ICBP Phase 2 Research

The ICBP has now published the updated cancer benchmark, where data on 3.9 million cancer cases was collected from population-based cancer registries in 21 jurisdictions in 7 countries during 1995-2014. Population-based net cancer survival, age-standardised 1 and 5-year survival were all calculated. Changes in survival were then mapped to changes in incidence and mortality rates to establish a holistic understanding of cancer control. 

1-year net survival changes

5-year net survival changes

Key findings

For all cancer sites studied, 1- and 5- year net survival increased in all countries over the 1995-2014 period. The differences internationally in 1-year survival narrowed over time for all cancer sites other than pancreas. This was also true for 5-year survival in oesophageal and rectal cancers only. Greater improvements in survival were seen in patients aged less than 75 years at diagnosis, compared to those aged 75+ years. 

One-year survival estimates were higher for all cancers in Australia, Canada and Norway, followed by Denmark, Ireland, New Zealand and the UK for the most recent 5-year period (2010-2014). This was similar for 5-year survival estimates with higher survival seen in Australia (except for lung in Canada and ovarian in Norway) and lower survival seen in the UK (except for oesophageal in Denmark and ovarian in Ireland).  

By exploring trends in incidence, survival and mortality, progress was seen in cancer control for all countries in stomach, colon, ovarian and lung cancer (in males only). 

International differences in survival continue to exist for those cancers associated with poorer prognosis. Pancreatic cancer has the lowest survival amongst the 7 cancer sites studied, however there were increases in survival in most countries.

Progress in cancer survival, mortality, and incidence in seven high-income countries 1995–2014 (ICBP SURVMARK-2): a population-based study (2019)

Differences in access to diagnostics may be contributing to observed international cancer outcomes. Investigating the variation in access to post-diagnosis investigations may provide insights into the extent of efforts to stage and characterise cancers, and the information available to plan treatment. This research is being carried out by the ICBP Programme Management team, based at Cancer Research UK.

This module has published research exploring PET-CT service provision across the ICBP countries – you can read the paper here.

The team also explored the variation in referral pathways within primary care across the ICBP countries, as well as exploring the complexity of these pathways.

High quality care of cancer patients consists of prompt access to the most appropriate and effective treatment – variations within this could partly explain the observed survival differences and impact cancer outcomes internationally.

The ICBP Programme Management team at Cancer Research UK are now conducting research to explore how differences in treatment guidelines, and to what extent they are implemented effectively, could be impacting differences in survival across ICBP jurisdictions.

The first treatments study focused on variation in ovarian cancer treatment – read the paper here. Another project is underway, exploring variation in the treatment of early stage lung cancer patients across the ICBP countries. We expect to see the results of this later on in 2021.

During Phase 1 research, it became evident that there may be more subtle differences impacting on cancer survival outcomes regardless of the ICBP partner jurisdictions being otherwise broadly comparable. One element contributing to these subtle differences is the structure of health care systems across the jurisdictions. This research is led by Dr Ellen Nolte at The London School of Hygiene and Tropical Medicine and focuses on:

• Identifying features of health systems that might explain observed international differences in cancer survival
• Understanding the likely influences of high- and medium-level (‘macro’ and ‘meso’) health system factors on the development, implementation and monitoring of pathway use 
• Working with other ICBP teams to triangulate findings and conclusions

So far, the team have published a conceptual logic model, visualising the pathways across the cancer patient journey and identifying key health system factors that may play a role in cancer outcomes – you can read the paper on this here. The team have also published explorations of key stakeholder views on the role of health service capacity and leadership cancer outcomes. We expect to soon see the latest publication providing an overview of the evolution of cancer policies across ICBP countries. Stay tuned.

Most participating jurisdictions have a cancer patient pathway, which sets out how patients should be treated at each stage of their cancer journey. The creation and structure of these were identified in Phase 1 research as a potential contributor to subtle international cancer survival differences. Professor Yoryos Lyratzopoulos at University College London is leading the research into the similarities and differences in the cancer patient pathways across the jurisdictions. The aims of this research module are to:

• Identify and map routine data sources in each jurisdiction that can support person-level analysis of patient pathways
• Visualise country-wide pathways for each cancer site using an online data analysis and visualisation tool (currently tested as a method to visualise policy applications for NHS hospitals in England, developed by Health Data Insight CiC) 
• Explore associations between care pathways with health system variables and survival