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Responding to the Challenge of Cancer in Europe © Institute of Public Health of the Republic of Slovenia, 2008 Responding to the challenge of cancer in Europe © Institute of Public Health of the Republic of Slovenia, 2008 All rights reserved. Please address requests for permission to reproduce or translate this publication to: Institute of Public Health of the Republic of Slovenia Trubarjeva 2 1000 Ljubljana Slovenia The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the Ministry of Health of the Republic of Slovenia, the European Commission, or the European Observatory on Health Systems and Policies or any of its partners. CIP – Cataloguing in publication National and University Library, Ljubljana, Slovenia 616-006(4) RESPONDING to the challenge of cancer in Europe / edited by Michel P. Coleman ... [et al.]. - Ljubljana : Institute of Public Health of the Republic of Slovenia, 2008 ISBN 978-961-6659-20-8 1. Coleman, Michel P. COBISS.SI-ID 236838144 Printed and bound in the Republic of Slovenia by Tiskarna Radovljica Further copies of this publication are available from: Institute of Public Health of the Republic of Slovenia Trubarjeva 2 1000 Ljubljana Slovenia Responding to the challenge of cancer in Europe Edited by Michel P Coleman, Delia-Marina Alexe, Tit Albreht and Martin McKee This publication arises from the project FACT – Fighting Against Cancer Today – which has received funding from the European Union, in the framework of the Public Health Programme. Contents List of tables, figures and boxes vii Foreword ˆ xiii Zofija Mazej Kukovic Acknowledgements xv About the contributors xvii Chapter 1 Responding to the challenge of cancer in Europe 1 Delia-Marina Alexe, Tit Albreht, Martin McKee and Michel P Coleman Chapter 2 The burden of cancer in Europe 7 Freddie Bray Chapter 3 The causes of cancer and policies for prevention 41 Jose M Martin-Moreno and Gu∂– jón Magnússon Chapter 4 Cancer screening 69 Matti Hakama, Michel P Coleman, Delia-Marina Alexe and Anssi Auvinen Chapter 5 Drugs for cancer 93 Karol Sikora Chapter 6 Organizing a comprehensive framework for cancer control 113 Robert Haward Chapter 7 Changes in the management of cancer: the example 135 of colorectal cancer Jean Faivre and Côme Lepage vi Responding to the challenge of cancer in Europe Chapter 8 Survival of European cancer patients 151 Franco Berrino and Riccardo Capocaccia Chapter 9 Information on cancer 177 Andrea Micheli and Paolo Baili Chapter 10 Cancer patients - partners for change 191 Hildrun Sundseth and Lynn Faulds Wood Chapter 11 The role of psychosocial oncology in cancer care 209 Luigi Grassi and Luzia Travado Chapter 12 Dying with cancer, living well with advanced cancer 231 Irene J Higginson and Massimo Costantini Chapter 13 Closing´ the gap: cancer in central and eastern Europe 253 Witold Zatonski and Joanna Didkowska Chapter 14 Cancer control in Slovenia: achievements, shortcomings and 279 ˆ opportunities ˆ Maja Primic Zakelj and Tina Zagar Chapterˆ 15 Researching cancer 297 Tanja Cufer and Richard Sullivan Chapter 16 Making progress against cancer 315 Tit Albreht, Martin McKee, Delia-Marina Alexe, Michel P Coleman and Jose M Martin-Moreno List of tables, figures and boxes Tables Table 2-1 Estimated number of new cases (incidence) and deaths 14 (mortality) in 2006 for the 17 most common cancers in the European Union of 25 Member States, and for the 5 most common cancers in Greater Europe, sorted in descending order of new cases Table 2-2 Estimated number of new cancer cases and deaths, 20 by country, greater Europe 2002 Table 2-3a Predicted numbers (thousands) of new cancer cases in 36 2020 in Europe, based on incidence rates in 2002 Table 2-3b Predicted numbers (thousands) of new cancer cases in 37 2020 in Europe, based on crude scenarios for annual change in the overall cancer incidence rates Table 4-1 Components of cancer screening programmes 73 Table 4-2 Randomized trials evaluating mortality effects of 78 mammography screening Table 4-3 Randomized trials evaluating mortality effects of colorectal 82 cancer screening based on faecal occult blood testing Table 4-4 Summary of evidence for cancer screening 88 Table 4-5 Cancer screening recommendations by various organizations 89 Table 5-1 The challenges of cancer care 97 Table 5-2 Drivers of molecular therapeutics 99 Table 5-3 Uncertainty of novel drugs for cancer 100 Table 5-4 Barriers to innovation 103 Table 5-5 High-cost cancer drugs likely to be approved by the Food 107 and Drug Administration (FDA) and EMEA, 2007-2010 Table 8-1 Population coverage, number of adult cancer patients 154 diagnosed 1995-99 and included in analyses, proportion of microscopically verified tumours and proportion of patients who were followed-up for less than five years of diagnosis: EUROCARE-4, by country Table 8-2 Relative survival (%) at one and five years after diagnosis, 158 and five-year survival among patients who had already survived at least 1 year, by country, selected cancers: EUROCARE-4, adults (15-99 years) diagnosed 1995-99 viii Responding to the challenge of cancer in Europe Table 8-3 Five-year relative survival (%) for selected cancers in adults: 166 Europe (EUROCARE data) and the USA (SEER data): period analysis for 2000-2002 Table 9-1 Relative risk between maximum and minimum levels of 177 incidence rates, mortality rates and 5-year relative survival across Europe: for all cancers combined Table 9-2 Indicators of progress in cancer control (EUROCHIP-1) 180 Table 9-3 Cancer registries in Europe 182 Table 11-1 Psychological morbidity and risk factors for psychosocial 212 morbidity in cancer patients Table 11-2 Summary of key recommendations of NICE clinical guidance 223 on supportive and palliative care Table 11-3 Main domains of the patient-centred model 224 Table 12-1 Deaths from cancer in Europe and selected other parts of 231 the world: 2000 and predicted for 2020 Table 12-2 Cancer patients: prevalence of symptoms and estimated 235 number of cancer patients with symptoms towards the end of life Table 12-3 Summary of results from a meta-analysis of a multiprofessional 247 palliative care team compared with conventional care. Description of the effect size for different patient outcomes Table 13-1 Contribution (years of life) of selected causes of death to the 256 difference in expectation of life at birth between central and eastern Europe and EU15, 2002 Table 13-2 Cancer incidence and mortality rates (per 100 000) in 257 Europe, 2002 Table 13-3 Number of alcohol-related deaths and rates per 100 000 262 population in central and eastern Europe, 2002 Table 13-4 Number of alcohol-related deaths and rates per 100 000 263 population in EU15, 2002 Table 14-1 Burden of cancer in Slovenia, 1992-1994 and 2002-2004 280 Table 15-1 Global investment in cancer research 306 List of tables, figures and boxes ix Figures Figures marked * appear in the colour section (CS) between pages 40 and 41. Figure 2-1 Availability of cancer mortality data by country (Source: WHO 10 mortality database) Figure 2-2 United Nations definition of the 38 countries and 4 regions of 13 Europe (Source: WHO) Figure 2-3 Distribution of new cases and deaths, by sex, for 23 different 16 cancers in Europe, 2002 (Source: Ferlay et al, 2004) Figure 2-4 Distribution of age-standardized (world) rates (ASR) of cancer 17 incidence and mortality, by country and sex, in descending order of incidence – all cancers except skin (Source: Ferlay et al, 2004) Figure 2-5 Distribution of age-standardized (world) rates (ASR) of 21/22 incidence and mortality, by country and sex, in descending order of incidence – lung cancer males (a) and females (b) (Source: Ferlay et al, 2004) Figure 2-6a Distribution of age-standardized (world) rates (ASR) of 24 incidence and mortality by country, in descending order of incidence – breast cancer (Source: Ferlay et al, 2004) Figure 2-6b Distribution of age-standardized (world) rates (ASR) of 25 incidence and mortality (ASR) by country, in descending order of incidence – prostate cancer (Source: Ferlay et al, 2004) Figure 2-7 Distribution of age-standardized (world) incidence and 26/27 mortality rates (ASR) by country and sex, in descending order of incidence – colorectal cancer males (a) and females (b) (Source: Ferlay et al, 2004) Figure 2-8a* Trends in age-standardized (world) mortality rates in CS selected countries in the four UN-defined regions of Europe – all cancers combined, males (Source: WHO mortality database) Figure 2-8b* Trends in age-standardized (world) mortality rates in selected CS countries in the four UN-defined regions of Europe – all cancers combined, females (Source: WHO mortality database) Figure 2-9a* Trends in age-standardized (world) mortality rates in selected CS countries in the four UN-defined regions of Europe – lung cancer, males (Source: WHO mortality database) Figure 2-9b* Trends in age-standardized (world) mortality rates in selected CS countries in the four UN-defined regions of Europe – lung cancer, females (Source: WHO mortality database) x Responding to the challenge of cancer in Europe Figure 2-10 Stages of worldwide tobacco epidemic (Source: Edwards, 31 2004; adapted from Lopez, Collishaw & Piha, 1994) Figure 2-11 Female lung cancer mortality, Spain 1974-2003 (solid line) 31 and predicted (dashed line) until 2020, based on age-period- cohort model (Source: Nordpred, Møller et al, 2003) Figure 2-12 Trends in smoking prevalence in the EU 1979-2002 32 (Source: Cancer Research UK, EU Factsheet, 2004) Figure 2-13* Trends in age-standardized (world) mortality rates in CS selected countries in the four UN-defined regions of Europe:
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