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Eurocare 3 - understanding the reasons for cancer patients' survival differences in Europe


Since 1990, on the EU Concerted Actions EUROCARE-1 & 2, a network of population based Cancer Registries (CRs) has been established, aimed at studying survival and care of cancer patients in Europe. At present, EUROCARE is analysing survival trends from 3 million patients from 42 populations in 16 European countries, diagnosed in 1978-1989. EUROCARE showed that in Europe major survival difference do actually exist for several cancer sites. We are faced now with the problem of understanding the reasons of these differences. In principle, understanding cancer survival differences means to be able to distinguish how much they depend on different treatments, on treatment effectiveness because of early or late diagnosis, and just an early diagnosis (lead-time) without later death.

In these perspectives, the aim of the present EUROCARE-3 project is threefold:
1) Continuing to monitor cancer patients' survival by population-based data, insuring standardization, quality control, centralized facilities for analysis and dissemination of results. A continuous updating of survival data is necessary for furnishing guidelines for actual health policies. Updating of the EUROCARE data base is also expected to provide substantially new information on long term survival, survival trends, and survival of rare tumours;
2) Monitoring patterns of care (diagnostic, staging and treatment procedures) and their relationship with survival. A number of CRs, representative of different European populations, should work in tight connection with clinicians to collect standardized clinicopathological information not routinely collected. The ultimate goal is to establish a stable registration network to monitor patterns of care on the cure of cancer, which leads to the third aim:
3) Assuring proper interpretation of survival differences between populations in order to give specific recommendations to improve either early diagnosis or treatment facilities. Interpretation of survival differences requires the availability of detailed data and the use of the most advanced statistical methodology. The former will be provided under the activity foreseen by the previous two tasks. A new and deeper insight into patterns of survival are expected by the extensive use of mixture survival models. These models allow to separately estimate the proportions of cured patients and the life expectancy of cases which die for the disease. Survival may be disentangled from lead-time bias and other arctifactual effects with this kind of analyse.

Summary of innovative aspects: - EVROCARE-3 will develop the usual activity of the population-based Cancer Registry towards a more clinical role. For this purpose, a sample of CRs representative of different European regions will collect clinical information necessary to explain survival differences. EUROCARE-3 will apply new methods of analysis through multivariate mixture models. The wide intercountry variability and the overtime trends of survival for cancer in Europe will be interpreted by means of the hardest survival indicator, i.e. the proportion of cured patients. This proportion will be put in relation with the patterns of care adopted in that area.


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Via Venezian 1
20133 MILANO

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