena, Parma, Ragusa, Romagna, Sassari, Torino, Malta, and Slovenia).

Related Stories

Large differences in cancer survival between European countries still remain despite major improvements in cancer diagno

December 4, 2013
Cancer survival still varies widely between European countries despite major improvements in cancer diagnosis and treatment during the first decade of the 21st century, according to the latest EUROCARE-5 reports covering ...

Study highlights varying cancer survival rates across Europe

December 13, 2013
Cancer survival rates are continuing to improve in England, according to the results from a Europe-wide collaborative project.

Improved treatments for chronic myeloid leukaemia have dramatically increased survival

December 12, 2012
Survival for people diagnosed with Chronic Myeloid Leukaemia (CML) has risen by nearly half, with around 58 per cent of people surviving their disease for at least five years compared with only around 40 per cent in the late ...

Big data to help blood cancer patients

May 20, 2014
A pioneering database at the University of Leeds will help match patients with certain types of blood cancers to the best treatments.

Effects of alcohol on lymphoma, leukemia, and other types of hematological cancers

November 13, 2012
Many observational epidemiologic studies have found an inverse association between alcohol consumption and hematological cancers (such as lymphoma and leukemia). This study, based on the Million Women's Study in the UK, is ...

Non-Hodgkin lymphoma survival doubles since early 1970s

May 23, 2013
More than half of patients diagnosed with Non-Hodgkin Lymphoma (NHL) are now surviving the disease thanks to improved diagnosis and treatment, according to a new report1 from Cancer Research UK.

Recommended for you

New approach attacks 'undruggable' cancers from the outside in

January 23, 2018
Cancer researchers have made great strides in developing targeted therapies that treat the specific genetic mutations underlying a patient's cancer. However, many of the most common cancer-causing genes are so central to ...

Study: Cells of three advanced cancers die with drug-like compounds that reverse chemo failure

January 23, 2018
Researchers at Southern Methodist University have discovered three drug-like compounds that successfully reverse chemotherapy failure in three of the most commonly aggressive cancers—ovarian, prostate and breast.

'Hijacker' drives cancer in some patients with high-risk neuroblastoma

January 23, 2018
Researchers have identified mechanisms that drive about 10 percent of high-risk neuroblastoma cases and have used a new approach to show how the cancer genome "hijacks" DNA that regulates other genes. The resulting insights ...

Enzyme inhibitor combined with chemotherapy delays glioblastoma growth

January 23, 2018
In animal experiments, a human-derived glioblastoma significantly regressed when treated with the combination of an experimental enzyme inhibitor and the standard glioblastoma chemotherapy drug, temozolomide.

Researchers identify a protein that keeps metastatic breast cancer cells dormant

January 23, 2018
A study headed by ICREA researcher Roger Gomis at the Institute for Research in Biomedicine (IRB Barcelona) has identified the genes involved in the latent asymptomatic state of breast cancer metastases. The work sheds light ...

Boosting cancer therapy with cross-dressed immune cells

January 22, 2018
Researchers at EPFL have created artificial molecules that can help the immune system to recognize and attack cancer tumors. The study is published in Nature Methods.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.