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Cancer survival rates worst in western Europe

Old 05-11-07, 01:54 PM
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Cancer survival rates worst in western Europe

http://www.telegraph.co.uk/news/main.../ncancer10.xml


Cancer survival rates worst in western Europe

By Nic Fleming, Medical Correspondent
Last Updated: 2:06am BST 11/05/2007

Patients in Europe and the US have better access to new drugs


While more than half of patients in France, Spain, Germany and Italy have access to new treatments provided since 1985, the proportion in the UK is four out of 10.

French women with cancer are 34 per cent more likely than those in the UK to still be alive five years after being diagnosed, while French male patients have a 23 per cent higher survival rate after the same period.

The report into cancer treatment in 25 countries found the uptake of newer cancer drugs was "low and slow" in the UK as well as New Zealand, Poland, Czech Republic and South Africa.


Its Swedish authors from the influential Karolinska Institute added that there was "no evidence" that the National Institute for Health and Clinical Excellence (Nice) was meeting its objective of avoiding significant delays in introducing new treatments.

The researchers studied Australia, Canada, New Zealand, Japan, South Africa and the US, as well as 19 European countries, with a total population of 984 million, and looked at access to 67 newer cancer drugs.

They found that the proportions of female cancer patients surviving five years beyond diagnosis in France, Spain, Germany, Italy were 71 per cent, 64 per cent, 63 per cent and 63 per cent respectively. In the UK it was 53 per cent.

Among men the proportions still alive at five years in the same countries were 53 per cent, 50 per cent, 53 per cent and 48 per cent. Again in the UK it was lower at 43 per cent.


Non-melanoma skin cancer was excluded from the research.

Dr Nils Wilking, a clinical oncologist at the Karolinska Institute in Stockholm, said: "Our report highlights that in many countries new drugs are not reaching patients quickly enough and that this is having an adverse impact on patient survival. Where you live can determine whether you receive the best available treatment or not.

"To some extent this is determined by economic factors, but much of the variation between countries remains unexplained. In the US we have found that the survival of cancer patients is significantly related to the introduction of new oncology drugs."

The researchers, whose report is published in the journal Annals of Oncology, found that Austria, France, Switzerland and the US were leaders in using new cancer drugs.

The greatest differences in the uptake of drugs were noted for the new colorectal and lung cancer drugs.

The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average.

Dr Bengt Jonsson, the director of the Centre for Health Economics at the Stockholm School of Economics, a co-author on the study, said: "The inequalities between countries in patients' access to cancer drugs cannot persist.

"Cancer patients will not accept that a standard of care available in one country is not available in other countries.

"It was the explicit objective at the establishment of Nice to avoid any significant delays to bringing innovations to the market. There is no evidence that this objective is met.

"Countries need to address urgently how they are going to accommodate newer drugs into health care systems and pay for them."

A spokesman for the Department of Health said: "We are making good progress in ensuring cancer patients have access to the drugs they need.

"A report published by the National Cancer Director last year confirmed a continued increase in the uptake of new cancer drugs by the NHS following positive Nice appraisal.

"Nice's single technology appraisal process is designed to provide authoritative advice on key new drugs within weeks of licensing.

"For example draft guidance was available within two weeks of Herceptin for early breast cancer being licensed."

Andrew Lansley, the shadow health secretary, said last night: "It is outrageous that we are the leading country in Europe for cancer research but the slowest in the uptake of new cancer drugs.

"All too often, the decisions about funding wait until Nice has completed its examination of clinical and cost effectiveness. There has to be a degree of clinical judgment about when it is right to use your budget to support a patient's treatment."

Information appearing on telegraph.co.uk is the copyright of Telegraph Media Group Limited and must not be reproduced in any medium without licence. For the full copyright statement see Copyright
I thought this deserved a new thread.
Would people here agree that "ten times higher" for our system here is a significant advantage?
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Old 05-11-07, 08:17 PM
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I'd be very curious to know if they controlled for one very important factor -

Grade/Stage of tumor at time of diagnosis.

I would think that it's possible that English patients are getting diagnosed later, thus dying sooner after diagnosis.
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Old 05-11-07, 08:24 PM
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I would think that it's possible that English patients are getting diagnosed later, thus dying sooner after diagnosis.
And why would that be?
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Old 05-11-07, 08:35 PM
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Originally Posted by nemein
And why would that be?
Because the other countries may have screening programs or "better" access to diagnosing tests.

The question then has to be asked, are these patients *really* living longer, or are they just living with the knowledge they have cancer for longer.

Make no mistake - earlier diagnosis can lead to better treatment and better survival, but not always. Hahn can give you incredible amounts of detail on this. Hopefully he'll chime in.
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Old 05-11-07, 08:50 PM
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Originally Posted by bhk
Would people here agree that "ten times higher" for our system here is a significant advantage?
It is, but that's comparing a country to the average of an entire continent. So you're comparing one system with a whole bunch of different systems.

Also:

The researchers, whose report is published in the journal Annals of Oncology, found that Austria, France, Switzerland and the US were leaders in using new cancer drugs.
So I assume the figures vary widely if you look at individual European nations.
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Old 05-13-07, 09:58 AM
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Originally Posted by eXcentris
It is, but that's comparing a country to the average of an entire continent. So you're comparing one system with a whole bunch of different systems.
The land area and population of the US is roughly equal to Europe. Also US medicine and medical insurance is mainly privatized, with many different companies and policies, except for Medicare. So you are comparing average of a bunch to average of a bunch.

There are probably important local variations in both regions if the data is available.
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Old 05-13-07, 11:52 AM
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Originally Posted by eXcentris
It is, but that's comparing a country to the average of an entire continent. So you're comparing one system with a whole bunch of different systems.
I need to look at the original paper but it looks like they evaluated individual countries in Europe.

So I assume the figures vary widely if you look at individual European nations.
Yes they did. With the UK being nearly at the bottom.
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Old 05-13-07, 11:55 AM
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I'd be very curious to know if they controlled for one very important factor -

Grade/Stage of tumor at time of diagnosis.

I would think that it's possible that English patients are getting diagnosed later, thus dying sooner after diagnosis.
In any medical study they compare like-to-like. I bet there was no statistical difference in the demographics, ages, overall health, or the stage of the people compared. If there was, the entire study would be invalid and wouldn't get published. Now there are certain studies that are published where there are differences but not this type.
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Old 05-13-07, 04:23 PM
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Originally Posted by Lord Rick
Because the other countries may have screening programs or "better" access to diagnosing tests.

The question then has to be asked, are these patients *really* living longer, or are they just living with the knowledge they have cancer for longer.

Make no mistake - earlier diagnosis can lead to better treatment and better survival, but not always. Hahn can give you incredible amounts of detail on this. Hopefully he'll chime in.
You've got it pretty much covered. It's encouraging to see some people thinking twice before taking study results at face value. That is not to say there isn't any value in looking at things like this. But there are certain words in discussions of studies like this that really irritate me. The biggest one is "significant differences". There's a BIG difference between statistical significance and 'meaningful'. Unfortunately, most doctors in the U.S. aren't trained in biostatistics and so they don't see a difference, and that comes across in their convictions and what they preach to their patients. Not to say that the drugs are useless, but I feel that many docs are overzealous in their faith in them and don't prescribe the appropriate grain of salt in their discussions with patients, or to the media who pass along their message.

Last edited by hahn; 05-13-07 at 04:37 PM.
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Old 05-13-07, 04:34 PM
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I'll also add that if you look a the big picture, this study is next to worthless. Why? Here's a listing of life expectancies from the CIA factbook. Note first of all that the U.S. is ranked 45th in the world. Note second that ALL the Western European countries are ranked ahead of the U.S. So even if this study were 100% accurate (which it isn't), it's quite meaningless. 'Facts' without context are not 'meaningful'.

This also is HIGHLY suggestive that the results of this study are confounded. Screening, IMHO, is a big factor in this confounding. Let's put it this way (I'll fully admit this is an oversimplification, but I'm making a point) - which would you prefer? Knowing you have cancer for 10 years and suffering for the last 2 years of it before you die. Or, living 8 years ignorant of your disease, but then dying at the same time, knowing that you had cancer for 2 years of your life? The statistics (aka the "facts") will show that in the first case, you survived for 10 years with cancer. In the second case, you will have survived for 2 years with your cancer. In both cases, you still die at the same age. So with this example, you start to see the problem in making broad generalizations with studies like this.

Last edited by hahn; 05-13-07 at 04:42 PM.
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Old 05-13-07, 04:58 PM
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Originally Posted by hahn
This also is HIGHLY suggestive that the results of this study are confounded. Screening, IMHO, is a big factor in this confounding. Let's put it this way (I'll fully admit this is an oversimplification, but I'm making a point) - which would you prefer? Knowing you have cancer for 10 years and suffering for the last 2 years of it before you die. Or, living 8 years ignorant of your disease, but then dying at the same time, knowing that you had cancer for 2 years of your life? The statistics (aka the "facts") will show that in the first case, you survived for 10 years with cancer. In the second case, you will have survived for 2 years with your cancer. In both cases, you still die at the same age. So with this example, you start to see the problem in making broad generalizations with studies like this.
I'll say it is an oversimplification. IF it were generally true (and I doubt it is), it would say treating cancer and screening for cancer are BOTH a complete waste of time and money and we should spend our medical dollars on more treatable things.
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Old 05-13-07, 05:44 PM
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Originally Posted by OldDude
I'll say it is an oversimplification. IF it were generally true (and I doubt it is), it would say treating cancer and screening for cancer are BOTH a complete waste of time and money and we should spend our medical dollars on more treatable things.
You are assuming our dollars are allocated efficiently, which is far from reality.

In a perfect world we would spend our money on the most treatable things, the ones with the most bang for the buck, but that doesn't happen.
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Old 05-13-07, 05:49 PM
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Originally Posted by OldDude
I'll say it is an oversimplification. IF it were generally true (and I doubt it is), it would say treating cancer and screening for cancer are BOTH a complete waste of time and money and we should spend our medical dollars on more treatable things.
Can you deny that the situation I proposed EVER happens? How often? The answer is that no one knows. The PROBLEM is that the effectiveness of screening DEPENDS upon this situation being false all the time, or at least MOST of the time. It's called "lead time bias" and is only one of 3 VERY problematic biases that afflict ALL screening studies. Any honest researcher will fully admit that it puts a BIG question mark on the effectiveness of screening, given that we don't even fully understand the natural history of most cancers.

It's not that it's a complete waste of time, OR a 100% solution. The question is, how much effort or money SHOULD we be allocating to screening and the treatments? People seem to be of the belief (and I emphasize "belief") that if we throw enough money or do enough things, that there will be a cure - therefore we should go balls out, pedal to metal. Make no mistake - this is a leap of faith. Futhermore, it is NOT inconsequential if the "experts" are wrong. Consider that a large number of people are made worse or killed through treatments - they are almost never examined in these analyses of cancer treatments. Granted because it makes analysis extraordinarily complicated. However, without looking at it, we have no idea if the benefits outweigh the consequences.

I emphasize AGAIN that I am not proposing that such efforts are a "waste", or that the solution is to ignore all medical advice. I am suggesting that it is worth questioning how much we have to gain through such time and effort, COMPARED to if we spent the money and effort in other arenas such as prevention through lifestyle changes and environmental improvements. Blindly trusting conventional wisdom does not lead to scientific progress. In fact, I would argue that the vast majority of scientific breakthroughs have been made when conventional wisdom was flagrantly ignored.

This is a very complex topic and people get emotionally invested in it. I have no delusions of being able to change your mind about what you already believe. But if you are interested in the other side of the debate and in finding out the problems with current medical consensus regarding cancer screening, I HIGHLY recommend checking out this book: http://www.amazon.com/Should-Be-Test...9092890&sr=8-1

Last edited by hahn; 05-13-07 at 05:57 PM.
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Old 05-13-07, 06:17 PM
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Originally Posted by hahn
This is a very complex topic and people get emotionally invested in it. I have no delusions of being able to change your mind about what you already believe. But if you are interested in the other side of the debate and in finding out the problems with current medical consensus regarding cancer screening, I HIGHLY recommend checking out this book:
Actually, you could on some cancers. I'm a layman, so I certainly don't know it all. I know there are cancers, like prostate, where there is quite a debate, because most old men have mild prostate cancer and die of something else before it gets serious. Still, men die of metasized prostate cancer, too. Gleason scores and the like seem to be crude tools for deciding between aggressive treatment and watchful waiting.

But, I didn't think lung cancer and colorectal cancer fell in that category. Also, as there is no mention of surgery, only chemotherapy, I am guesing that these might be serious, metasized cancers, but they don't really specify.
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Old 05-13-07, 06:44 PM
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Originally Posted by bhk
In any medical study they compare like-to-like. I bet there was no statistical difference in the demographics, ages, overall health, or the stage of the people compared. If there was, the entire study would be invalid and wouldn't get published. Now there are certain studies that are published where there are differences but not this type.
I wouldn't be so sure. Do you have a link to PubMed (or similar) to the original article?
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Old 05-22-07, 11:40 AM
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Originally Posted by bhk
In any medical study they compare like-to-like. I bet there was no statistical difference in the demographics, ages, overall health, or the stage of the people compared. If there was, the entire study would be invalid and wouldn't get published. Now there are certain studies that are published where there are differences but not this type.

I found the study.

Annals of Oncology. 2007 Jun;18 Suppl 3:iii67-iii77



They did NOT control for stage/grade of tumor at time of diagnosis.

More importantly, in the disclosures, we find out that the researchers are funded by an unrestricted grant from Roche Pharmaceuticals. Not surprising.
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Old 05-22-07, 11:48 AM
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Is the cancer rate higher in the Western European countries than it is in the United States?

I really don't know.
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Old 05-22-07, 11:53 AM
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I don't argue the fact that the American medical system is second-to-none in the world -- for those who can afford it. But there are 61 million Americans who are uninsured or underinsured -- what is the cancer survival rate for these people? What kind of screening can they afford? How often are they given these life-saving new oncology drugs?
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Old 05-22-07, 12:07 PM
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Originally Posted by NCMojo
I don't argue the fact that the American medical system is second-to-none in the world -- for those who can afford it. But there are 61 million Americans who are uninsured or underinsured -- what is the cancer survival rate for these people? What kind of screening can they afford? How often are they given these life-saving new oncology drugs?
and i always wondered about the raw data in this figure or how they count these people

a lot of them are small business owners who choose not to buy insurance
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Old 05-22-07, 12:34 PM
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Originally Posted by al_bundy
and i always wondered about the raw data in this figure or how they count these people

a lot of them are small business owners who choose not to buy insurance
I've heard 40 or so million. What's "underinsured", anyway? If you have a copay? If your insurance tops out at $1 million? No dental?

These figures include illegals from what I've heard. And young people who as a group really don't have any need for health insurance and are making a wise economic decision. Universal(ly taxed) health care will certainly get the money from the people who don't want insurance though.
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Old 05-22-07, 12:37 PM
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Originally Posted by X
I've heard 40 or so million. What's "underinsured", anyway? If you have a copay? If your insurance tops out at $1 million? No dental?

These figures include illegals from what I've heard. And young people who as a group really don't have any need for health insurance and are making a wise economic decision.
You've heard?



Young people get sick, too. Unexpected medical bills are the number one cause of bankruptcy.

Whatever you've heard, the system isn't working. By most measures, life expectancy, infant mortality, etc. we trail other countries.

Lose your job and try paying for COBRA for a family of four and get back to me.
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Old 05-22-07, 01:06 PM
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Originally Posted by Lord Rick
You've heard?

Oh, so you have an exact count? Please enlighten us!
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Old 05-22-07, 01:06 PM
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Originally Posted by Lord Rick
Whatever you've heard, the system isn't working. By most measures, life expectancy, infant mortality, etc. we trail other countries.
http://en.wikipedia.org/wiki/List_of...ife_expectancy

We're 13 years above global avg and only 5 years behind the leader. I hardly call that out of the norm.

indeed wrt infant mortality... didn't we just have that discussion.


Anyway, I agree there are problems w/ the system, but using these stats as evidence of that is ridiculous.
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Old 05-22-07, 01:09 PM
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Originally Posted by Lord Rick
Lose your job and try paying for COBRA for a family of four and get back to me.
I don't need to "lose my job". I'm paying for a family of three out of my own pocket now. And four would cost the same on this plan.

And the "lose your job" argument is exactly why employers shouldn't be supplying health insurance.
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Old 05-22-07, 01:12 PM
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Originally Posted by X
These figures include illegals from what I've heard.
It seems it does include illegals but this report from '03 indicates that native citizens are uninsured as well

http://www.kff.org/uninsured/upload/...ve-summary.pdf

If we combine the data from 1998 to 2003, we find that almost two-thirds of the increase of uninsured was among non-citizens (and somewhat more if we include the effects of reweighting as detailed in the body of this report). But this result is largely driven by the reduction in the number of uninsured native citizens between 1998 and 2000. This period seems an aberration because of extremely rapid economic growth and very tight labor markets, which disproportionately improved health coverage for native citizens. In contrast, the results from 1994-1998 period and from 2000-2003 period indicate that the growth in the uninsured is largely among native citizens.
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