Abstract

Background: Survival from cancer has historically been lower in England than in comparable high income countries. We explore the trends and drivers of this cancer survival deficit, considering the extent to which it is driven by differences in the timing of diagnosis and patient management.

Methods: Using population-based data from national cancer registries in several high-income countries, including England, we estimated age-standardised net survival, overall and by stage of disease for patients diagnosed with different cancers and during various timeframes up to the year 2012. For colorectal cancer patients, we also analysed international data on treatment using clinical audit data, and assessed the extent to which co-morbidity mediated differential treatment of patients by age at diagnosis within England, using mediation analysis.

Results: Net survival was lower in England than in five comparable countries for four cancers. The gap in survival was especially large for patients diagnosed with later stage disease and at older ages. The stage distribution was similar between England and elsewhere suggesting the timing of diagnosis was similar between countries. Survival was lower in England for patients diagnosed at specific stages of disease, indicating shortfalls in patient management. Analysing treatment for colorectal cancer revealed that the proportion of patients receiving radical surgery was lower in England than elsewhere, even when controlling for age, stage and (where possible) co-morbidity. The colorectal cancer survival deficit in England was especially large for older patients and, within England, age-related disparities in patient management were not mediated by co-morbidity.

Conclusion: Policies should focus on improving stage-specific survival in England, including improving the provision of treatment to the standards observed in comparable countries. The management of cancer in older patients in this country needs particular attention.