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Eur J Cancer. 2015 Oct;51(15):2120-2129. doi: 10.1016/j.ejca.2015.07.025. Epub 2015 Sep 26.

Age and case mix-standardised survival for all cancer patients in Europe 1999-2007: Results of EUROCARE-5, a population-based study.

Collaborators (198)

Hackl M, Zielonke N, Oberaigner W, Van Eycken E, Henau K, Valerianova Z, Dimitrova N, Sekerija M, Zvolský M, Dušek L, Storm H, Engholm G, Mägi M, Aareleid T, Malila N, Seppä K, Velten M, Troussard X, Bouvier V, Launoy G, Guizard AV, Faivre J, Bouvier AM, Arveux P, Maynadié M, Woronoff AS, Robaszkiewicz M, Baldi I, Monnereau A, Tretarre B, Bossard N, Belot A, Colonna M, Molinié F, Bara S, Schvartz C, Lapôtre-Ledoux B, Grosclaude P, Meyer M, Stabenow R, Luttmann S, Eberle A, Brenner H, Nennecke A, Engel J, Schubert-Fritschle G, Kieschke J, Heidrich J, Holleczek B, Katalinic A, Jónasson JG, Tryggvadóttir L, Comber H, Mazzoleni G, Bulatko A, Buzzoni C, Giacomin A, Sutera Sardo A, Mazzei A, Ferretti S, Crocetti E, Manneschi G, Gatta G, Sant M, Amash H, Amati C, Baili P, Berrino F, Bonfarnuzzo S, Botta L, Di Salvo F, Foschi R, Margutti C, Meneghini E, Minicozzi P, Trama A, Serraino D, Zucchetto A, De Angelis R, Caldora M, Capocaccia R, Carrani E, Francisci S, Mallone S, Pierannunzio D, Roazzi P, Rossi S, Santaquilani M, Tavilla A, Pannozzo F, Natali M, Bonelli L, Vercelli M, Gennaro V, Ricci P, Autelitano M, Randi G, Ponz De Leon M, Marchesi C, Cirilli C, Fusco M, Vitale MF, Usala M, Traina A, Zarcone M, Vitale F, Cusimano R, Michiara M, Tumino R, Giorgi Rossi P, Vicentini M, Falcini F, Iannelli A, Sechi O, Cesaraccio R, Piffer S, Madeddu A, Tisano F, Maspero S, Fanetti AC, Zanetti R, Rosso S, Candela P, Scuderi T, Stracci F, Rocca A, Tagliabue G, Contiero P, Dei Tos AP, Tognazzo S, Pildava S, Smailyte G, Calleja N, Micallef R, Johannesen TB, Rachtan J, Gózdz S, Mezyk R, Blaszczyk J, Kepska K, Bielska-Lasota M, Forjaz de Lacerda G, Bento MJ, Antunes L, Miranda A, Mayer-da-Silva A, Nicula F, Coza D, Safaei Diba C, Primic-Zakelj M, Almar E, Mateos A, Errezola M, Larrañaga N, Torrella-Ramos A, Díaz García JM, Marcos-Navarro AI, Marcos-Gragera R, Vilardell L, Sanchez MJ, Molina E, Navarro C, Chirlaque MD, Moreno-Iribas C, Ardanaz E, Galceran J, Carulla M, Lambe M, Khan S, Mousavi M, Bouchardy C, Usel M, Ess SM, Frick H, Lorez M, Ess SM, Herrmann C, Bordoni A, Spitale A, Konzelmann I, Visser O, Lemmens V, Coleman M, Allemani C, Rachet B, Verne J, Easey N, Lawrence G, Moran T, Rashbass J, Roche M, Wilkinson J, Gavin A, Fitzpatrick D, Brewster DH, Huws DW, White C, Otter R.

Author information

Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", via Venezian 1, 20133 Milan, Italy.
Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", via Venezian 1, 20133 Milan, Italy. Electronic address:
Epidemiology Unit and Girona Cancer Registry (Oncology Coordination Plan). Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute, Girona, Spain.
Netherlands Comprehensive Cancer Organisation (Department of Research), PO Box 19079, 3501 DB Utrecht, The Netherlands; MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente (Department of Health Technology and Services Research), Enschede, The Netherlands.
National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), National Institute of Health (Istituto Superiore di Sanità), Rome, Italy.
Informatics service, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy.
Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", via Venezian 1, 20133 Milan, Italy; Department of Health Sciences (DISS), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy.
PhD School in Applied Sociology and Methodology of Research, Department of Sociology, University of Milan-Bicocca, Milan, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.



Overall survival after cancer is frequently used when assessing a health care service's performance as a whole. It is mainly used by the public, politicians and the media, and is often dismissed by clinicians because of the heterogeneous mix of different cancers, risk factors and treatment modalities. Here we give survival details for all cancers combined in Europe, correlating it with economic variables to suggest reasons for differences.


We computed age and cancer site case-mix standardised relative survival for all cancers combined (ACRS) for 29 countries participating in the EUROCARE-5 project with data on more than 7.5million cancer cases from 87 population-based cancer registries, using complete and period approach.


Denmark, United Kingdom (UK) and Eastern European countries had lower survival than neighbouring countries. Five-year ACRS has been increasing throughout Europe, and substantial increases, between 1999-2001 and 2005-2007, have been achieved in countries where survival was lower in the past. Five-year ACRS for men and women are positively correlated with macro-economic variables like the Gross Domestic Product (GDP) and Total National Expenditure on Health (TNEH) (R2 about 70%). Countries with recent larger increases in GDP and TNEH had greater increases in cancer survival.


ACRS serves to compare all cancer survival in Europe taking account of the geographical variability in case-mixes. The EUROCARE-5 data on ACRS confirm previous EUROCARE findings. Survival appears to correlate with macro-economic determinants, particularly with investments in the health care system.


All cancer; Cancer survival; Case-mix by cancer site; EUROCARE; Population-based cancer registries


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