The Lancet is publishing a new survey of cancer care outcomes in six countries -- Canada, Australia, Denmark, Norway, Sweden, and Britain -- between 1995 and 2007 (report here; registration is required, but free). It's not of direct relevance to Northoma, because the statistics in question don't include lymphoma. However, it's always helpful to understand how Canadian healthcare compares to systems in other countries. Frustratingly, the United States was not part of this data set. I'll write more about that particular comparison later.
In the meantime, how did Canada measure up?
Not too shabbily, according to the researchers -- a team led by M.P. Coleman of the London School of Hygiene and Tropical Medicine, and funded by the British government. They examined a truly massive set of data: statistics on lung cancer, ovarian cancer, colon cancer, and breast cancer from all these countries, between 1995 and 2007, or a total of about 2.5 million individual patients. In Canada, as in a few other locations, data was actually collected from individual provinces: specifically, British Columbia, Alberta, Manitoba, and Ontario. So we're not actually dealing with data representative of all Canadians here, either.
In all countries, cancer death rates actually fell, indicating across-the-board progress in fighting the disease. Canada, Australia and Sweden improved faster, the report concludes, while Denmark and the U.K. still improved, but lagged behind the others. In Canada, Alberta had the worst outcome, with survival rates about 5% lower than those in other provinces. Overall, in the most recent reporting period, Canada had a 5-year survival rate of 64% for colon cancer (up 6% since 1995), 18% for lung cancer (up 2.5%), 83% for breast cancer (effectively unchanged), and 42% for ovarian cancer (up 4%).
Those figures compare, respectively, with Australia's survival rates of 66% for colon cancer, 17% for lung cancer, 88% for breast cancer, and 38% for ovarian cancer. Our countries were markedly higher than Britain (in the same order, 54%, 9%, 82%, and 36%).
Of particular interest to Canadians, however, is that in addition to the misleading "Canadian average" figures above (which, of course, are actually only an average of patients from certain provinces), the researchers also listed separately the rates for B.C., Alberta, Manitoba, and Ontario. Conventional wisdom has it that the Western provinces have invested more heavily in cancer, and, in particular, that if you have cancer you're better off in B.C. (Which is where I'm from originally, though now I live in Ontario, of all places.) Not so fast, says this report.
If you had one of these four cancers, it's clear you were better not living in conservative, oil-rich Alberta. Colon cancer rates were fairly close together in 1995, ranging from 56% in Alberta to 60% in B.C. (for an average of 58% nationally). Since then, Alberta has crept up only to the former average rate of 58%, while the other provinces are now in the mid-60s (B.C. sits at 64%, Ontario at 64.9%).
A similar story holds true for lung cancer. In 1995, the 5-year survival rate for lung cancer was 16%. Back then, the West lagged behind: Alberta and B.C. were stuck just short of 14%, while Ontario and Manitoba were up at a (still dismal) 16.6%. Now, Alberta is at 15%, B.C. is at 18%, Manitoba at 19%, and Ontario at 20%. B.C. leads Manitoba and Ontario by 2.5% in breast cancer (Alberta is last again), although all provinces reached at least the mid-80s. The real surprise is ovarian cancer, where survival rates actually fell in Alberta (-5%) and Manitoba (-4%), but climbed in Ontario (+4%) and especially in B.C. (+9%).
All in all, the report is a pretty mixed bag as far as the Canadian provinces go. At least for some cancers, it's clear that B.C.'s legendary rapid application of new drugs (at least compared to other provinces) is not leading in all cases to clear leadership in the statistics. Ontario actually does fairly well, despite its dubious record when it comes to new drug access through the public healthcare system. Given the apparent discrepancy between this data and various other measures we track more readily in Canada (like waiting lists), this is a very important discovery.
On the other hand, I'm still not totally persuaded to apply these conclusions in every case. Lymphoma patients unquestionably could benefit from access to drugs in B.C. that they can't get in Ontario, even if B.C.'s protocols aren't ideal either (Bexxar and Zevalin, for instance). Are proper national comparative statistics available? I'll dig some up, eventually. In the meantime, it's nice to know that rates are improving (slowly), and that Canada isn't completely embarrassing itself on the world stage.
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