International comparisons and the impact on UK cancer care
Michel Coleman
London School of Hygiene and Tropical Medicine, University of London, UK
Cancer will affect one in three of us in a typical lifetime. One in four of us will die of it. Over 5,000 people in the UK are diagnosed with cancer every week. Prevention is thus paramount, but even if, tomorrow, we prevented all cancers that are preventable on current knowledge, 3,000 people would still be diagnosed with cancer every week, most of them needing rapid access to optimal diagnostic services and life-saving treatment. For the foreseeable future, therefore, managing this huge burden of life-threatening disease efficiently and sensitively will remain a complex and expensive challenge for the NHS. A widely-used measure of overall success in cancer care is the percentage of patients who survive five or more years after diagnosis. Survival for many cancers has been improving in the UK, but also in other countries. International comparisons of five-year survival have often been unfavourable for the UK.
Cancer survival comparisons will be reviewed against the backdrop of cancer planning and health policy, starting with the first serious attempt to reform the delivery of cancer care in 1995. We will see why cancer survival is measured differently in the clinical medicine and public health settings, and why the results must also be interpreted differently. We will consider some of the criticisms of cancer survival comparisons, and whether such criticisms also apply to comparisons of incidence (new cases) and mortality (death) rates.
Many questions arise. Is five-year survival a suitable measure to evaluate health service performance for cancer? Is five-year survival affected by anything else? What other measures are available? Are the international comparisons robust? What has been their impact on cancer care? When can we expect to see any impact of recent changes in the NHS on improved cancer survival? Are we falling further behind comparator countries, or catching up? What further research is required?
