The Telegraph
Monday , September 30 , 2013

Spend link to cancer survival

New Delhi, Sept. 29: A nation’s expenditure on healthcare determines what proportion of patients will survive after a diagnosis of cancer, according to a new study from Europe that doctors say holds lessons for India currently debating universal free healthcare.

The study that examined per capita health expenditure in the 27 member states of the European Union has detected stark differences in cancer survival rates — from above 60 per cent in countries with the highest spending to below 40 per cent in countries with the lowest figures.

“The more a country spends on health, the fewer patients die (prematurely) after a diagnosis of cancer,” said Felipe Ades, an oncologist at the Jules Bordet Institute oncological hospital in Brussels, Belgium, who led the study, published this week in the Annals of Oncology.

Ades and his colleagues examined cancer incidence, mortality and health expenditure levels that vary significantly across the EU — from Luxembourg spending US$ 6,500 per person per year on health to Romania spending US$ 818 per person per year.

In countries such as Hungary, Poland or Romania with per capita health spending less than US$ 2,000, about 60 per cent of patients die prematurely after a diagnosis of cancer, the study found.

In Portugal, Spain and the UK, with spending between US$ 2,500 and US$ 3,500, cancer mortality after diagnosis lies between 40 per cent and 50 per cent. In Belgium, France and Germany, with per capita figures above US$ 4,000, less than 40 per cent patients die after diagnosis.

The study, whose findings will be presented at the European Cancer Congress on Sunday, has found eastern Europe had lower cancer incidence but higher cancer mortality, while western Europe had higher cancer incidence and lower cancer mortality.

Senior oncologists in India said while the association between health expenditure and survival rates is not surprising, it is likely to reflect multiple routes through which greater spending on health can improve the proportion of patients who survive.

“It’s probably not just because of better or superior methods of treatment,” said Harit Chaturvedi, chief of surgical oncology at Max Healthcare, New Delhi, and the organising secretary of the Indian Cancer Congress to be held here in November this year. “Higher spending may also help in early diagnosis through public-funded screening programmes,” Chaturvedi told The Telegraph.

Oncologists say early diagnosis dramatically increases the survival rates across virtually all cancers. “The 20 per cent of patients in India who get diagnosed early have (five-year) survival rates of 80 per cent,” said Goura Kishor Rath, professor and head of the Institute Rotary Cancer Hospital at the All India Institute of Medical Sciences, New Delhi. “But 80 per cent of patients in India get diagnosed late and have survival rates of 20 per cent.”

Public health experts have long decried India’s low per capita health expenditure and have argued that lack of public spending on screening for early diagnosis and appropriate cancer treatment contributes to pushing up cancer mortality rates.

The World Health Organisation’s national health account database shows that India’s per capita health expenditure was only US$ 43 in 2008 and climbed to US$ 59 in 2011, which is a fraction of even Romania’s per capita spending on health — the least within the EU.

India’s National Cancer Registry, a government programme that tracks cancer trends, has predicted that the annual number of patients who develop cancer in India is set to rise from about 9.79 lakh in 2010 to 11.4 lakh in 2020.

A government-appointed panel had two years ago recommended the launch of a free universal healthcare initiative that would use tax revenues to promote preventive health actions as well as support treatment of various illnesses, including cancer.

But the proposal has stalled with health economists and other experts debating strategies to introduce healthcare — some arguing that public and private insurance would play a key role in such an initiative, while others calling for spending from tax revenues.

A landmark study last year had estimated that 5.5 lakh people died of cancer in 2010, among whom 3.9 lakh deaths, or 71 per cent, occurred in people aged between 30 and 69.

The study led by Prabhat Jha, an epidemiologist at the Centre for Global Health Research at St Michael's Hospital in Toronto, Canada, had also found that — contrary to common perceptions — rates of cancer deaths were similar between rural and urban areas in India.