EPIDEMIOLOGY
treatment services, and lack of investment in health resources3. Figure 1: Aims of the CONCORD-2 study
This is also true for children: about 80% of childhood cancers
arise in low-income countries, where low survival is associated To provide quantitative and directly comparable estimates of
cancer survival in many countries world-wide, for 10
with failure either to start treatment, or to complete it, in up to
malignancies that are common in adults, and childhood
60% of cases4. Variation in survival within Europe is associated leukaemia, using individual data from population-based
with national wealth (gross domestic product), total national cancer registries, supplied to agreed standards and analysed
expenditure on health and the level of investment in health centrally.
technology such as CT scanners5,6. To document world-wide trends in cancer survival since
International differences in survival can be viewed through 1995 as the basis for systematic global surveillance of cancer
survival, to enable examination of the underlying causes of
the same lens as the differences in survival within a given
survival differences, and to derive measures such as the
country between rich and poor7,8 or insured and under- population “cure” fraction, cancer prevalence and the number
insured9 patients. Survival also varies widely between of avoidable premature deaths as a basis for informing
countries of low- and middle-income10. The priorities for national and global policy for cancer control.
improving outcomes differ between these economic groups of
countries11.
Figure 2: The CONCORD programme is endorsed by
Cancer control plans • WHO Regional Office for Europe (WHO-EURO)
(Copenhagen)
Inequalities in cancer survival revealed by the EUROCARE
• Organisation for Economic Co-operation and Development
studies12-14 are partly responsible for the re-appearance of
(OECD) (Paris)
cancer control on the political agenda of the European • Canadian Association of Provincial Cancer Agencies
Union15-17. Survival trends have also provided an instructive (CAPCA) (Toronto)
backdrop for the evaluation of cancer control strategies in • Jolanta Kwaśniewska Foundation (Warsaw)
Europe and the USA18. • Members of the European Parliament Against Cancer (MAC)
(Brussels)
Today, some national cancer plans are explicitly focused on
• Association of European Cancer Leagues (ECL) (Brussels)
improving survival. Within the last 15 years, also, international
• Danish Cancer Society (Copenhagen)
disparities in survival have underpinned cancer plans in • European CanCer Organisation (ECCO) (Brussels)
Denmark (2005)19, Northern Ireland (1996)20, England (2000, • Asociación Española contra el Cáncer (aecc) (Madrid)
2007)21,22, Wales (2006)23, Victoria (Australia) (2008)24 and • North American Association of Central Cancer Registries
Sweden (2009)25. (NAACCR) (Chicago)
• US National Cancer Institute, Center for Global Health
Cancer survival trends are now also being used to evaluate
(Washington DC)
the effectiveness of national cancer plans once they have been
• Many other bodies (list on request)
implemented, by assessing their contribution to improving
overall survival26,27 or reducing socioeconomic inequalities in incidence has provided information for aetiological research
28
survival . and the basis of prevention and screening since the 1960s34,35.
We can predict that continuous, global surveillance of
Global surveillance of cancer survival cancer survival will become equally valuable: a reliable
Population-based cancer survival provides one measure of information source for cancer patients and researchers, a
progress in cancer control. It is important to evaluate patterns stimulus for change in health policy and health care systems,
and trends in incidence and mortality alongside those for and a key metric for the global surveillance of cancer control.
29
survival . Comparisons of incidence, survival and mortality Global surveillance of cancer survival is seen as important by
have been published for many cancers in Europe30,31, and for many national and international agencies (Figure 2).
32
Europe, Australia and Canada , but not worldwide. Where At the World Cancer Congress in Geneva in 2008, the
possible, incidence, survival and mortality trends will be Union for International Cancer Control (UICC) updated the
compared for countries participating in CONCORD-2, to help World Cancer Declaration36,37, with 11 ambitious goals to be
29,30,32,33
improve the interpretation of survival comparisons . achieved by 2020, including: “there will be major
Reliable information on global trends and disparities in improvements in cancer survival rates... in all countries”. UICC
cancer patient survival can be expected to help focus debate is committed to providing progress reports every two years.
11
on reducing geographic and racial or ethnic inequalities . The CONCORD programme for surveillance of cancer
Long-term surveillance of worldwide trends in cancer survival supports several of the goals in the UICC World
CANCER CONTROL 2013 61