Abstract
Background Differences in cancer survival between the Nordic countries have previously been reported. The aim of this study was to examine whether these differences in outcome remain, based on updated information from five national cancer registers. Materials and methods The data used for the analysis was from the NORDCAN database focusing on nine common cancers diagnosed 1990–2016 in Denmark, Finland, Iceland, Norway and Sweden with maximum follow-up through 2017. Relative survival (RS) was estimated at 1 and 5 years using flexible parametric RS models, and percentage point differences between the earliest and latest years available were calculated. Results A consistent improvement in both 1- and 5-year RS was found for most studied sites across all countries. Previously observed differences between the countries have been attenuated. The improvements were particularly pronounced in Denmark that now has cancer survival similar to the other Nordic countries. Conclusion The reasons for the observed improvements in cancer survival are likely multifactorial, including earlier diagnosis, improved treatment options, implementation of national cancer plans, uniform national cancer care guidelines and standardized patient pathways. The previous survival disadvantage in Denmark is no longer present for most sites. Continuous monitoring of cancer survival is of importance to assess the impact of changes in policies and the effectiveness of health care systems.
Highlights
Marked differences in cancer incidence and survival between countries and jurisdictions have been documented in several reports, as well as differences in temporal trends across countries and calendar time [1,2,3,4]
A series of 13 articles published in 2010 comparing time trends in cancer incidence and outcomes in the five Nordic countries 1964–2003 confirmed earlier findings of both similarities and differences in cancer survival, with notable poorer outcomes observed in Denmark
The incidence of colon cancer increased in both sexes over the study period, while there was a slight decrease in mortality (Supplementary Figure 1a and 1b)
Summary
Marked differences in cancer incidence and survival between countries and jurisdictions have been documented in several reports, as well as differences in temporal trends across countries and calendar time [1,2,3,4]. With more than 10 years of additional data available, it is possible to investigate if concerted national efforts to improve early detection and quality of cancer care have had detectable effects, and if differences in cancer survival between the Nordic countries still persist. Since the 2010 comprehensive Nordic comparison, efforts to improve cancer care have been made in each Nordic country These efforts include implementing and updating national cancer plans and guidelines, changes in screening programs, centralization of cancer treatment, accelerated cancer patient pathways and improved access to new cancer therapies. Conclusion: The reasons for the observed improvements in cancer survival are likely multifactorial, including earlier diagnosis, improved treatment options, implementation of national cancer plans, uniform national cancer care guidelines and standardized patient pathways. Continuous monitoring of cancer survival is of importance to assess the impact of changes in policies and the effectiveness of health care systems
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