1. Kathrin Strasser-Weippl 1 st Medical Department Wilhelminen Hospital, Vienna Cancer Care in Europe

2. Cancer in Europe Cancer is the 2nd most common cause of death in Europe 2 mio. people are diagnosed with cancer/year 1 out of 3 people will be diagnosed with cancer during their lifetime 1 out of 4 people in the EU die of cancer

3. Cancer Incidence in Europe Cancer incidence in Europe is on the increase Difference in cancer incidence between different parts of Europe  differences in lifestyle and associated risk factors, e.g. smoking, diet, reproductive behaviour  unknown factors

4. Cancer mortality in Europe Cancer mortality is different according to country and region in Europe  different incidence of tumour types  other reasons?

5. Incidence versus Mortality : Males 2002 Mortality (ASR) Incidence (ASR)

6. Incidence versus Mortality: Females 2002 Incidence (ASR) Mortality (ASR Mortality (ASR )

7. Difference in mortality is NOT solely due to difference in cancer incidence  Other reasons? - stage at diagnosis? - organizational? - availability of cancer drugs? - patient advocacy groups? Cancer Survival in Europe

8. Difference in Mortaliy is NOT solely due to difference in cancer incidence  Other reasons? - stage at diagnosis? - organizational? - availability of cancer drugs? - patient advocacy groups? Cancer Survival in Europe

9. Stage at diagnosis: Breast cancer, Slovenia 1973-2002 Cancer Registry of Slovenia

10. Stage at diagnosis Difference in mortality between NW and CE Europe is explained by differences in incidence/stage at diagnosis for: - Breast cancer - Colorectal cancer - Female reproductive tract  effective screening measures in NW Europe:  pap smear screening for cervical cancer precursors starting not later than the age of 30;  mammography screening for breast cancer in women aged 50-69 in accordance with European guidelines on quality assurance in mammography  faecal occult blood screening for colorectal cancer in men and women age 50 ‑ 74. EUROCARE 3 study

11. screening measures lead to diagnosis earlier in the disease process  increase in cancer incidence Lead-time bias! - Early diagnosis falsely appears to prolong survival BUT: early diagnosis also facilitates earlier treatment and potentially saves lifes Cancer Diagnosis and Follow-Up

12. Difference in Mortaliy is NOT solely due to difference in cancer incidence  Other reasons? - stage at diagnosis? - organizational (cancer centres, money, education)? - availability of cancer drugs? - patient advocacy groups? Cancer Survival in Europe

13. Patients with breast cancer have 9% better survival at five years and 8% better survival at 10 years when cared for by specialist surgeons A reduction in risk of dying of 16% (6-25%) was found after adjustment for the prognostic factors of age, tumor size socioeconomic status, and nodal involvement Cancer care by specialists Gillis CR, Hole DJ 1996

14. proportion of gross domestic product devoted to health care in Europe varies: - Poland: 6% - Germany: 10.6% not all countries have National Cancer Registries and National Cancer Plans – quality control decentralisation of healthcare structure in CEE countries has lead to regional inequities  25% of the difference in mortality rates between NW and CE Europe are due to inadequacies in healthcare Organizational Issues: NW vs CE Europe Institute des Sciences de la Sante 2004

15. medical education strongly correlates with research efforts in 2002/03 1.43 billion Euro were spent on cancer research in Europe 93% of total funding came from EU countries, and >50% from the former EU-15 9 NW European countries spend > 10 mio. Euro on cancer research/year 10 European countries spend < 1 mio. Euro on cancer research/year Cancer Education in Europe Wilking, Jöngsson Karolinska Institutet 2005

16. Difference in Mortaliy is NOT solely due to difference in cancer incidence  Other reasons? - stage at diagnosis? - organizational? - availability of cancer drugs? - patient advocacy groups? Cancer Survival in Europe

17. Availibility of Cancer Drugs Wilking, Jöngsson Karolinska Institutet 2005

18. the median time for approval of new cancer drugs in Europe is 418 days the target time for approval set by the EU is 90 days! Austria, Spain, Switzerland are above average in terms of adoption of new cancer drugs Czech Republic, Hungary, Norway, Poland and UK are below average Availibility of Cancer Drugs Wilking, Jöngsson Karolinska Institutet 2005

19. Availibility of Cancer Drugs: Drugs approved 2000- 2004 Wilking, Jöngsson Karolinska Institutet 2005 Country% Of DrugsTime delay (days) Austria6982 Czech Rep.62389 Estonia41131 Germany820 France55431 Hungary20214 Poland1062190 Slovakia40453 UK860 USA1000

20. Availibility of Cancer Drugs Wilking, Jöngsson Karolinska Institutet 2005 there is strong inequality in the uptake of new cancer drugs throughout Europe (except for Imatinib) the ability of cancer patients to access new drugs depends on where they live uptake of new cancer drugs is generally slower in CEE countries

21. Availibility of Cancer Drugs F. Lichtenberg 2005 the increase in the number of cancer drugs in 1975- 95 in the US accounted for 50% of the increase in survival 6years after diagnosis it accounted for >10% of the increase of US life expectancy  the number of available cancer drugs is associated with 1-year and 5-year survival rates

22. Difference in Mortaliy is NOT solely due to difference in cancer incidence  Other reasons? - stage at diagnosis? - organizational? - availability of cancer drugs? - patient advocacy groups? Cancer Survival in Europe

23. European Cancer Patient Coalition: 153 members none of the founding member organizations from CEE countries by 2005 only 9/153 member organizations from CEE countries association between quality of cancer care and work of patient advocacy groups?? EU funds for new member countries make work of lobbies very important Patient Advocacy Groups ECPC Website

24. There is a gap in cancer survival between NW and CEE countries lead-time-bias however, part of this gap is due to inequalities in cancer care in Europe availability of cancer drugs is hampered in CEE countries structure of healthcare often leads to regional inequalities in CEE countries Cancer Care in Europe – Conclusion (1)

25. funding for research is less in CEE countries than in NW Europe (and less in NW Europe than in the US) EU structural funds for new members may help to reduce the health gap between NW and CE Europe  lobby work of patient advocacy groups to apply for and adequately direct EU funds is very important  Patient advocacy groups play a major role in improving cancer care in Europe Cancer Care in Europe – Conclusion (2)