title: Age and case mix-standardised survival for all cancer patients in Europe 1999-2007: Results of EUROCARE-5, a population-based study.
abstract: BACKGROUND
  Overall survival after cancer is frequently used when assessing a health care service's performance as a whole. It is mainly used by the public, politicians and the media, and is often dismissed by clinicians because of the heterogeneous mix of different cancers, risk factors and treatment modalities. Here we give survival details for all cancers combined in Europe, correlating it with economic variables to suggest reasons for differences.
  
  
  METHODS
  We computed age and cancer site case-mix standardised relative survival for all cancers combined (ACRS) for 29 countries participating in the EUROCARE-5 project with data on more than 7.5million cancer cases from 87 population-based cancer registries, using complete and period approach.
  
  
  RESULTS
  Denmark, United Kingdom (UK) and Eastern European countries had lower survival than neighbouring countries. Five-year ACRS has been increasing throughout Europe, and substantial increases, between 1999-2001 and 2005-2007, have been achieved in countries where survival was lower in the past. Five-year ACRS for men and women are positively correlated with macro-economic variables like the Gross Domestic Product (GDP) and Total National Expenditure on Health (TNEH) (R2about 70%). Countries with recent larger increases in GDP and TNEH had greater increases in cancer survival.
  
  
  CONCLUSIONS
  ACRS serves to compare all cancer survival in Europe taking account of the geographical variability in case-mixes. The EUROCARE-5 data on ACRS confirm previous EUROCARE findings. Survival appears to correlate with macro-economic determinants, particularly with investments in the health care system.
authors.affiliation: Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", via Venezian 1, 20133 Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Baili
authors.affiliation: Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", via Venezian 1, 20133 Milan, Italy. Electronic address: francesca.disalvo@istitutotumori.mi.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Salvo
authors.affiliation: Epidemiology Unit and Girona Cancer Registry (Oncology Coordination Plan). Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute, Girona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Marcos-Gragera
authors.affiliation: Netherlands Comprehensive Cancer Organisation (Department of Research), PO Box 19079, 3501 DB Utrecht, The Netherlands; MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente (Department of Health Technology and Services Research), Enschede, The Netherlands.
authors.forename: Sabine
authors.initials: S
authors.lastname: Siesling
authors.affiliation: National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), National Institute of Health (Istituto Superiore di Sanità), Rome, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mallone
authors.affiliation: Informatics service, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Santaquilani
authors.affiliation: Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", via Venezian 1, 20133 Milan, Italy; Department of Health Sciences (DISS), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Micheli
authors.affiliation: PhD School in Applied Sociology and Methodology of Research, Department of Sociology, University of Milan-Bicocca, Milan, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lillini
authors.affiliation: National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), National Institute of Health (Istituto Superiore di Sanità), Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Francisci
keywords: All cancer; Cancer survival; Case-mix by cancer site; EUROCARE; Population-based cancer registries