medwireNews: The third iteration of the CONCORD global surveillance program (CONCORD-3) shows that although cancer survival trends are improving on the whole, the majority of this improvement is restricted to high-income countries.
As reported in The Lancet, the analysis included records from 322 population-based cancer registries – of which 47 provided 100% coverage – for over 37 million patients diagnosed with one of 18 malignancies between 2000 and 2014 in 71 countries and territories.
Claudia Allemani, from the London School of Hygiene & Tropical Medicine in the UK, and co-researchers found that “survival trends are generally increasing, even for some of the more lethal cancers,” with increases in age-standardized 5-year survival rates of up to 5% for liver, pancreatic, and lung cancers.
However, for most tumor types, the 5-year survival rates remain highest for high-income countries, including the USA, Canada, Australia, New Zealand, Finland, Iceland, Norway, and Sweden. For instance, the 5-year survival rates for breast cancer diagnosed in 2010–2014 is 90.2% in the USA and 89.5% in Australia, but only 66.1% in India, and for pediatric acute lymphoblastic leukemia cases diagnosed in the same period, the rates range from 95.2% in Finland to 49.8% in Ecuador.
In an accompanying commentary, Richard Sullivan (King’s College London, UK) writes: “Notably, the data for LMICs [low- and middle-income countries] in CONCORD-3 reflect those countries with better cancer control systems. For most LMICs not covered by CONCORD-3, outcomes will be even worse.
“In the era of universal health coverage imperatives, the stark inequalities in outcomes shown by CONCORD-3 illuminate the core problems at the heart of global cancer control: from insufficient funding and governance failures through to deficits in workforces fundamental to cancer treatment, such as surgery and radiotherapy.”
He continues: “Oncoplutocracy, in which cancer progress only benefits wealthy countries and patients, needs to stop.
“However, delivery of better and affordable cancer control is a two-way street. Many LMICs, particularly in the upper-middle bracket, need to properly fund their public health and cancer care systems, and to adopt rigorous governance models to improve the quality of care,” says Sullivan.
The findings also highlight the shortfalls in the coverage by cancer registries in some parts of the world. For example, the CONCORD-3 investigators could not systematically assess survival trends in Africa as for some registries up to 40% of records had missing data, while for others the follow-up was less than 5 years.
Allemani et al also highlight problems arising from poor linking of cancer registries to regional or national death indices as a result of legal, administrative, or technical difficulties, which can be an issue even in some high-income countries, such as Canada.
They write: “It is crucial for national and regional governments to recognise that population-based cancer registries are key policy tools, both to monitor the impact of cancer prevention strategies and to evaluate the effectiveness of the health system for all patients diagnosed with cancer.
“All registries, especially those in [LMICs], need to be given adequate resources to register all patients with cancer in a timely fashion, the right to access up-to-date national and regional death records to establish their vital status, and the legislative stability to operate efficiently over the long term.”
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