Geographic patterns of cancer survival in England: Adults diagnosed 2003 to 2010 and followed up to 2015

Survival at 1 year and 5 years after diagnosis improved for the 8 cancers examined in this report among adults diagnosed in England between 2003 and 2010.

This is the first time survival estimates by Cancer Alliances and Sustainability and Transformation Plans in England have been reported.

Differences in net survival between the 4 NHS Regions are generally small, of the order 1% to 3%. Survival improved slightly but consistently in all 4 regions for 7 of the 8 cancers.

For 5-year survival, the largest annual increase among Cancer Alliances for men was for colon cancer in South Yorkshire, Bassetlaw, North Derbyshire and Hardwick (2.4% per year) and for women, for cervical cancer in National Cancer Vanguard: North Central and North East London (2.6% per year).

There are wide geographic disparities in survival among the 44 Sustainability and Transformation Plans that cover the whole of England. The geographic range in 1-year survival was greater than 15% for cancers of the oesophagus and stomach (both men and women), and for women with cancer of the bladder and cervix. For 5-year survival, the range was wider than 15% for cancers of the bladder in both men and women, for colon cancer in men and for cancers of the stomach and cervix in women.

Cancer survival has been examined for adults (15 to 99 years) diagnosed with 1 of 8 common cancers in England between 2003 and 2010. All the patients were followed up for their vital status for at least 5 years up to 31 December 2015. The cancers are those of the oesophagus, stomach, colon, lung, breast (women), cervix, prostate and bladder (Background notes 1 and 2). These cancers represent around 60% of new cancers diagnosed in England in 2014¹. These 8 cancers were included in this analysis as they have a wide range of pathways for diagnosis and treatment, and different levels of survival. Estimates of 1-year and 5-year net survival (Background note 2) are presented for each sex, and for both sexes combined.

Following advice from key stakeholders, sub-national survival estimates are presented for new geographical areas of the NHS. Results are presented for England as a whole, and for three levels of organisation of the NHS in England – 4 NHS Regions, 19 Cancer Alliances (average population about 2.9 million) and 44 Sustainability and Transformation Plan (STP) areas (average population about 1.2 million) (Background note 6).

Age-standardised survival estimates are presented for adults who were diagnosed during 2008 to 2010 and followed up to 31 December 2015. Estimates are age-standardised to adjust for changes in the age profile of cancer patients over time and differences between geographical areas (Background note 3). To show the wide disparity in cancer survival between STPs, we present in Tables 1 and 2 the range of age-standardised survival estimates (difference between the minimum and maximum) between all the STPs.

To show trends over time, unstandardised survival estimates for each year during the period 2003 to 2010 are also presented, together with the average annual change in net survival over this 8-year period (Background note 5).

The cancer registration data in this publication were collected by the National Cancer Registration and Analysis Service in Public Health England. This publication is produced in partnership with the Cancer Survival Group at the London School of Hygiene & Tropical Medicine.

England

In England as a whole, 1-year survival was above 70% and 5-year survival above 55% for cancers of the colon, breast (women), cervix and prostate, and for bladder cancer in men (Figure 1).

For bladder cancer in women, 1-year survival was just below 70% (68%) and just above 45% (47.7%) at 5 years. Changes in the coding and classification of bladder cancer since 2000 have contributed to a reduction in the survival estimates in England, and to some of the observed regional variation (Background note 7).

For cancers of the oesophagus, stomach and lung, survival remains very low, with 1-year survival below 45% and 5-year survival below 20%.

One-year survival is generally higher in men, except for lung cancer which is around 5% lower in men. While 5-year survival is generally higher in women, except for bladder cancer which is around 10% lower in women. For bladder cancer, both 1-year and 5-year survival are about 10% higher in men than in women.

Trends in cancer survival are shown in the reference tables as the annual change in net survival over the 8-year period, 2003 to 2010. This is presented as the average difference from one year to the next (Background note 5). In England as a whole and for both sexes combined, 1-year and 5-year survival improved by up to 1.2% a year between 2003 and 2010 for seven of the eight cancers examined in this report. There was almost no change in bladder cancer survival.

The largest annual improvements in 1-year survival in England in men were for cancers of the oesophagus and stomach (average increase 1.0% per year), and in women, for cancer of the colon (1.0%).

The largest annual improvements in 5-year survival were for colon cancer in men and for cervical cancer in women (1.2% per year). For all other cancers at national level, 1-year and 5-year survival continued to increase, albeit slowly, between 2003 and 2010 (average increase less than or equal than 1% per year).

NHS Regions

The largest annual improvements in 1-year survival for men amongst the 4 NHS regions were for oesophageal cancer in the North of England and stomach cancer in the South of England (average increases of 1.5% per year). For women, the largest improvement in 1-year survival was the average annual increase of 1.7% for stomach cancer, in London.

For 5-year survival, the largest increase over this 8-year period for men was for colon cancer in the South of England and London (1.4% per year). For women, the largest increase was for cervical cancer, also in London (1.4% per year).

Cancer Alliances

For men, 1-year survival for cancers of the stomach and colon increased in all 19 Cancer Alliances (CAs), with the average annual increase ranging from 0.4% to 2.5% per year for stomach and from 0.2% to 2.2% per year for colon.

1-year survival also increased for cancers of the oesophagus (17 CAs), lung (18 CAs), and prostate (16 CAs). 5-year survival increased for 15 out of 19 CAs for 7 of the 8 cancers, except for bladder cancer, for which 10 CAs showed an increase in 5-year survival.

For women, 1-year survival for colon cancer rose in all 19 CAs, with the average annual increase ranging from 0.1% to 1.7% per year. 1-year survival also increased for cancer of the lung in 18 CAs and in 17 CAs for cancer of the cervix. 5-year survival increased in all 19 CAs for cancers of the colon, lung and breast, and in 17 CAs for cervical cancer.

Sustainability and Transformation Plans

Sustainability and Transformation Plans (STP) are smaller areas than Cancer Alliances, and more variation can be expected due to smaller populations. Wide differences in age-standardised survival between the 44 STPs in England were seen for patients diagnosed during the 3-year period 2008 to 2010 for each of the 8 cancers examined (see Tables 1 and 2).

For women, the range in 1-year survival estimates between STPs was more than 15% for cancers of the oesophagus, stomach, cervix and bladder, and wide differences persisted in 5-year survival for stomach, cervix and bladder.

For men, the range in survival between STPs was more than 15% for 1-year survival from cancers of the oesophagus and stomach, and for 5-year survival from cancers of the colon and bladder. It should be noted that some of the geographic variation in bladder cancer survival may be attributed to differences between the regions of England in the speed of adoption of changes in pathological coding and classification during this period (Background note 7).

Further information about our cancer survival estimates can be found in the Cancer Survival Quality and Methodology Information report. These are overview notes containing important qualitative information on the quality of statistics and a summary of the methods used to compile the output.

Statistics on cancer are produced:

• in Scotland by the Scottish Cancer Registry

• in Wales by the Welsh Cancer Intelligence and Surveillance Unit

• in Northern Ireland by the Northern Ireland Cancer Registry

Health policy-makers use population-based cancer survival statistics to plan services aimed at cancer prevention and treatment. Cancer survival estimates feed in to national cancer plans, such as: ‘Achieving world-class cancer outcomes: A Strategy for England 2015 to 2020’. The report recommends 6 strategic priorities to help improve cancer survival in England by 2020.

Cancer survival estimates also feed into outcomes strategies that set out how the NHS, public health and social care services will contribute to the progress agreed with the Secretary of State, in each of the high-level outcomes frameworks. The indicators set for the National Health Service (NHS) Outcomes Framework include 1- and 5-year survival from colorectal, breast and lung cancers.

Aurélien Belot^a, Michel P. Coleman^a, Winnie Magadi^a, Jasveer Kaur^b, Matthew Peet^b, Stephen Rowlands^b, Neil Bannister^b, and Bernard Rachet^a

a Cancer Survival Group, London School of Hygiene & Tropical Medicine
b Cancer Analysis Team, Office for National Statistics

The National Cancer Registry at the Office for National Statistics and the London School of Hygiene and Tropical Medicine wish to acknowledge the work of the National Cancer Registration and Analysis Service in Public Health England, which provides the raw data for these analyses.