Long-term survival for myeloid neoplasms and national health expenditure: a EUROCARE-6 retrospective, population-based study

Claudia Vener; Roberto Lillini; Simone Bonfarnuzzo; Roberta De Angelis; Helene A. Poirel; Annalisa  Trama; Otto Visser; Xavier Troussard; Rafael Marcos-Gragera; Marc Maynadié; Elena Demuru; Elena Demuru; Corrado Di Benedetto; Tom Børge  Johannesen; Marta Solans; Keiu  Paapsi; Marcela  Guevara; Seyed  Mohsen Mousavi; Marcel Blum; Roger  Von Moos; Damien Bennett; Milena Sant; Charlene M. McShane

doi:10.1016/j.ejca.2025.115231

Long-term survival for myeloid neoplasms and national health expenditure: a EUROCARE-6 retrospective, population-based study

Claudia Vener^*, Roberto Lillini, Simone Bonfarnuzzo, Roberta De Angelis, Helene A. Poirel, Annalisa Trama, Otto Visser, Xavier Troussard, Rafael Marcos-Gragera, Marc Maynadié, Elena Demuru, Elena Demuru, Corrado Di Benedetto, Tom Børge Johannesen, Marta Solans, Keiu Paapsi , Marcela Guevara , Seyed Mohsen Mousavi, Marcel Blum, Roger Von MoosDamien Bennett, Milena Sant, Charlene M. McShane

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background
EUROCARE, a European population-based cancer project, has shown geographical survival disparities for myeloid neoplasms (MN) suggesting healthcare inequalities. Total National Health Expenditure (TNHE) might influence population-based MN survival. We studied the long-term survival of 15 MN and the TNHE impact on prognosis between European countries.

Methods
In this observational, retrospective, population-based study, we analysed the EUROCARE-6 dataset (comprising data from 27 European countries) of patients aged 15 or older diagnosed with a MN between 2001 and 2013, and followed up to December 31, 2014. Countries were classified according to their mean TNHE quartile in 2001–13. For each MN, 5-year and 10-year age-standardised relative survival (ASRS) was calculated using the period approach. Generalised linear models indicated the effects of age at diagnosis, sex, and TNHE on the relative excess risk of death (RER).

Findings
We identified 267 968 MN cases [median follow-up time: 13 years (IQR 13–14)]. The 10-year ASRS was highest for myeloproliferative neoplasms (MPN) (61.2 % [95 % CI 60.3–62.0 %]), in particular chronic myeloid leukaemia (52.5 % [95 % CI 51.1–53.9 %]), polycythemia vera (70.9 % [95 % CI 69.0–72.8 %]), essential thrombocythemia (75.2 % [95 % CI 73.3–77.1 %]), and lowest for acute myeloid leukaemia (AML) (15.6 % [95 % CI 15.2–16.1 %]), except for acute promyelocytic leukaemia (52.2 % [95 % CI 46.3–58.7 %]). For AML, MPN, myelodysplastic syndrome, 5-year and 10-year ASRS was higher in countries in the highest TNHE quartile (high expenditure) than countries in the lowest quartile (low expenditure). Ten-year RERs for almost all MN increased with decreasing health expenditure, albeit not uniformly.

Interpretation
TNHE is associated with geographical inequalities in MN prognosis. Policy decisions on allocating economic resources are needed to reduce these differences.

Original language	English
Article number	115231
Number of pages	14
Journal	European Journal of Cancer
Volume	220
Early online date	07 Mar 2025
DOIs	https://doi.org/10.1016/j.ejca.2025.115231
Publication status	Published - 02 May 2025

Keywords

myeloid neoplasms
national health expenditure
EUROCARE-6

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Vener, C., Lillini, R., Bonfarnuzzo, S., De Angelis, R., Poirel, H. A., Trama, A., Visser, O., Troussard, X., Marcos-Gragera, R., Maynadié, M., Demuru, E., Demuru, E., Di Benedetto, C., Johannesen, T. B., Solans, M., Paapsi , K., Guevara , M., Mohsen Mousavi, S., Blum, M., ... McShane, C. M. (2025). Long-term survival for myeloid neoplasms and national health expenditure: a EUROCARE-6 retrospective, population-based study. European Journal of Cancer, 220, Article 115231. https://doi.org/10.1016/j.ejca.2025.115231

@article{0e949af95de44d5190d127d052192da8,

title = "Long-term survival for myeloid neoplasms and national health expenditure: a EUROCARE-6 retrospective, population-based study",

abstract = "BackgroundEUROCARE, a European population-based cancer project, has shown geographical survival disparities for myeloid neoplasms (MN) suggesting healthcare inequalities. Total National Health Expenditure (TNHE) might influence population-based MN survival. We studied the long-term survival of 15 MN and the TNHE impact on prognosis between European countries.MethodsIn this observational, retrospective, population-based study, we analysed the EUROCARE-6 dataset (comprising data from 27 European countries) of patients aged 15 or older diagnosed with a MN between 2001 and 2013, and followed up to December 31, 2014. Countries were classified according to their mean TNHE quartile in 2001–13. For each MN, 5-year and 10-year age-standardised relative survival (ASRS) was calculated using the period approach. Generalised linear models indicated the effects of age at diagnosis, sex, and TNHE on the relative excess risk of death (RER).FindingsWe identified 267 968 MN cases [median follow-up time: 13 years (IQR 13–14)]. The 10-year ASRS was highest for myeloproliferative neoplasms (MPN) (61.2 % [95 % CI 60.3–62.0 %]), in particular chronic myeloid leukaemia (52.5 % [95 % CI 51.1–53.9 %]), polycythemia vera (70.9 % [95 % CI 69.0–72.8 %]), essential thrombocythemia (75.2 % [95 % CI 73.3–77.1 %]), and lowest for acute myeloid leukaemia (AML) (15.6 % [95 % CI 15.2–16.1 %]), except for acute promyelocytic leukaemia (52.2 % [95 % CI 46.3–58.7 %]). For AML, MPN, myelodysplastic syndrome, 5-year and 10-year ASRS was higher in countries in the highest TNHE quartile (high expenditure) than countries in the lowest quartile (low expenditure). Ten-year RERs for almost all MN increased with decreasing health expenditure, albeit not uniformly.InterpretationTNHE is associated with geographical inequalities in MN prognosis. Policy decisions on allocating economic resources are needed to reduce these differences.",

keywords = "myeloid neoplasms, national health expenditure, EUROCARE-6",

author = "Claudia Vener and Roberto Lillini and Simone Bonfarnuzzo and {De Angelis}, Roberta and Poirel, {Helene A.} and Annalisa Trama and Otto Visser and Xavier Troussard and Rafael Marcos-Gragera and Marc Maynadi{\'e} and Elena Demuru and Elena Demuru and {Di Benedetto}, Corrado and Johannesen, {Tom B{\o}rge} and Marta Solans and Keiu Paapsi and Marcela Guevara and {Mohsen Mousavi}, Seyed and Marcel Blum and {Von Moos}, Roger and Damien Bennett and Milena Sant and McShane, {Charlene M.}",

year = "2025",

month = may,

day = "2",

doi = "10.1016/j.ejca.2025.115231",

language = "English",

volume = "220",

journal = "European Journal of Cancer",

issn = "1879-0852",

publisher = "Elsevier Ltd",

}

Vener, C, Lillini, R, Bonfarnuzzo, S, De Angelis, R, Poirel, HA, Trama, A, Visser, O, Troussard, X, Marcos-Gragera, R, Maynadié, M, Demuru, E, Demuru, E, Di Benedetto, C, Johannesen, TB, Solans, M, Paapsi , K, Guevara , M, Mohsen Mousavi, S, Blum, M, Von Moos, R, Bennett, D, Sant, M & McShane, CM 2025, 'Long-term survival for myeloid neoplasms and national health expenditure: a EUROCARE-6 retrospective, population-based study', European Journal of Cancer, vol. 220, 115231. https://doi.org/10.1016/j.ejca.2025.115231

TY - JOUR

T1 - Long-term survival for myeloid neoplasms and national health expenditure: a EUROCARE-6 retrospective, population-based study

AU - Vener, Claudia

AU - Lillini, Roberto

AU - Bonfarnuzzo, Simone

AU - De Angelis, Roberta

AU - Poirel, Helene A.

AU - Trama, Annalisa

AU - Visser, Otto

AU - Troussard, Xavier

AU - Marcos-Gragera, Rafael

AU - Maynadié, Marc

AU - Demuru, Elena

AU - Di Benedetto, Corrado

AU - Johannesen, Tom Børge

AU - Solans, Marta

AU - Paapsi , Keiu

AU - Guevara , Marcela

AU - Mohsen Mousavi, Seyed

AU - Blum, Marcel

AU - Von Moos, Roger

AU - Bennett, Damien

AU - Sant, Milena

AU - McShane, Charlene M.

PY - 2025/5/2

Y1 - 2025/5/2

N2 - BackgroundEUROCARE, a European population-based cancer project, has shown geographical survival disparities for myeloid neoplasms (MN) suggesting healthcare inequalities. Total National Health Expenditure (TNHE) might influence population-based MN survival. We studied the long-term survival of 15 MN and the TNHE impact on prognosis between European countries.MethodsIn this observational, retrospective, population-based study, we analysed the EUROCARE-6 dataset (comprising data from 27 European countries) of patients aged 15 or older diagnosed with a MN between 2001 and 2013, and followed up to December 31, 2014. Countries were classified according to their mean TNHE quartile in 2001–13. For each MN, 5-year and 10-year age-standardised relative survival (ASRS) was calculated using the period approach. Generalised linear models indicated the effects of age at diagnosis, sex, and TNHE on the relative excess risk of death (RER).FindingsWe identified 267 968 MN cases [median follow-up time: 13 years (IQR 13–14)]. The 10-year ASRS was highest for myeloproliferative neoplasms (MPN) (61.2 % [95 % CI 60.3–62.0 %]), in particular chronic myeloid leukaemia (52.5 % [95 % CI 51.1–53.9 %]), polycythemia vera (70.9 % [95 % CI 69.0–72.8 %]), essential thrombocythemia (75.2 % [95 % CI 73.3–77.1 %]), and lowest for acute myeloid leukaemia (AML) (15.6 % [95 % CI 15.2–16.1 %]), except for acute promyelocytic leukaemia (52.2 % [95 % CI 46.3–58.7 %]). For AML, MPN, myelodysplastic syndrome, 5-year and 10-year ASRS was higher in countries in the highest TNHE quartile (high expenditure) than countries in the lowest quartile (low expenditure). Ten-year RERs for almost all MN increased with decreasing health expenditure, albeit not uniformly.InterpretationTNHE is associated with geographical inequalities in MN prognosis. Policy decisions on allocating economic resources are needed to reduce these differences.

AB - BackgroundEUROCARE, a European population-based cancer project, has shown geographical survival disparities for myeloid neoplasms (MN) suggesting healthcare inequalities. Total National Health Expenditure (TNHE) might influence population-based MN survival. We studied the long-term survival of 15 MN and the TNHE impact on prognosis between European countries.MethodsIn this observational, retrospective, population-based study, we analysed the EUROCARE-6 dataset (comprising data from 27 European countries) of patients aged 15 or older diagnosed with a MN between 2001 and 2013, and followed up to December 31, 2014. Countries were classified according to their mean TNHE quartile in 2001–13. For each MN, 5-year and 10-year age-standardised relative survival (ASRS) was calculated using the period approach. Generalised linear models indicated the effects of age at diagnosis, sex, and TNHE on the relative excess risk of death (RER).FindingsWe identified 267 968 MN cases [median follow-up time: 13 years (IQR 13–14)]. The 10-year ASRS was highest for myeloproliferative neoplasms (MPN) (61.2 % [95 % CI 60.3–62.0 %]), in particular chronic myeloid leukaemia (52.5 % [95 % CI 51.1–53.9 %]), polycythemia vera (70.9 % [95 % CI 69.0–72.8 %]), essential thrombocythemia (75.2 % [95 % CI 73.3–77.1 %]), and lowest for acute myeloid leukaemia (AML) (15.6 % [95 % CI 15.2–16.1 %]), except for acute promyelocytic leukaemia (52.2 % [95 % CI 46.3–58.7 %]). For AML, MPN, myelodysplastic syndrome, 5-year and 10-year ASRS was higher in countries in the highest TNHE quartile (high expenditure) than countries in the lowest quartile (low expenditure). Ten-year RERs for almost all MN increased with decreasing health expenditure, albeit not uniformly.InterpretationTNHE is associated with geographical inequalities in MN prognosis. Policy decisions on allocating economic resources are needed to reduce these differences.

KW - myeloid neoplasms

KW - national health expenditure

KW - EUROCARE-6

U2 - 10.1016/j.ejca.2025.115231

DO - 10.1016/j.ejca.2025.115231

M3 - Article

SN - 1879-0852

VL - 220

JO - European Journal of Cancer

JF - European Journal of Cancer

M1 - 115231

ER -

Long-term survival for myeloid neoplasms and national health expenditure: a EUROCARE-6 retrospective, population-based study

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Keywords

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