Cancer mortality in Greece during the financial crisis [9] Christianen MEMC, Schilstra C, Beetz I, Muijs CT, Chouvalova O, Burlage FR, et al. Predictive modelling for swallowing dysfunction after primary (chemo)radiation: Results of a prospective observational study. Radiother Oncol 2012;105:107–14. [10] Dijkema T, Raaijmakers CPJ, Ten Haken RK, Roesink JM, Braam PM, Houweling AC, et al. Parotid gland function after radiotherapy: The combined michigan and utrecht experience. Int J Radiat Oncol Biol Phys 2010;78:449–53. [11] Deasy JO, Moiseenko V, Marks L, Chao KSC, Nam J, Eisbruch A. Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys 2010;76:S58–63. [12] Bedford JL. Treatment planning for volumetric modulated arc therapy. Med Phys 2009;36:5128. [13] Cao D, Afghan MKN, Ye J, Chen F, Shepard DM. A generalized inverse planning tool for volumetric-modulated arc therapy. Phys Med Biol 2009;54:6725–38. [14] Cameron C. Sweeping-window arc therapy: An implementation of rotational IMRT with automatic beam-weight calculation. Phys Med Biol 2005;50:4317–36.
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[15] Chi A, Ma P, Fu G, Hobbs G, Welsh JS, Nguyen NP, et al. Critical structure sparing in stereotactic ablative radiotherapy for central lung lesions: helical tomotherapy vs. volumetric modulated arc therapy. PLoS One 2013;8:e59729. [16] Guckenberger M, Richter A, Krieger T, Wilbert J, Baier K, Flentje M. Is a single arc sufficient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes? Radiother Oncol 2009;93:259–65. [17] Vanetti E, Nicolini G, Nord J, Peltola J, Clivio A, Fogliata A, et al. On the role of the optimization algorithm of RapidArc(®) volumetric modulated arc therapy on plan quality and efficiency. Med Phys 2011;38:5844–56. [18] Bzdusek K, Friberger H, Eriksson K, Hårdemark B, Robinson D, Kaus M. Development and evaluation of an efficient approach to volumetric arc therapy planning. Med Phys 2009;36:2328. [19] Ong CL, Cuijpers JP, Senan S, Slotman BJ, Verbakel WFAR. Impact of the calculation resolution of AAA for small fields and RapidArc treatment plans. Med Phys 2011;38:4471–9.
Supplementary material available online Supplementary Appendix, Figure 1 and Table I to be found online at http://informahealthcare.com/doi/ abs/10.3109/0284186X.2014.934968).
Cancer mortality in Greece during the financial crisis
NIKOLAOS VRACHNIS1, NIKOLAOS VLACHADIS1, NIKOLAOS SALAKOS1, MARIA VLACHADI2 & ZOE ILIODROMITI1 1National
and Kapodistrian University of Athens, School of Medicine, Aretaieio hospital, Athens, Greece and of Political Sciences, University of Crete, Rethymno, Greece
2Department
Cancer is the second leading cause of death in Greece and throughout developed countries worldwide. While scientific progress in oncology has led to improvement in cancer survival, this has been accompanied by a steep increase in cancer care cost [1]. The economic crisis that hit Greece in late 2008 and that resulted in a significant reduction in funding of health services had raised concern that cancer death rates would be negatively affected due to delayed diagnosis, limited access to treatment or inadequate care [2]. To evaluate the potential impact of financial downturn on cancer mortality in Greece, we present the cancer death rates during 2004–2012 based on the official data obtained from the Hellenic Statistical Authority (http://www.statistics.gr/portal/page/ portal/ESYE).
During the pre-crisis quadrennium (2004–2008), age-standardized cancer mortality in Greece showed no significant trend, decreasing non-significantly by 0.9% (p ⫽ 0.31), whereas the overall cancer death rate fell substantially during the crisis period (2008– 2012). In 2012, the cancer mortality rate had dropped significantly, compared with the last pre-crisis year (2008), by 4.5% overall and by 3.9% and 5.9% for men and women, respectively (p ⬍ 0.001 for all comparisons) (Figure 1). While cancer death rates have improved globally, there is nevertheless a cancer care crisis in both Europe and the United States translating into inequalities in treatments and outcomes [3], with one important issue being ageism, i.e. inequality in treatment of elderly patients with neoplasms. Encouragingly, however, in
Correspondence: N. Vlachadis, National and Kapodistrian University of Athens, School of Medicine, Aretaieio hospital, 76 Vasilissis Sofias Avenue, 11528, Athens, Greece. Tel: ⫹ 30 6976658565. E-mail: [email protected] (Received 12 August 2014 ; accepted 19 August 2014 ) ISSN 0284-186X print/ISSN 1651-226X online © 2014 Informa Healthcare DOI: 10.3109/0284186X.2014.958785
288
N. Vrachnis et al. Men
Total
mortality remains lower than during the pre-crisis period. However, clearly there is an urgent need, via efficient use of financial resources, to develop optimum but cost-efficient solutions for cancer patients. For this, emphasis must be placed on early diagnosis through good quality universal cancer screening, which is currently of poor quality in the country, especially for individuals of low socioeconomic status [5]. Furthermore, cancer prevention efforts can be more effective in times of economic crisis, since people reduce unhealthy habits in order to reduce costs and they may be more receptive to healthier lifestyle choices [6]; hence the economic downturn could be an opportunity of strengthening cancer prevention policies in Greece, as well as in other countries.
Women
Age-Standardized Cancer Mortality Rate
350
300
250
200
150 2004
2005
2006
2007
2008
2009
2010
2011
2012
Year
Figure 1. Cancer mortality rates in Greece 2004 – 2012. Cancer mortality rates are defined as the number of deaths attributable to cancer (International Classification of Diseases 9th Revision, codes 140-239) per 100 000 inhabitants, and are age-standardized to the 2008 population of Greece. Data are derived from the Hellenic Statistical Authority (http://www.statistics.gr/portal/page/ portal/ESYE).
Greece suffering under austerity, the largest decline in cancer mortality was observed among the oldest age groups. Specifically, from 2008 through 2012, the cancer mortality rate for subjects aged ⱖ 70 years steadily declined by 8.0% (p ⬍ 0.001) (data not shown). Death rates in Greece for all cancers combined are substantially lower than the European Union (EU) average, especially for women, for which Greece ranked fourth among the European Union countries in 2012 [4]. Our findings revealed that despite the enormous difficulties, the country’s healthcare system has coped adequately and cancer
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. References [1] Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 2011;103:117–28. [2] Tsiligianni IG. Politics and cancer management: Lessons from Greece. Lancet 2013;381:e4. [3] Lawler M, Duffy S, La Vecchia C, Le Chevalier T, Selby PJ, Sullivan R, et al. America’s cancer care crisis – is Europe any better? Lancet 2013;382:1628. [4] Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer 2013;49:1374–403. [5] Dimitrakaki C, Boulamatsis D, Mariolis A, Kontodimopoulos N, Niakas D, Tountas Y. Use of cancer screening services in Greece and associated social factors: Results from the nation-wide Hellas Health I survey. Eur J Cancer Prev 2009;18:248–57. [6] Martin-Moreno JM, Alfonso-Sanchez JL, Harris M, Lopez-Valcarcel BG. The effects of the financial crisis on primary prevention of cancer. Eur J Cancer 2010;46:2525–33.
Copyright of Acta Oncologica is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
287
[15] Chi A, Ma P, Fu G, Hobbs G, Welsh JS, Nguyen NP, et al. Critical structure sparing in stereotactic ablative radiotherapy for central lung lesions: helical tomotherapy vs. volumetric modulated arc therapy. PLoS One 2013;8:e59729. [16] Guckenberger M, Richter A, Krieger T, Wilbert J, Baier K, Flentje M. Is a single arc sufficient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes? Radiother Oncol 2009;93:259–65. [17] Vanetti E, Nicolini G, Nord J, Peltola J, Clivio A, Fogliata A, et al. On the role of the optimization algorithm of RapidArc(®) volumetric modulated arc therapy on plan quality and efficiency. Med Phys 2011;38:5844–56. [18] Bzdusek K, Friberger H, Eriksson K, Hårdemark B, Robinson D, Kaus M. Development and evaluation of an efficient approach to volumetric arc therapy planning. Med Phys 2009;36:2328. [19] Ong CL, Cuijpers JP, Senan S, Slotman BJ, Verbakel WFAR. Impact of the calculation resolution of AAA for small fields and RapidArc treatment plans. Med Phys 2011;38:4471–9.
Supplementary material available online Supplementary Appendix, Figure 1 and Table I to be found online at http://informahealthcare.com/doi/ abs/10.3109/0284186X.2014.934968).
Cancer mortality in Greece during the financial crisis
NIKOLAOS VRACHNIS1, NIKOLAOS VLACHADIS1, NIKOLAOS SALAKOS1, MARIA VLACHADI2 & ZOE ILIODROMITI1 1National
and Kapodistrian University of Athens, School of Medicine, Aretaieio hospital, Athens, Greece and of Political Sciences, University of Crete, Rethymno, Greece
2Department
Cancer is the second leading cause of death in Greece and throughout developed countries worldwide. While scientific progress in oncology has led to improvement in cancer survival, this has been accompanied by a steep increase in cancer care cost [1]. The economic crisis that hit Greece in late 2008 and that resulted in a significant reduction in funding of health services had raised concern that cancer death rates would be negatively affected due to delayed diagnosis, limited access to treatment or inadequate care [2]. To evaluate the potential impact of financial downturn on cancer mortality in Greece, we present the cancer death rates during 2004–2012 based on the official data obtained from the Hellenic Statistical Authority (http://www.statistics.gr/portal/page/ portal/ESYE).
During the pre-crisis quadrennium (2004–2008), age-standardized cancer mortality in Greece showed no significant trend, decreasing non-significantly by 0.9% (p ⫽ 0.31), whereas the overall cancer death rate fell substantially during the crisis period (2008– 2012). In 2012, the cancer mortality rate had dropped significantly, compared with the last pre-crisis year (2008), by 4.5% overall and by 3.9% and 5.9% for men and women, respectively (p ⬍ 0.001 for all comparisons) (Figure 1). While cancer death rates have improved globally, there is nevertheless a cancer care crisis in both Europe and the United States translating into inequalities in treatments and outcomes [3], with one important issue being ageism, i.e. inequality in treatment of elderly patients with neoplasms. Encouragingly, however, in
Correspondence: N. Vlachadis, National and Kapodistrian University of Athens, School of Medicine, Aretaieio hospital, 76 Vasilissis Sofias Avenue, 11528, Athens, Greece. Tel: ⫹ 30 6976658565. E-mail: [email protected] (Received 12 August 2014 ; accepted 19 August 2014 ) ISSN 0284-186X print/ISSN 1651-226X online © 2014 Informa Healthcare DOI: 10.3109/0284186X.2014.958785
288
N. Vrachnis et al. Men
Total
mortality remains lower than during the pre-crisis period. However, clearly there is an urgent need, via efficient use of financial resources, to develop optimum but cost-efficient solutions for cancer patients. For this, emphasis must be placed on early diagnosis through good quality universal cancer screening, which is currently of poor quality in the country, especially for individuals of low socioeconomic status [5]. Furthermore, cancer prevention efforts can be more effective in times of economic crisis, since people reduce unhealthy habits in order to reduce costs and they may be more receptive to healthier lifestyle choices [6]; hence the economic downturn could be an opportunity of strengthening cancer prevention policies in Greece, as well as in other countries.
Women
Age-Standardized Cancer Mortality Rate
350
300
250
200
150 2004
2005
2006
2007
2008
2009
2010
2011
2012
Year
Figure 1. Cancer mortality rates in Greece 2004 – 2012. Cancer mortality rates are defined as the number of deaths attributable to cancer (International Classification of Diseases 9th Revision, codes 140-239) per 100 000 inhabitants, and are age-standardized to the 2008 population of Greece. Data are derived from the Hellenic Statistical Authority (http://www.statistics.gr/portal/page/ portal/ESYE).
Greece suffering under austerity, the largest decline in cancer mortality was observed among the oldest age groups. Specifically, from 2008 through 2012, the cancer mortality rate for subjects aged ⱖ 70 years steadily declined by 8.0% (p ⬍ 0.001) (data not shown). Death rates in Greece for all cancers combined are substantially lower than the European Union (EU) average, especially for women, for which Greece ranked fourth among the European Union countries in 2012 [4]. Our findings revealed that despite the enormous difficulties, the country’s healthcare system has coped adequately and cancer
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. References [1] Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 2011;103:117–28. [2] Tsiligianni IG. Politics and cancer management: Lessons from Greece. Lancet 2013;381:e4. [3] Lawler M, Duffy S, La Vecchia C, Le Chevalier T, Selby PJ, Sullivan R, et al. America’s cancer care crisis – is Europe any better? Lancet 2013;382:1628. [4] Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer 2013;49:1374–403. [5] Dimitrakaki C, Boulamatsis D, Mariolis A, Kontodimopoulos N, Niakas D, Tountas Y. Use of cancer screening services in Greece and associated social factors: Results from the nation-wide Hellas Health I survey. Eur J Cancer Prev 2009;18:248–57. [6] Martin-Moreno JM, Alfonso-Sanchez JL, Harris M, Lopez-Valcarcel BG. The effects of the financial crisis on primary prevention of cancer. Eur J Cancer 2010;46:2525–33.
Copyright of Acta Oncologica is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
