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CONCORD Working GroupCork, Ireland, 20-21 September 2012

GlobalsurveillanceofcancersurvivaltheCONCORDprogramme


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Achieve major improvements in cancer survivalin all countries (#11)

Improve measurement of global cancer burdenand impact of cancer control interventions (#2)

Ensure effective delivery systems (#1) Dispel damaging myths and misconceptions (#5) Provide training opportunities (#9)Surveillance and reporting every two years

World Cancer Declaration 11 goals for 2020UICC, Geneva, 2008

www.uicc.org/wcd/wcd2008.pdf, 31 August 2008


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Global variations in cancer survival

Access to diagnostic and treatment services

Lack of investment in health resources

Poor countries:

80% of childhood cancers Failure to start or complete treatment - 60%Rich countries:

Gross domestic product Total national expenditure on health Health technology - CT scanners

Coleman 2008; Mostert 2011; Micheli 2003; Vercelli 2006


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50countriesrepresented

AlgeriaArgen>na

Austria

Belgium

Brazil

BulgariaCanada

Chile

China

Colombia

Croa>aCzechRepublic

Denmark

EstoniaFinland

France

Gambia

Germany

GhanaIndia

Indonesia

Ireland

Italy

JapanJordan

Libya

LithuaniaMali

Malta

Netherlands

Nigeria

NorwayPoland

Portugal

Qatar

Romania

RussianFed.Slovakia

Slovenia

SouthAfricaSpain

Switzerland

Taiwan

Thailand

TurkeyUK

Uruguay

USA

Yemen

Zimbabwe

CONCORD Working GroupCork, Ireland, 20-21 September 2012


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What could explain survival differences ?

Longer delays, more advanced stage Availability and uptake of screening

Access to treatment Differences in co-morbidity Quality of treatment Organisation of treatment services Human and financial resources

after Richards, 2009


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Cancer survival in five continents(first CONCORD study)

31 countries 1.9 million cancer patients (aged 15-99) Breast (F), colon, rectum, prostate Diagnosed 1990-94, followed to 1999

Lancet Oncology 2008; 9: 730-756


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Five-year relative

survival (%) -

breast cancer,

women (15-99 years)

50.7

41.7

5.6

1.0

0 20 40 60 80 100

CUBA

USA

CANADA

SWEDEN

JAPAN

AUSTRALIAFINLAND

FRANCE

ITALY

ICELAND

SPAIN

NETHERLANDS

NORWAY

SWITZERLAND

GERMANYAUSTRIA

DENMARK

MALTA

PORTUGAL

N IRELAND

SCOTLAND

ENGLAND

IRELAND

WALESSLOVENIA

POLAND

CZECH REP.

ESTONIA

BRAZIL

SLOVAKIA

ALGERIA BREAST (F)

*

Lancet Oncol 2008; 9: 730-756


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Wider geographic coverage Additional registries up to 180 Additional countries up to 60

Long-term trends, additional cancers

Patients diagnosed 1995-2009 (+15 years) Follow-up to 2009 (+10 years) Stomach, colon, rectum, liver, lung, breast,

cervix, ovary, prostate, leukaemia Childhood leukaemia

CONCORD-2 - broader scope


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Ten cancers world-wide, 2008


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Ten cancers in CONCORD-2, 1995-2009


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CONCORD CONCORD-2Africa 1 8

America C&S 2 7

America, North 2 2Asia 1 14

Europe 24 27

Oceania 1 2

31 60

Countries* in CONCORD programme

* Provisional recruitment still in progress


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CONCORD CONCORD-2 Registries Africa 1 8 11

America C&S 2 7 24

America, North 2 2 24Asia 1 14 30

Europe 24 27 87

Oceania 1 2 4

31 60 180

Registries* in CONCORD programme

* Provisional recruitment still in progress


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Additional analyses

Timely, high-quality estimates:

Geographic variation Survival trends from 1995 to 2010 ... Short-term predictions Estimates by race/ethnic group Prevalence by time since diagnosis

Population cure Avoidable premature deaths (cancer, race)


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Wider programme

Survival analyses, plus

Analytic tools Training in survival methodology

Short courses in London (8th course in 2013) Bursaries for low-income countries Field courses

Doctoral and post-doc fellowships Methodological development network Health policy applications Involvement of patients


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Time-line

Protocol [final amendments ...] Ethical and statutory approval Peer review Funding decisions [also in progress] Data submission from October 2012 Quality control byJune 2013

Analyses completed from June 2013 Cancer survival course 24-28 June 2013 First publications from Oct 2013


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The CONCORD programme:

Fills a huge gap in the knowledge of cancersurvival world-wide

Enables comparison between low-incomecountries with innovative programmes

Evidence base for health-care effectiveness High-quality evidence for surveillance of

public health threats Coherent with WHO strategic objectives

World Health Organisation (Europe)

WHO Regional Office for Europe, May 2011

Documents

10 Concord Lutz