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Potential for improvement in cancer management: reducing mortality in the European Union.

ABSTRACT: Overall age-standardized cancer mortality rates in the European Union (EU) have declined by approximately 20% through 2010 (17% in women, 22% in men) since the peak value reached in 1988. This corresponds to the avoidance of more than 250,000 cancer deaths in 2010 alone and approximately 2.2 million deaths over the 1989-2010 22-year period. A more than twofold difference remains between the highest cancer mortality rates (in Hungary and other central European countries) and the lowest (in selected Nordic countries and Switzerland). Part of this gap is due to tobacco, alcohol, and other lifestyle and environmental exposures, and another part is attributable to differences in cancer diagnosis, treatment, and management. There are also appreciable differences in 5-year cancer survival across the EU, with lower survival rates in central and eastern Europe. If overall cancer survival in EU countries with low rates could be raised to the median, approximately 50,000 additional cancer deaths would be avoided per year, and more than 100,000 would be avoided if overall survival in all countries were at least that of the 75% percentile--4% and 8%, respectively, of the approximately 1.3 million cancer deaths registered in the EU in 2010. There is, however, substantial uncertainty about any such estimate because differences in cancer survival are partly or largely attributable to earlier diagnosis, in variable proportion for each cancer site and probably to different degrees in different countries, even in the absence of changes in the date of death or avoidance of death. Consequently, these approximations are the best available and may be used cautiously to compare countries, health care approaches, and changes that occur over time.

SUBMITTER: La Vecchia C

PROVIDER: S-EPMC4425394 | biostudies-literature | 2015 May

REPOSITORIES: biostudies-literature

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Potential for improvement in cancer management: reducing mortality in the European Union.

La Vecchia Carlo C Rota Matteo M Malvezzi Matteo M Negri Eva E

The oncologist 20150417 5

Overall age-standardized cancer mortality rates in the European Union (EU) have declined by approximately 20% through 2010 (17% in women, 22% in men) since the peak value reached in 1988. This corresponds to the avoidance of more than 250,000 cancer deaths in 2010 alone and approximately 2.2 million deaths over the 1989-2010 22-year period. A more than twofold difference remains between the highest cancer mortality rates (in Hungary and other central European countries) and the lowest (in select ...[more]

PMID: 25888268

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Project description:Improving colorectal cancer (CRC) screening rates for patients from socioeconomically disadvantaged backgrounds is a recognized public health priority.Our aim was to determine if implementation of a system-wide screening intervention could reduce disparities in the setting of improved overall screening rates.This was an interrupted time series (ITS) analysis before and after a population management intervention.Patients eligible for CRC screening (age 52-75 years without prior total colectomy) in an 18-practice research network from 15 June 2009 to 15 June 2012 participated in the study.The Technology for Optimizing Population Care (TopCare) intervention electronically identified patients overdue for screening and facilitated contact by letter or telephone scheduler, with or without physician involvement. Patients identified by algorithm as high risk for non-completion entered into intensive patient navigation.Patients were dichotomized as???high school diploma (? HS), an indicator of socioeconomic disadvantage, vs. >HS diploma (> HS). The monthly disparity between???HS and?>?HS with regard to CRC screening completion was examined.At baseline, 72% of 47,447 eligible patients had completed screening, compared with 75% of 51,442 eligible patients at the end of follow-up (p?<?0.001). CRC screening completion was lower in???HS vs. >HS patients in June 2009 (65.7% vs. 74.5%, p?<?0.001) and remained lower in June 2012 (69.4% vs. 76.7%, p?<?0.001). In the ITS analysis, which accounts for secular trends, TopCare was associated with a significant decrease in the CRC screening disparity (0.7%, p?<?0.001). The effect of TopCare represents approximately 99 additional???HS patients screened above prevailing trends, or 26 life-years gained had these patients remained unscreened.A multifaceted population management intervention sensitive to the needs of vulnerable patients modestly narrowed disparities in CRC screening, while also increasing overall screening rates. Embedding interventions for vulnerable patients within larger population management systems represents an effective approach to increasing overall quality of care while also decreasing disparities.

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Dataset Information

Potential for improvement in cancer management: reducing mortality in the European Union.

Publications

Potential for improvement in cancer management: reducing mortality in the European Union.

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