Quality of Life in Long-term Cancer Survivors: Implications for Future Health Technology Assessments in Oncology

Office of Health Economics | July 2018 | Quality of Life in Long-term Cancer Survivors: Implications for Future Health Technology Assessments in Oncology

The Office of Health Economics has undertaken a literature review which  examines whether there is evidence to support the assumption that the quality of life (QoL) of  long-term cancer survivors (LTCS) can be similar to that of age-/sex-matched population samples.  The review included 20 papers which represented  23 studies covering a range of cancers, with the LTCS in the studies were more likely to have experienced early-stage cancer relative to late-stage cancer (Source: Office of Health Economics).

The news release is available from the Office of Health Economics 

The literature review can be downloaded from the OHE

Cancer survival trends

Little evidence for any direct impact of national cancer policies on short-term survival in England and no evidence for a reduction in socioeconomic inequalities in cancer survival. Findings emphasise that socioeconomic inequalities in survival remain a major public health problem. |  London School of Hygiene & Tropical Medicine | British Medical Journal

New research from the London School of Hygiene and Tropical Medicine found that despite overall improvements in cancer survival, the gap in survival between the most affluent and most deprived groups of patients remains unchanged for most cancers.

Survival trends were examined for 21 cancers in men and 20 cancers in women.

For each cancer, the chances of survival at one year after diagnosis were estimated separately for men and women in five levels of socio-economic deprivation, from the most affluent to the most deprived, and in each of the three calendar periods.

Researchers focused on one-year survival because most of the inequalities in cancer survival in England arise shortly after diagnosis. The survival estimates were corrected for the risk of dying from other causes of death. Estimates were also adjusted for differences in the age profile of cancer patients between men and women, and over time.

The “deprivation gap” in survival between the most affluent and most deprived groups of patients remained unchanged for most cancers. There was a clear and persistent pattern of lower survival among more deprived patients. It narrowed slightly for some cancers, where one-year survival was already more than 65% in 1996, such as cervical cancer and skin melanoma in men. By contrast, the deprivation gap in survival widened between the late 1990s and 2013 for brain tumours in men and lung cancer in women.

Full story at London School of Hygiene and Tropical Medicine

Link to the research: Aimilia Exarchakou et al.  (2018). Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study. BMJ.

Prevention of bowel cancer

Bowel Cancer UK has published Finding the Key to the Cures: a plan to end bowel cancer by 2050.

Bowel cancer is the UK’s second biggest cancer killer with 16,000 people dying from the disease, and the fourth most common cancer with over 41,200 people diagnosed each year. The key to reducing the numbers of people dying from this condition is early diagnosis. This report examines ways and methods of increasing earlier detection methods which could transform survival rates and ultimately benefit thousands of people in the future.  

UK has 6th highest rate of obesity – OECD

Health at a Glance 2017: OECD Indicators | Organisation for Economic Cooperation and Development | OnMedica

A report from the Organisation for Economic Cooperation and Development (OECD) has found that the UK has the sixth highest rate of adult obesity. The report looks at health indicators across its 100 member countries.

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It shows that almost 27% of the adult population of the UK is obese, compared with the OECD average of 19.4%. The UK has a smoking prevalence of 16.1%, which is below the OECD average of 18.4%.

However average alcohol consumption per UK adult is higher than the OECD average, with consumption averaging at 9.5 litres per adult.

The report highlights cancer by way of an example of both the good progress made and continuing challenges. Cancer survival has improved over time, due in part to high screening rates. Breast and rectal cancer survival rates are now slightly higher than the OECD average, with, respectively, 85.6% and 62.5% of people diagnosed living for at least a further five years, versus 85% and 61% in the OECD as a whole. Both rose at a faster pace than average over the course of ten years. But bowel cancer survival is still below the OECD average (60% compared to 62.8%), and overall cancer mortality rates remain relatively high (222 deaths per 100 000 people, compared with an OECD average of 204).

Full document: Health at a glance 2017 – OECD indicators.

Bowel cancer deaths drop by a third in 20 years

The rate of people dying from bowel cancer in the UK has plummeted by more than 30 per cent in the last 20 years | Cancer Research UK 

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Image source: CRUK 

Bowel cancer was responsible for 38 deaths per 100,000 people in 1995, falling to 26 deaths per 100,000 people by 2015. The drop in rates, taking into account changing population figures, equates to a decrease in bowel cancer deaths from 17,600 in 1995 to 15,800 in 2015.

Experts believe better treatment lies behind the dramatic drop in deaths. Improved public awareness among both patients and doctors, the bowel screening programme, may also be playing a part.

Read the full blog post here

‘Burden of cancer’ increasing as UK trails behind Europe in cancer care

A new report published today shows that the UK is trailing behind the rest of Europe in the treatment of cancer | ABPI

ABPI
Image source: ABPI

British patients have worse survival rates after five years – the international benchmark for measuring the quality of cancer care – compared to the European average in nine out of ten cancers – only exceeding the EU average in melanoma.

​​​​​​​​​​​​Despite the increasing burden of cancer on society, the UK spends over 20 per cent less per person on cancer than the top five EU economies; 20 per cent less of its total health budget on cancer than the rest of the EU; and 10 per cent less of its GDP on healthcare than the rest of the EU.

On cancer survival:

  • UK cancer survival rates lag behind the European average in 9 out of 10 cancers
  • If the UK achieved the cancer survival rates of Germany, over 35,000 more people would be alive five years after diagnosis.
  • The UK has the worst survival outcomes across Europe for ovarian cancer. The UK’s Ovarian cancer survival rate is 34.0% of patients surviving for five years or more. European average is 40.8%​
  • The UK has the second worst survival rates for lung cancer – 8 per cent of patients surviving more than five years (ahead only of Bulgaria – 7 per cent). European average is 12.62 per cent.​
  • The UK has the second worst survival rates for pancreatic cancer – 3 per cent of patients surviving more than five years (ahead only of Iceland – 2.56 per cent) European average is 5.84 per cent.​
  • If the UK had the mortality rates of France, more than 100,000 women’s deaths could be prevented over the next ten years.

View the full report here

Characteristics and Outcome of Cancer Patients Admitted to the ICU

This study aims to describe trends in outcomes of cancer patients with an unplanned admission to the ICU between 1997 and 2013 and to identify risk factors for mortality of those admitted between 2009 and 2013 | Critical Care Medicine

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Design: Retrospective analysis.

Measurements and Main Results: In solid tumor patients admitted between 2009 and 2013, hospital mortality was 26.4%. Independent risk factors for hospital mortality were metastatic disease (odds ratio, 1.99), cardiopulmonary resuscitation before ICU admission (odds ratio, 1.63), Intensive Care National Audit & Research Centre Physiology score (odds ratio, 1.14), admission for gastrointestinal (odds ratio, 1.12), respiratory (odds ratio, 1.48) or neurological (odds ratio, 1.65) reasons, and previous ICU admission (odds ratio, 1.18). In patients with a hematological malignancy admitted between 2009 and 2013, hospital mortality was 53.6%. Independent risk factors for hospital mortality were age (odds ratio, 1.02), cardiopulmonary resuscitation before ICU admission (odds ratio, 1.90), Intensive Care National Audit & Research Centre Physiology Score (odds ratio, 1.12), admission for hematological (odds ratio, 1.48) or respiratory (odds ratio, 1.56) reasons, bone marrow transplant (odds ratio, 1.53), previous ICU admission (odds ratio, 1.43), and mechanical ventilation within 24 hours of admission (odds ratio, 1.33). Trend analysis showed a significant decrease in ICU and hospital mortality and length of stay between 1997 and 2013 despite little change in severity of illness during this time.

Conclusions: Between 1997 and 2013, the outcome of cancer patients with an unplanned admission to ICU improved significantly. Among those admitted between 2009 and 2013, independent risk factors for hospital mortality were age, severity of illness, previous cardiopulmonary resuscitation, previous ICU admission, metastatic disease, and admission for respiratory reasons.

Full reference: Ostermann, M. et al. (2107) Characteristics and Outcome of Cancer Patients Admitted to the ICU in England, Wales, and Northern Ireland and National Trends Between 1997 and 2013. Critical Care Medicine. Published online: 4th July 2017