National comparisons of lung cancer survival in England, Norway and Sweden 2001-2004; differences occur early in follow up

The odds of surviving lung cancer are significantly higher in Norway and Sweden than they are in England, reveals a comparison of the three countries published in Thorax today.

This is despite the fact that healthcare spend and infrastructure in each of these countries are similar, says the study.

The researchers base their findings on five year survival rates for lung cancer patients in Norway, Sweden, and England, all of whom were diagnosed between 1996 and 2004.

During this period 250,828 patients were diagnosed in England, 18,386 in Norway, and 24,886 in Sweden, according to data from lung cancer registries in all three countries.

Survival rates were lowest in England and highest in Sweden, irrespective of age, sex, and length of monitoring period, all of which are known to affect outcome.

Almost twice as many Swedish lung cancer patients survived five years as did their English counterparts, the data show.

Set against the expected survival for a given age, 11.3% of Swedish men diagnosed with lung cancer survived five years. This compares with 9.3% of Norwegian men and 6.5% of English men with the disease.

Comparable figures for women still showed England lagging behind Norway and Sweden.

In Sweden just under 16% of women diagnosed with lung cancer survived five years compared with 13.5% of those diagnosed in Norway and just 8.4% of those diagnosed in England.

The difference in death rates seemed to be concentrated largely in the first year after diagnosis, the study shows.

The chances of a lung cancer patient in England dying in the first three months after diagnosis between 2001 and 2004 were between 23% and 46% higher than they were for a patient in Norway, depending on age and sex.

And they were between 56% and 91% higher than for a patient in Sweden.

The authors cite data, showing that patients in England are less likely to be actively treated with surgery and drugs than their Scandinavian counterparts. This may be because symptom awareness is poor in England, and patients delay seeking medical help, so that by the time they do, their disease is already advanced and beyond curative treatment, they suggest.

They add that the number of diagnoses and deaths from lung cancer in England has plummeted since the 1970s, and that the prevalence of smoking - a key risk factor for lung cancer - is higher in the UK than it is in either Norway or Sweden.

"However, we cannot exclude that differences in treatment activity - related or not to [other co-existing illness] - play a role," they conclude.


Source: BMJ-British Medical Journal