Statistical bulletin: Cancer Survival by Cancer Network, England: Patients diagnosed 1997-2010 and followed up to 2011

Key Findings

• One-year and five-year net survival from cancers of the oesophagus, stomach, colon, lung and breast (women) improved by 2 to 15% for adults in England diagnosed in 2010 compared to those diagnosed in 1997.
• There were disparities in net survival between the 28 Cancer Networks of England, with a difference of over 10% between the networks with the highest and lowest one-year net survival for cancers of the oesophagus, stomach, and lung (women) in 2010.
• Regional disparities were relatively stable over the period 1997–2010, despite the large overall improvements in survival.

Summary

This report presents one-year and five-year age-standardised net survival estimates (see Background Note 1) for the 28 Cancer Networks of England, for patients who were diagnosed with a cancer of the oesophagus, stomach, colon, lung, breast (women) or cervix during 1997–2010 and followed up to 31 December 2011. One-year survival estimates are reported for patients diagnosed in 1997, 2002, 2006 and 2010, and five-year survival estimates for those diagnosed in 1997, 2002 and 2006.

Figure 1: One-year age-standardised net survival (per cent), England, adults(1) diagnosed with one of six cancers 1997–2010, by year of diagnosis and sex

Source: Office for National Statistics

Notes:

1. Adults aged 15–99 years

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Results

Table 1a: Range in one-year age-standardised net survival between Cancer Networks, England, adults (1) diagnosed with one of six cancers 1997–2010 and followed up to 2011, by year of diagnosis and sex

Table source: Office for National Statistics

Table notes:

1. Adults aged 15-99 years

Table 1b: Range in five-year age-standardised net survival between Cancer Networks, England, adults (1) diagnosed with one of six cancers 1997–2006 and followed up to 2011, by year of diagnosis and sex

Table source: Office for National Statistics

Table notes:

1. Adults aged 15-99 years

The range in one-year survival between the Cancer Networks with the highest and lowest survival in 2010 was widest for women diagnosed with stomach cancer, at 23.6%, and narrowest for women diagnosed with breast cancer, at 3.4%. For five-year survival the range between the Cancer Networks in 2006 was widest for women diagnosed with stomach cancer, at 11.8%, and narrowest for women diagnosed with lung cancer, at 5.2%.

These estimates should not be used to rank Cancer Networks by their survival, because a change of just 1 or 2 % may radically alter the ranking of a given network.

One-year and five-year age-standardised net survival estimates for each of the six cancers are presented in tables and charts in the associated data section of this publication. These tables and charts show net survival estimates by Cancer Network, sex and calendar period. Maps (Figures 2–7) show the most recent survival estimates by Cancer Network and sex for patients diagnosed in 2010 (one-year survival) and 2006 (five-year survival). A summary map (Figure 8) shows the location of the Cancer Networks in England.

List of Figures:

Figure 2a: One-year age-standardised net survival from oesophageal cancer for patients diagnosed during 2010, by Cancer Network and sex (150.2 Kb Png image) .

Figure 2b: Five-year age-standardised net survival from oesophageal cancer for patients diagnosed during 2006, by Cancer Network and sex (141 Kb Png image) .

Figure 3a: One-year age-standardised net survival from stomach cancer for patients diagnosed during 2010, by Cancer Network and sex (150.6 Kb Png image) .

Figure 3b: Five-year age-standardised net survival from stomach cancer for patients diagnosed during 2006, by Cancer Network and sex (138.7 Kb Png image) .

Figure 4a: One-year age-standardised net survival from colon cancer for patients diagnosed during 2010, by Cancer Network and sex (148.4 Kb Png image) .

Figure 4b: Five-year age-standardised net survival from colon cancer for patients diagnosed during 2006, by Cancer Network and sex (150.6 Kb Png image) .

Figure 5a: One-year age-standardised net survival from lung cancer for patients diagnosed during 2010, by Cancer Network and sex (152.6 Kb Png image) .

Figure 5b: Five-year age-standardised net survival from lung cancer for patients diagnosed during 2006, by Cancer Network and sex (147.4 Kb Png image) .

Figure 6: One- and five-year net survival from breast cancer (women) for patients diagnosed during 2010 and 2006 respectively, by Cancer Network (143.9 Kb Png image) .

Figure 7: One- and five-year net survival from cervical cancer for patients diagnosed during 2010 and 2006 respectively, by Cancer Network (149.7 Kb Png image) .

Figure 8: Cancer Network boundaries, 2009 (113.7 Kb Png image) .

Oesophageal Cancer Maps

Figure 2a: One year age standardised net survival from oesophageal cancer for patients diagnosed during 2010, by Cancer Network and sex

Source: Office for National Statistics

Figure 2b: Five-year age standardised net survival from oesophageal cancer for patients diagnosed during 2006, by Cancer Network and sex

Source: Office for National Statistics

 

Stomach Cancer Maps

Figure 3a: One-year age standardised net survival from stomach cancer for patients diagnosed during 2010, by Cancer Network and sex

Source: Office for National Statistics

Figure 3b: Five-year age standardised net survival from stomach cancer for patients diagnosed during 2006, by Cancer Network and sex

Source: Office for National Statistics

Colon Cancer Maps

Figure 4a: One-year age standardised net survival from colon cancer for patients diagnosed during 2010, by Cancer Network and sex

Source: Office for National Statistics

Figure 4b: Five-year age standardised net survival from colon cancer for patients diagnosed during 2006, by Cancer Network and sex

Source: Office for National Statistics

 

Lung Cancer Maps

Figure 5a: One-year age standardised net survival from lung cancer for patients diagnosed during 2010, by Cancer Network and sex

Source: Office for National Statistics

Figure 5b: Five-year age standardised net survival from lung cancer for patients diagnosed during 2006, by Cancer Network and sex

Source: Office for National Statistics

Breast Cancer Maps

Figure 6: One and five year net survival from breast cancer (women) for patients diagnosed during 2010 and 2006 respectively, by Cancer Network

Source: Office for National Statistics

Cervical Cancer Maps

Figure 7: One and five year net survival from cervical cancer for patients diagnosed during 2010 and 2006 respectively, by Cancer Network

Source: Office for National Statistics

Cancer Network Boundaries Map

Figure 8: Cancer Network Boundaries, 2009

Additional Information

Further information about cancer survival estimates published by the Office for National Statistics (ONS) can be found in the Cancer Survival Quality and Methodology Information paper. Quality and Methodology Information papers are overview notes which pull together key qualitative information on the various dimensions of the quality of statistics as well as providing a summary of the methods used to compile the output. Information about key users of these statistics is also provided.

The Scottish Cancer Registry produces statistics on cancer in Scotland.

Statistics on cancer in Wales are produced by the Welsh Cancer Intelligence and Surveillance Unit.

The Northern Ireland Cancer Registry produces statistics on cancer in Northern Ireland.

In line with recent changes to the NHS, the functions, accountability and form of Cancer Networks are likely to change over the coming 12 months. ONS plan to review the format and content of the Cancer Survival by Cancer Network in England publication in line with these changes before the next annual update.

Users and uses

Key users of cancer survival estimates include the Department of Health, academics and researchers, cancer charities, cancer registries, other government organisations, researchers within ONS, the media, and the general public. The Department of Health uses cancer survival figures to brief parliamentary ministers, and as part of the evidence base to inform cancer policy and programmes, for example in drives to improve survival rates. Cancer survival estimates will also be used to measure progress against NHS Outcomes Framework indicators.

Academics and researchers use the figures to inform their own research. Similarly cancer registries and other government organisations use the figures to carry out individual and collaborative projects to apply subject knowledge to practice. Charities use the data so they can provide reliable and accessible information about cancer to a wide range of groups, including patients and health professionals via health awareness campaigns and cancer information leaflets/web pages. Researchers within ONS use the data to support further research and to publish alongside other National Statistics.

Policy Context

In ‘Improving Outcomes: A Strategy for Cancer’ (January 2011), the Department of Health stated that although improvements have been made in the quality of cancer services in England, a significant gap remains in survival compared with the European average. Survival estimates for cervical, colorectal and breast cancer are some of the lowest among Member States of the Organisation for Economic Co-operation and Development (OECD). The strategy document sets out how the Department of Health aims to improve outcomes for all cancer patients and improve cancer survival, with the aim of saving an additional 5,000 lives every year by 2014/15.

Outcomes strategies set out how the NHS, public health and social care services will contribute to the ambitions for progress agreed with the Secretary of State in each of the high-level outcomes frameworks. The indicators set for the NHS Outcomes Framework 2013 to 2014 – focus on measuring health outcomes include one- and five-year cancer survival indicators for all cancers combined, and for colorectal, breast and lung cancers combined.

References

Akaike H (1974). A new look at the statistical model identification. IEEE Transactions on Automatic Control, 19, 716-23.

Ashley J (1990). The International Classification of Diseases: the structure and content of the Tenth Revision. Health Trends, 22, 135-7.

Cancer Research UK Cancer Survival Group (2004). Life tables for England and Wales by sex, calendar period, region and deprivation. London School of Hygiene and Tropical Medicine.

Danieli C, Remontet L, Bossard N, Roche L, Belot A (2012). Estimating net survival: the importance of allowing for informative censoring. Statistics in Medicine, 31, 775-786.

Department of Health (2000). The NHS Cancer Plan. London, Department of health.

Ellis L, Rachet B, Coleman MP (2007). Cancer survival indicators by Cancer Network: a methodolgical perspective. Health Statistics Quarterly, 36 (Winter), 36-41.

Expert Advisory Group on Cancer (1995). A policy framework for commissioning cancer services. London, Department of Health.

Lambert PC, Royston P (2009). Further development of flexible parametric models for survival analysis. Stata Journal, 9, 265-290.

Royston P, Parmar MK (2002). Flexible parametric proportional-hazards and proportional-odds models for censored survival data, with application to prognostic modelling and estimation of treatment effects. Statistics in Medicine, 21, 2175-2197.

StataCorp (2011). STATA statistical software, Version 12. College Station, Texas, Stata Corporation.

Authors

Ula Nur^a, Michel P Coleman^a, Sarah Whitehead^b and Bernard Rachet^a

This report was produced by the Cancer Research UK Cancer Survival Group at London School of Hygiene and Tropical Medicine^a (LSHTM), the National Cancer Registry at the Office for National Statistics^b (ONS) and funded by the Department of Health.

Acknowledgements

The National Cancer Registry at the Office for National Statistics, the National Cancer Intelligence Network and the London School of Hygiene and Tropical Medicine wish to thank the Geographic Information Systems Team at West Midlands Cancer Intelligence Unit for providing the digital boundary data. They also acknowledge the work of the regional cancer registries in England, which provide the raw data for these analyses.

Background notes

1. Net survival in a population of cancer patients is their survival from the cancer of interest in the absence of other causes of death. It was estimated at one and five years after diagnosis for each cancer, sex and year of diagnosis. Net survival was estimated with an excess hazard model in which the all-cause mortality is modelled as the sum of the excess (cancer-related) mortality hazard and the expected (or background) mortality. The background mortality is defined by life tables from the general population. This approach enables population-level cancer survival to be estimated in the absence of detailed data on the cause of death. To obtain an unbiased estimation of net survival, age needs to be carefully modelled to account for the informative censoring associated with age (Danieli et al., 2012).

   We used flexible parametric models (Royston and Parmar, 2002) with age and year of diagnosis as main effects and an interaction between age and year of diagnosis. We also examined interactions between year and follow-up time and between age and follow-up time to deal with potential non-proportionality of the excess hazards over time since diagnosis. The Akaike Information Criterion (AIC)  (Akaike, 1974) was used to select the best-fitting statistical model using the relative goodness of fit. The publicly available program, stpm2, was used to estimate net survival (Lambert and Royston, 2009). Analyses were performed in Stata 12 (Statacorp, 2011).

2. National cancer registration data for England were received from the National Cancer Registry at the Office for National Statistics (ONS), which collates cancer registrations submitted by regional cancer registries in England. The NHS Information Centre (NHS IC) updates these records with the registration of death or emigration. The data used in these analyses were extracted from the live database at ONS on 18 May 2012 and provided to the Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine on 8 June 2012.

3. All adults (15–99 years) who were diagnosed with a first, invasive, primary, malignancy during the period 1997–2010 were eligible for inclusion in the analyses. We excluded patients who were diagnosed with a tumour that was benign (behaviour code 0), in situ (2) or of uncertain behaviour (1). Patients were excluded if their cancer was only registered from a death certificate. Patients with zero recorded survival time were included in the analyses with one day added to their survival. Table 2 shows the number of patients excluded and Table 3 shows the final number of patients in each Cancer Network who were included in the analyses.

   Table 2: Number of patients eligible for analysis, exclusions, and number (per cent) of eligible patients included in analyses: six cancers, England, adults(1) diagnosed 1997–2010 and followed up to 2011

   Malignancy	ICD-10 code2	Eligible for analysis	Exclusions				Patients included
   			DCO3		Other4		Number	Per cent
   Oesophagus	C15	88,557	2,713		375		85,469	96.5
   Stomach	C16	99,006	4,051		509		94,446	95.4
   Colon	C18	266,523	9,440		4,607		252,476	94.7
   Lung	C33, C34	449,020	26,588		3,443		418,989	93.3
   Breast (women)	C50	517,814	8,361		21,523		487,930	94.2
   Cervix	C53	34,546	478		381		33,687	97.5

   Table source: Office for National Statistics

   Table notes:

   1. Adults aged 15-99 years
   2. International Classifications of Diseases, tenth edition
   3. Registration from a death certificate only (DCO): date of diagnosis unknown
   4. Aged 100 years or over at diagnosis, sex or vital status unknown, sex-site error, invalid dates, duplicate registration, synchronous tumours, or previous cancer of the same organ since 1971

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   Table 3: Number of patients included in analyses, by cancer: Cancer Networks, England, adults (1) diagnosed 1997–2010 and followed up to 2011

   Cancer Network				Oesophagus		Stomach		Colon		Lung		Breast		Cervix
   England				85,469		94,446		252,476		418,989		487,930		33,687
   N01	Lancashire and South Cumbria			3,063		3,234		8,015		14,438		14,883		1,259
   N02	Greater Manchester & Cheshire			5,714		6,548		14,788		28,778		28,170		2,235
   N03	Merseyside & Cheshire			4,146		4,620		10,742		21,948		19,898		1,574
   N06	Yorkshire			4,274		5,457		12,271		25,437		23,894		2,136
   N07	Humber & Yorkshire Coast			2,087		2,379		5,613		11,221		10,489		1,023
   N08	North Trent			3,240		4,645		9,275		19,224		17,337		1,293
   N11	Pan Birmingham			3,147		4,133		8,783		15,474		16,819		1,383
   N12	Arden			1,671		1,787		4,942		7,162		9,719		703
   N20	Mount Vernon			1,599		1,810		5,295		8,534		11,938		650
   N21	North West London			1,833		2,042		5,810		9,933		13,320		857
   N22	North London			1,709		2,028		5,348		9,526		12,040		786
   N23	North East London			1,754		2,493		5,158		10,663		10,731		830
   N24	South East London			1,882		2,376		5,523		11,356		12,127		904
   N25	South West London			2,080		2,001		6,634		9,938		14,001		825
   N26	Peninsula			3,551		3,234		10,671		13,239		19,047		1,164
   N27	Dorset			1,513		1,378		5,447		6,086		8,936		448
   N28	Avon, Somerset & Wiltshire			3,415		3,151		10,335		12,872		19,763		1,522
   N29	Three Counties			1,879		1,570		6,142		7,092		11,386		591
   N30	Thames Valley			3,379		3,012		10,739		14,482		22,589		1,287
   N31	Central South Coast			3,383		3,327		11,048		14,264		20,704		1,212
   N32	Surrey, West Sussex & Hampshire			1,773		1,562		5,649		7,428		11,825		566
   N33	Sussex			2,381		1,825		6,910		9,289		13,047		634
   N34	Kent & Medway			2,979		2,515		7,554		12,969		16,084		957
   N35	Greater Midlands			3,664		4,510		10,337		15,941		19,276		1,423
   N36	North of England			5,286		7,907		17,391		37,386		29,211		2,442
   N37	Anglia			4,395		5,031		15,457		20,781		28,692		1,484
   N38	Essex			2,339		2,298		6,994		10,903		14,327		622
   N39	East Midlands			7,332		7,573		19,603		32,623		37,670		2,877
   Missing Cancer Network code				1		-		2		2		7		-

   Table source: Office for National Statistics

   Table notes:

   1. Adults aged 15-99 years

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4. Life tables were constructed for the years 1997, 2002, and 2006 using the mid-year population estimates and the mean annual number of deaths in the three years centred on those index years (Cancer Research UK Cancer Survival Group, 2004). Life tables for each year from 1997 to 2005 were created by linear interpolation. The life table for 2005 was used for 2006–10. Background mortality changes with time and varies by sex, age, socio-economic status and region, so life tables were created by single year of age, sex, region and deprivation quintile for each calendar year of death.

5. The age distribution of cancer patients at diagnosis changes with time and varies between Cancer Networks. Since survival also varies with age at diagnosis, robust summary comparisons of survival require control for these differences. The directly standardised overall survival figure for each cancer is a weighted average of the age-specific survival estimates, with standard weights taken from the proportionate distribution by age and sex of patients diagnosed in England and Wales during 1996–99.

   Age-standardisation requires a set of survival estimates for each age group. It is not always possible to obtain an estimate for each combination of cancer, age group, sex and calendar year of diagnosis in geographic units with small populations because of the limited number of cases. In this situation, the missing estimate was replaced by the equivalent age-specific estimate for England.

6. A 95% confidence interval is a measure of the uncertainty around an estimate. It provides a range of values which contains the true population value with a 95% level of confidence.

7. Cancer Networks were formed in 2001 following the recommendations of the Calman–Hine report  (Expert Advisory Group on Cancer, 1995) and the NHS Cancer Plan (Department of Health, 2000). The most recent Cancer Network boundaries were applied to the whole period 1991–2006, enabling geographic trends to be charted over time (Figure 8). Cancer Network populations range from 0.6 to 3.0 million (2002 figures), making them more suitable for detailed statistical comparison of survival than smaller health geographies such as Primary Care Trusts.

   The role of Cancer Networks in the organisation of cancer services, and in improving regional equity in cancer management, makes them a meaningful unit with which to describe the geography of cancer survival in England  (Ellis et al., 2007). In line with recent changes to the NHS, the functions, accountability and form of Cancer Networks are likely to change over the coming 12 months. ONS plan to review the format and content of the Cancer Survival by Cancer Network in England publication in line with these changes before the next annual update.

8. Cancers were defined by codes in the International Classification of Diseases, Tenth Revision (ICD-10) and International Classification of Diseases for Oncology, Second Edition (ICD-O-2) (Ashley, 1990). See Table 2.

9. A list of the names of those given pre-publication access to the statistics and written commentary is available in Pre-release Access List: Cancer Survival by Cancer Networks, England: Patients diagnosed 1997-2010 and followed up to 2011 (33.6 Kb Pdf) . The rules and principles which govern pre-release access are featured within the Pre-release Access to Official Statistics Order 2008.

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