Survival after Cancer
Diagnosis Strongly Associated With Governments’ Spending On Health Care
The
more an EU (European Union) national government spends on health, the fewer the
deaths after a cancer diagnosis in that country, according to new research to
be presented to the 2013 European Cancer Congress (ECC2013) and published
simultaneously in the leading cancer journal Annals of Oncology.
Researchers
will tell the meeting that higher wealth and higher health expenditure are
strongly associated both with increased cancer incidence and decreased cancer
mortality. In the case of breast cancer, increased health expenditure appears
to be even more strongly associated with better outcomes.
Dr
Ades and his colleagues obtained information on populations, cancer incidence,
and mortality from the World Health Organization, the International Monetary
Fund and the World Bank [4]. They looked at factors such as countries’ gross
domestic product (GDP), the percentage of GDP invested in healthcare and health
expenditure per person per year, and compared these wealth and health
expenditure indicators with their own estimates of the proportion of patients
dying after a cancer diagnosis.
While
the population of Western Europe – approximately 400 million inhabitants – is
around four times larger than that of Eastern Europe, Western countries’ total
GDP is more than 10-fold higher than that of Eastern Europe [5]. The
researchers also found a significant difference between the health expenditure
of these countries.
“Not
surprisingly, health expenditure per capita is strongly correlated with the GDP
per capita and with the percentage of GDP spent on heath,” Dr Ades will say.
“The cut-off point between Eastern and Western European countries for health
expenditure per person per year is around 2,600 US dollars. For instance, among
the Western European countries Portugal has the lowest per capita expenditure
at 2,690 dollars, while among the Eastern European countries, Slovenia has the
highest per capita expenditure at 2,551 dollars. In the West, Luxembourg spent
the most per person per year – 6,592 dollars – while in the East, Romania spent
the least – 818 dollars.”
The
researchers found that, proportionally, Eastern Europe had lower cancer
incidence and higher cancer mortality, while the opposite was the case in
Western Europe. Dr Ades will tell the congress:
“From our results it is evident
that Eastern European countries, except Cyprus, have higher mortality rates
than the Western European countries for approximately the same range of
incidence. This indicates that proportionally more patients die after a
diagnosis of cancer in Eastern Europe than in Western Europe. This pattern is
strongly associated with health expenditure; the more a country spends on
health, the fewer patients die after a cancer diagnosis.
“In
countries spending less than 2,000 dollars per capita in health care, like
Romania, Poland and Hungary, around 60% of the patients die after a diagnosis
of cancer; in countries spending between 2,500-3,500 dollars this figure is
around 40% and 50%, as in the case of Portugal, Spain and the United Kingdom;
moving up to around 4,000 dollars, less than 40% of the patients die, as in the
case of France, Belgium and Germany.”
The
research does not analyse the reasons for the higher incidence of cancer in
Western European countries. However, it suggests that, as cancer deaths do not
increase in the same proportion to incidence in these countries, it may be due
partly to the existence of greater numbers of Western screening programmes,
which detect more cancers at their early, more treatable stages, and to the
availability of effective treatments in these countries.
Dr
Ades and his colleagues also looked specifically at breast cancer. “We did this
because breast cancer is the best example of an oncologic disease with
effective screening methods. Also, in European populations it has been shown that
breast cancer screening reduces mortality in comparison to non-screening,” he
will say.
“We found that the association between greater wealth and higher
health expenditure and the incidence of breast cancer was even stronger than in
other cancers, a fact possibly linked to the inherent higher incidence of
breast cancer in Western countries but also to the increased detection due to
screening availability, although this was not the case for deaths from the
disease as breast cancer mortality is similar across the European Union.
"However, when we divided the number of new cases of breast cancer by the number
of deaths from breast cancer to establish the ratio of deaths to incidence, we
found that a smaller fraction of patients died after diagnosis in Western
Europe than in Eastern Europe, and this was also strongly associated with
higher wealth and health expenditure.”
Dr
Ades will also say: “Although financing health systems is a responsibility of
national governments, the European Union has enacted a Charter of Fundamental
Rights to standardise public health policies. Our research demonstrates that
despite the initiatives to render more uniform the health policy across the EU
member states, there are still marked differences between Eastern and Western
Europe in regards to cancer indicators. More research is needed to investigate
these issues further.”
ECCO
president, Professor Cornelis van de Velde, commented: “This is an interesting
study confirming that, just as overall life expectancy is higher in countries
that spend proportionately more on health, so cancer patients’ survival is also
higher in these countries. It is interesting to see that this association is
even stronger for patients with breast cancer as compared to other cancers, and
that, despite the initiatives to standardise health care across Europe,
disparities are still present.
“Factors
such as the proportion of GDP spent on health, levels of employment and numbers
of hospital beds are associated with a favourable prognosis for cancer
patients, and previous studies have shown that these appear to be responsible
for over 65% of the variations between countries in survival for breast cancer
in Western Europe.”
ESMO
spokesperson, Professor José Martin-Moreno, Professor of Public Health at the
Medical School at the Universidad de Valencia (Spain), commented: “Cancer is a
leading cause of mortality in Europe, and yet there is an important deficit
between the resources needed to control it and those deployed to do so. In this
context, Dr Ades and colleagues have produced an important study, confirming
that funding for health systems is crucial to ensuring good patient outcomes
and warning over health inequalities across the EU countries.
"Given the ongoing
economic recession, this is a message that European governments and citizens
need to know. Public health expenditure, along with adequate governance and
accountability mechanisms, evidence-based guidelines, and proper
capacity-building, are all essential ingredients for a strong health system and
for a better society.”
[1]
The 2013 European Cancer Congress is the 17th congress of the European CanCerOrganisation
(ECCO), the 38th congress of the European Society for Medical Oncology (ESMO)
and the 32nd congress of European Society for Therapeutic Radiology and
Oncology (ESTRO).
[2]
“Discrepancies in cancer incidence and mortality and its relationship to health
expenditure in the 27 European Union member states,” by F. Ades, C. Senterre,
E. de Azambuja, R. Sullivan, F. Popescu F. Parent & M. Piccart. Annals of
Oncology. doi: 10.1093/annonc/mdt352. Annals of Oncology website:
http://annonc.oxfordjournals.org/
[3]
The study was performed before Croatia joined the European Union on July 1,
2013.
[4]
Data extracted from the publicly available databases of the World Health
Organization (GLOBOCAN 2008 and WHO World Health Statistics 2012), the
International Monetary Fund Report 2009, and the World Bank Report 2011.
[5]
Total Western countries GDP is US$ 16,166,150,000,000. Total Eastern countries
GDP is US$ 1,375,320,000,000.
[6]
This study received no external funding.
Story Source:
The
above story is based on materials provided by The European CanCer Organisation
(ECCO), via AlphaGalileo.
Note: Materials may be edited for content and length. For further
information, please contact the source cited above.
Journal Reference:
1.
F. Ades, C. Senterre, E.
de Azambuja, R. Sullivan, F. Popescu F. Parent & M. Piccart. Discrepancies
in cancer incidence and mortality and its relationship to health expenditure in
the 27 European Union member states. Annals of Oncology,
September 2013 DOI: 10.1093/annonc/mdt352
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The European CanCer Organisation (ECCO) (2013, September 27).
Survival after cancer diagnosis strongly associated with governments spending
on health care. ScienceDaily. Retrieved September 29, 2013, from
http://www.sciencedaily.com/releases/2013/09/130927183114.htm