Relative survival in elderly European cancer patients: evidence for health care inequalities

Vercelli, Marina; Capocaccia, Riccardo; Quaglia, Alberto; Casella, Claudia; Puppo, Antonella; Coebergh, Jan Willem

doi:10.1016/s1040-8428(00)00075-5

Cited by 111 publications

(64 citation statements)

References 16 publications

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“…5 Poorer survival amongst older women is also consistent with several detailed analyses of EUROCARE data, which show that in countries with lower overall survival the differences by age are more marked. [25][26][27][28] Our observation that extent of disease does not help explain differences in survival between Australia and England contrasts with 2 previous international analyses within Europe and between Europe and the USA. [29][30][31][32][33][34][35] These studies have concluded that a large proportion of the differences in survival between the UK and other developed nations can be attributed to differences in stage at diagnosis.…”

Section: Discussioncontrasting

confidence: 99%

Large differences in patterns of breast cancer survival between Australia and England: A comparative study using cancer registry data

Woods

Rachet

O’Connell

et al. 2009

Intl Journal of Cancer

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Survival from breast cancer in the UK is lower than in other countries in Western Europe, the USA and Australia. However, these international differences have not yet been examined in relation to tumor characteristics, treatment, screening history or other prognostic factors. We calculated relative survival by age, period of diagnosis, category of unemployment and extent of disease for women diagnosed with breast cancer during the period 1980–2002 in New South Wales (Australia) and West Midlands (England). National cancer registry data for each country for the period 1990–1994 were also examined. The excess hazard ratio was modeled as a function of prognostic covariables. Survival in Australia and New South Wales was higher than in England and West Midlands, respectively. In both regions, survival was lower for more deprived women and for the elderly. These differences were greater in West Midlands. Survival from localized and regional disease in New South Wales was higher than in West Midlands, but survival from metastatic disease was similar. Differences in breast cancer survival are unlikely to be entirely due to differences in data quality or to limitations of the analyses, although the measure of extent of disease used may not have been adequate to elucidate the effect of stage fully. One possible causal explanation is that the management of breast cancer differs between these regions. Further research should acquire better data on stage and investigate the effect of comorbidity and of patterns of care upon the difference in breast cancer survival between England and Australia. © 2008 Wiley‐Liss, Inc.

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Section: Discussioncontrasting

confidence: 99%

Large differences in patterns of breast cancer survival between Australia and England: A comparative study using cancer registry data

Woods

Rachet

O’Connell

et al. 2009

Intl Journal of Cancer

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“…People aged 85 or more years were not included because of the limits inherent the statistics in the very elderly, namely the poorer completeness and quality of data collection. 6,9 Table I shows the number of cases for the two age groups, by sex and every country participating in EUROCARE 3 study, while in Table II the same number of cases is displayed by cancer site. Elderly patients were 435,319 in men and 347,886 in women, while 148,103 and 150,280 in middle aged subjects.…”

Section: Methodsmentioning

confidence: 99%

“…Actually, large population-based studies on cancer survival in Europe found marked differences between the elderly and middle aged individuals. 5,6 The prognosis observed for European elderly cancer patients was very poor if compared with that of the same age patients from the U.S.; in Europe, unlike the U.S., cancer survival depended strongly on age at diagnosis. …”

mentioning

confidence: 99%

“…4 Actually, large population-based studies on cancer survival in Europe found marked differences between the elderly and middle aged individuals. 5,6 The prognosis observed for European elderly cancer patients was very poor if compared with that of the same age patients from the U.S.; in Europe, unlike the U.S., cancer survival depended strongly on age at diagnosis. 7 The present study, an in depth analysis of EUROCARE-3 programme, 8 is aimed at describing relative survival rates of cancer patients aged from 65 to 84 years in 22 European countries, by providing an update of data referred to the last available incidence period (1990)(1991)(1992)(1993)(1994).…”

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confidence: 99%

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A wide difference in cancer survival between middle aged and elderly patients in Europe

Quaglia¹,

Capocaccia²,

Micheli³

et al. 2007

Intl Journal of Cancer

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Nowadays the burden of cancer in elderly people has reached an alarming extent. The purpose of this study is comparing cumulative and conditional relative survival in elderly patients between 65 and 84 years and younger adults aged from 55 to 64. Fifty-three cancer registries of 22 European countries, participating in the EUROCARE-3 programme, collected information on the cases diagnosed over the period [1990][1991][1992][1993][1994]. We computed cumulative and conditional relative survival for 16 cancer sites. Middle aged patients experienced a better prognosis than the elderly for all cancer sites, in both sexes and the differences were more marked at 1 than 5 years since diagnosis. The very large differences noted in the first period after cancer detection declined in the subsequent years and, when 5-years conditional survival was considered, for several cancers the elderly and younger adults had the same probabilities of surviving. The death relative excess risks (RERs) in the elderly with respect younger individuals were really very high and markedly larger at 1 than 5 years, and in women than men. Genitourinary and gynaecological cancers showed the highest RERs, around 2.0 and between 1.5 and 2.5 respectively. This very high early mortality could be due not only to clinical aspects: the barriers to health care access and a consequent late diagnosis might represent for elderly patients the main determinant of this very large prognostic disadvantage. In conclusion, clinical management of cancer in the elderly remains a major issue to be faced with complex social and health care policies. ' 2007 Wiley-Liss, Inc.Key words: cancer; conditional and cumulative relative survival; health care inequalities; elderly Western populations are rapidly ageing; this phenomenon has accelerated at least since the early 80 s. Now the magnitude of this issue has reached an alarming extent and the burden of chronic diseases like cancer requires an extraordinary effort by health care systems and social services.According to data by the United Nations, in 2000 the elderly over 65 years amounted in Northern, Western and Southern Europe to about 13-14% and 18-19% of all resident population in men and in women respectively. The phenomenon will reach a peak when the people born during the period of the ''baby boom'', in the 50-60 s, will be 65 years old. For instance, in Italy, the country with the highest proportion of people aged 65 years or over (15% in men and 21% in women), by 2030 this population segment will represent 29% and 35% of total population. In this demographic context the cancer burden is quickly increasing; on one hand incidence and mortality trends of some major cancers are levelling off or declining, on the other hand crude rates are growing as a consequence of people ageing. If we consider the single European macro-regions in 2002, we observe very variant situations: in Eastern countries only 49% in men and 48% in women of all cancers were detected in the elderly, the corresponding values increased to 67% and 58%...

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“…However, no similar studies have been undertaken in the UK and these results may not be representative of practice in the UK, especially in light of the comparatively lower survival rate of women aged X65 years compared to the rest of Europe (Vercelli et al, 2000) and the United States (ONS, 2002;Ries et al, 2003) and differences in health care services between countries.…”

mentioning

confidence: 99%

Non-standard management of breast cancer increases with age in the UK: a population based cohort of women ⩾65 years

Lavelle

Todd

Moran³

et al. 2007

Br J Cancer

114

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Evidence suggests that compared to younger women, older women are less likely to receive standard management for breast cancer. Whether this disparity persists once differences in tumour characteristics have been adjusted for has not been investigated in the UK. A retrospective cohort study involving case note review was undertaken, based on the North Western Cancer Registry database of women aged X65 years, resident in Greater Manchester with invasive breast cancer registered over a 1-year period (n ¼ 480). Adjusting for tumour characteristics associated with age by logistic regression analyses, older women were less likely to receive standard management than younger women for all indicators investigated. Compared to women aged 65 -69 years, women aged X80 years with operable (stage 1 -3a) breast cancer have increased odds of not receiving triple assessment (OR ¼ 5.5, 95% confidence interval (CI): 2.1 -14.5), not receiving primary surgery (OR ¼ 43.0, 95% CI: 9.7 -191.3), not undergoing axillary node surgery (OR ¼ 27.6, 95% CI: 5.6 -135.9) and not undergoing tests for steroid receptors (OR ¼ 3.0, 95% CI: 1.7 -5.5). Women aged 75 -79 years have increased odds of not receiving radiotherapy following breast-conserving surgery compared to women aged 65 -69 years (OR ¼ 11.0, 95% CI: 2.0 -61.6). These results demonstrate that older women in the UK are less likely to receive standard management for breast cancer, compared to younger women and this disparity cannot be explained by differences in tumour characteristics.

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Relative survival in elderly European cancer patients: evidence for health care inequalities

Cited by 111 publications

References 16 publications

Large differences in patterns of breast cancer survival between Australia and England: A comparative study using cancer registry data

Large differences in patterns of breast cancer survival between Australia and England: A comparative study using cancer registry data

A wide difference in cancer survival between middle aged and elderly patients in Europe

Non-standard management of breast cancer increases with age in the UK: a population based cohort of women ⩾65 years

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