Study reveals why the survival of patients with blood cancer still varies between regions in Europe -
Failure to obtain the best treatment and changes in the quality of care are the most likely reasons why survival for patients with blood cancer still varies widely between the regions of Europe, according to the largest study population-based survival among European adults to date , published in The Lancet Oncology .
"the good news is that survival at 5 years for most cancers of the blood has increased over the past 11 years, most likely reflecting the approval of new targeted drugs in the early 00s, as rituximab for non-Hodgkins lymphoma and imatinib for chronic myeloid leukemia, "said study leader Dr Milena Sant Fondazione IRCCS Istituto the Nazionale dei Tumori in Milan, Italy.
"But there are still persistent differences between regions. For example, the absorption and utilization of new technologies and therapies was much slower in Eastern Europe than other regions. This may have contributed to the great differences in management and patient outcomes. "
The Eurocare study analyzed data from 30 cancer registries covering all patients diagnosed in 20 European countries to compare changes in the 5-year survival for more than 560,400 adults (aged 15 and over ) 11 diagnosed with lymphoid and myeloid cancers between 1997 and 08 and followed until the end of 08.
Certain blood cancers showed particularly large increases in survival between 1997 and 08, for example, follicular lymphoma (59% to 74%), diffuse large B-cell lymphoma (42% to 55%), chronic myeloid leukemia (32% to 54%) and acute promyelocytic leukemia (50% to 62%).
the greatest improvements in survival during 1997-08 were in northern, central and eastern Europe, although adults in Eastern Europe (where survival in 1997 was the lowest) continue to have lower survival for most blood cancers elsewhere.
But survival gains were lower in southern Europe and the UK. For example, improved 5-year survival of chronic myeloid leukemia in the north (29% to 60%) and Central Europe (34% to 65%) were consistently higher than in the UK (35 % to 56%) and in Southern Europe (37% to 55%). For more detailed results for all cancers by European area see Table 4 on page 6 and Figure 2 on page 6.
The risk of death within 5 years of diagnosis fell so significant for all malignancies, with the exception of myelodysplastic syndromes between 1997 and 08. But not all regions have seen such improvements. For example, compared to the UK, the excess risk of death was significantly higher in Eastern Europe than in other regions for most cancers studied, but significantly lower in Northern Europe. For more detailed results for all cancers in the European zone and age See Table 5 on page 7.
The authors suggest that the most likely reasons for continuing geographic differences in survival inequalities in the provision of care and the availability and use of new treatments.
"We know that rituximab, imatinib, thalidomide, bortezomib and were first made available for general use in Europe in 1997, 01, 1998 and 03 respectively. The years following mailing generally these drugs coincided with a sharp increase in the survival of chronic myeloid leukemia, diffuse large cell lymphoma B, and follicular lymphoma, with an increase in smaller but significant survival for multiple myeloma plasmacytoma "say. authors.
However, they emphasize that the absorption and use of these drugs has not been uniform throughout Europe. For example, rituximab absorption, imatinib and bortezomib market was lower in Eastern Europe and elsewhere could always explain the lower survival in this region
According Sant :.
High resolution studies using clinical records to collect detailed clinical information for representative samples of cancer registry can more directly link treatment and clinical characteristics of survival.
Write a comment linked, Alastair Munro of the University of Dundee Medical School in Scotland question whether these improvements in survival can be simply attributed to drugs, saying, "A better understanding the 5-EUROCARE findings require additional information on changes over time (and space) concerning: survival according to the broad categories of disease (Hodgkin's lymphoma, non-Hodgkin's lymphoma, leukemia, myeloma and other malignancies myeloid), distribution of histological subtypes and their relationship with the age distribution of the population; the phase distribution at diagnosis, and the time of active intervention for tumors indolent. ... in comparison, either in time or in space, one must consider the effect of potential confounding factors. is it all on drugs? the answer is, not quite. "
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