Patterns of care and survival of cancer patients in Ireland 1994 to 2004

This report published today shows marked improvements in treatment and survival of Irish cancer patients over the period 1994-2004. However, geographic disparities in treatment and survival (at the level of HSE administrative area) are still evident, although reduced to some degree. These findings highlight the need to improve access to consistent levels of care for Irish cancer patients, a major aim of the National Cancer Control Programme and the ongoing reorganization of cancer treatment services.

Treatment and stage: key findings

For the major cancers, the percentage of cancer patients treated surgically did not change markedly between 1995-1999 and 2000-2004, the main exception being a 35% relative reduction in surgery for prostate cancer. However, the use of chemotherapy increased considerably for a range of cancers. Radiation therapy became more frequent for some sites (e.g. colorectal) but became less used for others (e.g. a slight reduction for breast).

A strong dependence of treatment on age persists. The percentage of patients over 80 having surgery remains low and has decreased for breast cancer (from 46% to 43%) and for prostate cancer (from 43% to 27%). Use of chemotherapy and radiation therapy, although still relatively low, has increased in the over 80s.

Variations in treatment uptake by HSE area are of a similar magnitude as noted previously for the former health board areas. Although treatment tended to be more frequent in the two Dublin areas, this was not consistent either by cancer site or period. Apart from a general increase in the use of chemotherapy, there was little evidence of common time trends in treatment for the most common cancers, or of increased consistency of treatment of patients in different geographical areas.

There was evidence of a reduction in the number of centres performing surgery for five or fewer cases per year of the four most common cancers. There was less evidence of any movement of caseload to larger centres (>20 cases per year), with the exception of breast cancer.

There was only limited evidence of a shift to earlier stage disease between the periods 1995-99 and 2000-2004, mainly involving a significant shift to stage II prostate cancers in all regions and to stage I breast cancers in women living in the Dublin/Mid-Leinster and Dublin/North-East areas.

Survival: key findings

Relative survival of patients diagnosed with almost all types of cancer showed improvement between the diagnosis periods 1994-1999 and 2000-2004. Statistically significant improvements (age-adjusted) were seen for all cancers combined, colorectal cancers, cancers of the lung, female breast, prostate, oesophagus, stomach, liver, gallbladder, pancreas, testis, brain and adrenal gland melanoma of skin, Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma and leukaemia. For breast and prostate cancer, it cannot be ruled out that some of the apparent improvement in survival is an artefact of increases in screening. However, for the most common cancers, improvements in survival were seen across most tumour-stage categories, suggesting improvements in appropriateness or availability of treatment.

Some marked differences in survival were seen during 2000-2004 between different areas of residence or of first treatment, with a range of cancers having significantly lower survival in the Dublin/North-East or (especially) Southern or Western areas compared with Dublin/Mid-Leinster. For colorectal, breast and prostate cancers, area disparities, though still evident, appeared to be reduced compared with the period 1994-1999, reflecting improvements in survival at area scale.

During 2000-2004, colorectal, lung and female breast cancer patients surgically treated in the eight hospitals recently proposed as specialist cancer centres had significantly higher survival compared with other public acute general hospitals, after adjustment for age and stage. Even more markedly, colorectal, prostate and female breast cancer patients in private hospitals had significantly higher survival than those treated in the proposed centres, although interpretation of this finding is difficult because of the possible involvement of socioeconomic factors.