The more an EU (European Union) national government spends on health, the fewer the deaths after a cancer diagnosis in that country, according to new research to be presented to the 2013 European Cancer Congress (ECC2013) today (Sunday) and published simultaneously in the leading cancer journal Annals of Oncology.
Researchers will tell the meeting that higher wealth and higher health expenditure are strongly associated both with increased cancer incidence and decreased cancer mortality. In the case of breast cancer, increased health expenditure appears to be even more strongly associated with better outcomes.
Dr Felipe Ades, MD, a medical oncologist at the Breast European Adjuvant Studies Team (BrEAST), a clinical trials unit and data centre in Belgium, will say: "We have observed that the more spent on health, the fewer the deaths after a cancer diagnosis and this is specially marked in breast cancer. We have also noticed that, despite all the initiatives to standardise public health policies, there is significant variation between health expenditure and cancer incidence and mortality in the 27 EU member states. This disparity is more glaring between the Western and Eastern European countries."
Dr Ades and his colleagues obtained information on populations, cancer incidence, and mortality from the World Health Organization, the International Monetary Fund and the World Bank. They looked at factors such as countries' gross domestic product (GDP), the percentage of GDP invested in healthcare and health expenditure per person per year, and compared these wealth and health expenditure indicators with their own estimates of the proportion of patients dying after a cancer diagnosis.
While the population of Western Europe - approximately 400 million inhabitants - is around four times larger than that of Eastern Europe, Western countries' total GDP is more than 10-fold higher than that of Eastern Europe. The researchers also found a significant difference between the health expenditure of these countries.
"Not surprisingly, health expenditure per capita is strongly correlated with the GDP per capita and with the percentage of GDP spent on heath," Dr Ades will say. "The cut-off point between Eastern and Western European countries for health expenditure per person per year is around 2,600 US dollars. For instance, among the Western European countries Portugal has the lowest per capita expenditure at 2,690 dollars, while among the Eastern European countries, Slovenia has the highest per capita expenditure at 2,551 dollars. In the West, Luxembourg spent the most per person per year - 6,592 dollars - while in the East, Romania spent the least - 818 dollars."
The researchers found that, proportionally, Eastern Europe had lower cancer incidence and higher cancer mortality, while the opposite was the case in Western Europe. Dr Ades will tell the congress: "From our results it is evident that Eastern European countries, except Cyprus, have higher mortality rates than the Western European countries for approximately the same range of incidence. This indicates that proportionally more patients die after a diagnosis of cancer in Eastern Europe than in Western Europe. This pattern is strongly associated with health expenditure; the more a country spends on health, the fewer patients die after a cancer diagnosis.
"In countries spending less than 2,000 dollars per capita in health care, like Romania, Poland and Hungary, around 60% of the patients die after a diagnosis of cancer; in countries spending between 2,500-3,500 dollars this figure is around 40% and 50%, as in the case of Portugal, Spain and the United Kingdom; moving up to around 4,000 dollars, less than 40% of the patients die, as in the case of France, Belgium and Germany."
The research does not analyse the reasons for the higher incidence of cancer in Western European countries. However, it suggests that, as cancer deaths do not increase in the same proportion to incidence in these countries, it may be due partly to the existence of greater numbers of Western screening programmes, which detect more cancers at their early, more treatable stages, and to the availability of effective treatments in these countries.