Relative survival in elderly European cancer patients: evidence for healthcare inequalities

This paper examines the survival of elderly European cancer patients, on th e basis nf the EUROCARE II results. Using Hakulinen and Abeywickrama's meth od, the relative survival rates at 1 and 5 years from diagnosis were comput ed by sex and quinquennial age group for the elderly (65-99 years old). Age -standardised rates for the whole elderly group were also calculated. The a nalysis covered: all malignancies combined, stomach, colon, rectum, pancrea s, lung. melanoma, bladder, kidney and non-Hodgkin's lymphomas for both sex es; prostate and larynx for men; and breast, ovary, uterine cervix and corp us for women. Data relating to 701 521 cancer patients came from 44 populat ion-based cancer registries in 16 European countries. The relative risks of death (RRs) of older patients (65-99) with respect to middle-aged adults ( 55-64) were computed by ses and country, for all malignancies only. The mos t prominent finding was the decrease in survival rates with increasing age for almost all cancer sites. The age-curves of survival rates at 1 year fro m diagnosis usually had a steeper slope than those at 5 years, particularly in women. This suggests that disease stage at presentation plays an import ant role in determining survival, particularly in the elderly. Thus, all fa ctors which influence timing diagnosis in the elderly and cause a delay in tumour detection, such as psyche-social factors. access to care, co-morbidi ties and other clinical features affecting performance status, are very imp ortant predictors of prognosis. Very large geographic variations in relativ e survival rates were found among European countries. The ordering of count ries was similar for almost all cancer sites. Western and Central Europe ge nerally had the best survival, followed by Northern countries and by Southe rn ones (the latter with survival around the European average: 39% in men, 47% in women). The UK had survival rates unexpectedly lower than rates of n earest nations, often below the European average. Eastern countries usually had the lowest rates. in the very elderly patients lover 85 years), an app arent rise in the survival rates was noted, particularly at 5 years from di agnosis and in men. This 'too good' survival is unlikely to be due to real better prognosis, but rather to a selection bias. Countries with this unusu al rise are also those registering a high proportion of DCO cases (those ca ses retrieved by death certificate only) (around 10%) or DCO unavailable. A nother 'natural' bias has also to be taken into account: in elderly patient s with a very bad prognosis, who are often suffering from other serious co- morbid conditions, cancer diagnoses could be under-notified and not reach a t all the data sources commonly monitored by cancer registries. (C) 2000 El sevier Science Ireland Ltd. All rights reserved.