Download `phase 2` cancer survival benchmark

International Cancer Benchmarking Partnership: open call for expressions of interest for
‘phase 2’ cancer survival benchmark
Brief for commissioned research project to establish the most recent international survival
comparisons for cancers of the lung, oesophagus, stomach, ovary, colon, rectum, liver and pancreas for
‘phase 2’ of the International Cancer Benchmarking Partnership
International survival comparisons have been key in driving efforts towards improving cancer outcomes for
patients. Against a backdrop of changes to policy and practice, improvements in data collection and the
opportunity of building on existing knowledge, expertise, tools & methodologies, there is now great potential in
updating and expanding previous analyses, providing greater insights.
This commissioned project will provide the most recent international cancer survival benchmark, using the most up
to date data, and will underpin an ambitious research programme for ‘phase 2’ of the International Cancer
Benchmarking Partnership (ICBP). It will be funded by all participating ICBP partners, through a range of funding
sources.
Key timescales
If you are planning to submit a proposal, please first notify the ICBP team of your intention by emailing
[email protected] no later than 5pm on Friday 6th November 2015 (GMT), including a short overview of your
application using the form provided at the end of this document. If your application is within remit, you will be
invited to submit a full project proposal. Full applications need to be received by the ICBP team by 5pm on Friday
18th December 2015 (GMT). Full applications will be subject to independent expert review and a final funding
decision will be made by the ICBP Programme Board.
Project aim
The aim of this project is to establish the most up to date international cancer survival benchmark for cancers of
the lung, oesophagus, stomach, ovary, colon, rectum, liver and pancreas across at least five comparable
countries, alongside providing a greater understanding of the impact of stage at diagnosis and stage-specific
survival.
Two supplementary analyses are included in the brief for this study:
 An overview of jurisdiction adherence to international coding frameworks, including staging classifications
– to enable robust comparisons and to recommend how these could be harmonised.
 Quantifying the impact of local registration practices on short-term cancer survival – to improve the
sensitivity of international comparisons.
Who can apply?
The partnership welcomes expressions of interest from teams, consortia or collaborations based within and/or
outside of participating ICBP countries, from a range of research areas including epidemiology, statistics and policy
research. We are open to receiving expressions of interest for delivering any one – or multiple elements – of the
three analyses.
Background to the partnership
The International Cancer Benchmarking Partnership is a unique and innovative global partnership of clinicians,
academics, data experts and policymakers. It is the first of its kind seeking not only to quantify international
differences in cancer survival in high-income countries, but also to explore factors that might influence observed
variations. This programme of work is generating insights and deeper understanding of the changes to policy and
practice needed to deliver the best possible outcomes for cancer patients (Butler et al, 2013). These findings are
relevant for all ICBP partners, and potentially more widely. The partnership has involved 13 jurisdictions from 6
countries across 3 continents to date: Australia (New South Wales and Victoria); Canada (Alberta, British Columbia,
Manitoba and Ontario); Denmark; Norway; Sweden; and the UK (England, Northern Ireland, Scotland and Wales).
The partnership has focused on four tumour types - ovary, lung, breast and colorectal - in ‘phase 1’.
Inclusion of partners within ICBP is based on having long established, timely and high quality population-based
cancer registry data, as well as comparable and relatively high levels of spending on, and universal access to, health
care. The ICBP has pioneered a range of methods and research tools to enable robust international comparisons.
12 high quality peer reviewed papers have been published1 - more are in the pipeline. These have included a
landmark study in The Lancet providing an international cancer survival benchmark and the first international
comparison of cancer survival and stage at diagnosis using routine data; the first international comparison of public
cancer awareness, attitudes and beliefs on this scale and the first study to identify factors in primary care that
could be contributing to international differences in cancer outcomes.
ICBP research and insight to date has informed policy developments, to advocate for service planning and
enhancements; led efforts to improve the completeness and comparability of routinely collected cancer data;
informed the development of innovative programmes to improve diagnostic pathways and supported the
continued need for public awareness campaigns for cancer.
The ICBP is now starting ‘phase 2’ of the partnership, including growing the partnership to involve new partner
jurisdictions, refocusing the work programme on new tumour types and launching an ambitious new research
programme.
Background to this commissioning brief
International differences in cancer survival persist. The ICBP published survival comparisons between six countries
for breast, colorectal, lung and ovarian cancer patients diagnosed between 1995-2007 (Coleman et al, 2011). The
data show that overall survival improved across all countries during the time period but that differences remain –
survival was consistently higher in Australia, Canada and Sweden, intermediary in Norway, and lowest in the UK
and Denmark. The survival ‘gap’ between the best performing countries and the lowest thus remains – except for
breast cancer where the UK and Denmark are closing the ‘gap’. The lower survival in Denmark and England was
attributed to more advanced stage of diagnosis, treatment variation, and the disproportionate impact of poorer
outcomes in older patients.
The recent CONCORD-2 study highlighted that international differences in cancer survival persist for patients
diagnosed until the end of 2009 for the cancers studied in the ICBP, and five additional cancers - cervix, liver,
leukaemia, prostate and stomach (Allemani et al, 2015).
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As of September 2015.
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ICBP analyses, using a novel method (Walters et al, 2013a) of comparing international survival with routinely
collected stage at diagnosis, reveal a complex picture across partners for ovarian, colorectal, lung and breast
cancers (Maringe et al, 2012; Maringe et al, 2013; Walters et al, 2013b; Walters et al, 2013c).
The data suggest that a large element of the survival ‘gap’ for Denmark in comparison to better performing
countries was driven by a later stage at the time of diagnosis. The UK also had a worse stage distribution in
comparison to ICBP partner countries, notably for colorectal and lung cancer, with late-stage patients also having
lower survival than elsewhere. Sweden was one of the best performing countries, with consistently better 1-year
survival for breast, colorectal and lung cancers. Canada had high late stage survival for ovarian cancer and while
Norway and Canada had comparable survival for early stage breast cancer patients to others, their late stage
breast patients had lower survival than those in Australia and Sweden. The data also reveal that treatment
differences appear to play a more significant role than perhaps expected with survival within stage being variable
too between partners, particularly for breast and ovarian cancer.
These analyses were limited by the availability and quality of stage data in participating countries and highlight the
importance of understanding international differences in staging practices. Work in ‘phase 1’ has also highlighted
that even within common agreed frameworks, variations in topography and morphology coding practice exist
between registries. In addition, clinical practice, as well as variable existence, inclusion and availability of local data
feeds, has been shown to impact on short-term survival (Eden et al, manuscript in preparation).
Efforts in several ICBP jurisdictions since 2007 have improved data completeness and access (Rashbass and Peake,
2014). National cancer policies and practice have continued to evolve over the past decade across a number of
countries. These have been driven by evidence and insights from international survival comparisons, including
those from the ICBP and other initiatives, with a focus on early diagnosis, specifically improving the efficiency of
the pathway from presentation to treatment, colorectal cancer screening and public awareness campaigns
(Coleman 2014; Hiom 2015; Ironmonger et al, 2015; Vedsted & Olesen 2015). Against a backdrop of changes to
policy and practice, improvements in data collection and the opportunity of building on existing knowledge,
expertise, tools & methodologies, there is now great potential in updating and expanding previous analyses,
providing greater insights.
Aims of this commissioned project
To launch and underpin ‘phase 2’, the ICBP seeks to obtain the most up to date international cancer survival
benchmark alongside a greater understanding of the impact of stage at diagnosis and stage-specific survival for
cancers of the lung, oesophagus, stomach, ovary, colon, rectum, liver and pancreas. This benchmark will be
complemented by a robust assessment of jurisdiction adherence to international coding frameworks and the
impact of local coding and registration practices on short-term survival measures. These outputs will provide the
backbone and context to further studies undertaken as part of ‘phase 2’. The focus remains on a small number of
developed countries with up to date and advanced cancer data collections, providing insight into the current state
of international cancer survival and what might be driving any observed differences, allowing the partnership to
make timely recommendations for policy and practice.
Key questions and scope of this project
A. Epidemiological core benchmarking - to establish the most recent international cancer survival
comparisons and provide a greater understanding of the impact of stage at diagnosis and stage-specific
survival
B. Overview of jurisdiction adherence to international coding frameworks, including staging classifications to enable robust comparisons and to recommend how these could be harmonised.
C. Quantifying the impact of local registration practices on short-term cancer survival – to improve the
sensitivity of international comparisons.
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A. Epidemiological core benchmarking
1) Establishing the most recent possible international net/relative cancer survival benchmark for cancers of
the lung, colon, rectum, ovary, pancreas, oesophagus, stomach, and liver.
a. The study will provide the most up to date benchmark, using the most recent incidence and followup data available, starting with patients diagnosed from 1st January 2005.
b. Key net/relative survival metrics are 1-year, 5-year and 5-1 year conditional survival and survival
curves by tumour site, including morphological groups (where relevant), age and gender (except
for ovary).
c. The analyses will focus on primary cancers of the lung, colon, rectum, ovary, liver, oesophagus,
stomach and pancreas.
d. Data need to be reported at country level, with jurisdictional breakdowns also available, for all
ICBP ‘phase 2’ partners. This will include a minimum of five countries (approx. 15 jurisdictions).
2) Providing incidence and mortality trends for the same time period for all tumour types
a. Incidence trends should be further reported by stage.
b. This must include site-specific clinical input to interpret the stage specific incidence trends.
3) Establishing stage distributions and stage specific net/relative survival comparisons over time for all
tumour types and partner jurisdictions/countries for each tumour type by age, gender and morphology
Note: To our knowledge, no international cancer survival comparisons have previously been reported for
oesophageal and pancreatic cancers, and no international survival comparisons by stage have been reported for
liver, oesophageal, stomach and pancreatic cancers. Inclusion of these tumour types in these two sets of analyses
will be subject to the availability and comparability of data as established as part of the work in ‘element’ B in this
commissioning brief. It is therefore essential that work on the benchmarking (element A) and coding frameworks
(element B) takes place concurrently with close collaboration between lead researchers.
B. Overview of jurisdiction adherence to international coding frameworks, including staging
classifications
To maximise the robustness of comparisons it is important that data definitions are consistent across partners
and that any differences are captured and their potential impact quantified. International comparison studies,
including by the ICBP, have highlighted that variations in topography and morphology coding practice exist
between registries.
a. This work will provide an overview of existing registry coding practices for cancers of the lung,
colon, rectum, ovary, pancreas, oesophagus, stomach, and liver across ICBP partners, with a
particular focus on:
i. Topography
ii. Morphology
iii. Primary vs metastatic vs recurrence cancers
iv. Sources of staging data
This work, notably for cancers of the pancreas, oesophagus, stomach and liver, will determine the feasibility of
international robust cancer survival and/or cancer survival by stage comparisons (as per element A in this
commissioning brief). It is therefore essential that work on the benchmarking (element A) and coding frameworks
(element B) takes place concurrently with close collaboration between lead researchers.
Coding differences may be driven by availability of specific data feeds, which in turn may depend on local clinical
policy or practice frameworks. This exercise will require multi-disciplinary input from cancer registry and data
experts as well as site-specific clinicians from participating countries to provide local context and expertise. It will
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form the basis of a set of policy and practice recommendations on coding from the ICBP to support international
survival analyses on these tumour types.
C. Quantifying the impact of local registration practices on short term survival comparisons
Module 5 of ICBP ‘phase 1’ has already demonstrated that differences exist between cancer registries in the
availability and collection of data and processes that determine how that data is recorded. These differences can
have an effect on short-term survival metrics for breast, colorectal, lung and ovarian cancers [Eden et al,
manuscript in preparation]. This work will:
a. Extend the Eden et al study, including incorporating local practice assessments for new ICBP
partner jurisdictions and tumour types for ‘phase 2’ (for existing and new ICBP partner
jurisdictions) to identify factors that could affect short term survival calculations.
b. Explore the feasibility of providing an ‘adjustment coefficient’ that can be used to adjust the
impact of local registration practice differences on short term survival calculations.
Core expected outputs
Epidemiological core benchmarking - to establish the most recent cancer survival comparisons
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A report including of country and jurisdiction level descriptive and analyses tables and graphs for all key
questions, including incidence, survival, mortality, stage, age, gender, morphology, local clinical
interpretation and other considerations. This report will provide additional and more detailed information
than would be available in potential peer reviewed publications.
A central quality assured ICBP database that can be shared, subject to ethics and information governance
requirements, with other ICBP and non-ICBP researchers.
Manuscript(s) suitable to be submitted for consideration to peer reviewed journals.
Interim reports and project updates at agreed milestones.
Overview of jurisdiction adherence to international coding frameworks, including staging classifications
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A descriptive summary report of how information was collected during an agreed study period from each
jurisdiction, key informants and information on registration practices by jurisdiction. To include a set of
tables detailing coding practices for topography and morphology assignments, and whether a tumour is
primary, recurrent or metastastic in all jurisdictions for cancers of the lung, colon, rectum, ovary, pancreas,
oesophagus, stomach, and liver.
A set of coding recommendations, based on current practice and expert input, to enable international
survival comparisons for these tumour types.
A report and manuscript summarising the methodology, findings and recommendations – with a view to a
submission to peer reviewed journal(s).
Interim reports and project updates at agreed milestones.
Quantifying the impact of local registration practices on short term outcomes
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A set of tables detailing current available data feeds and processes for cancer registration in all
jurisdictions.
An ‘adjustment coefficient’ that can be applied to short-term outcome calculations to adjust for local
registration practice differences.
A report and manuscript summarising the methodology, findings and adjustment coefficient – with a view
to a submission to peer reviewed journal(s).
Interim reports and project updates at agreed milestones.
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Timescale and processes
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Expressions of interest to the ICBP team ([email protected]) by 5pm on Friday 6th November 2015 (GMT)
including a short project overview (see separate form).
Where expressions of interest are within remit, applicants will be asked to submit a full application,
including detailed methodology, milestones, duration, budget breakdown and proposed collaborations
(where relevant) should be submitted to [email protected] by 5pm on Friday 18th December
2015 (GMT).
The applications will be reviewed by a group of independent international experts; final funding decisions
will be made by the ICBP Programme Board.
The three elements of this brief (A, B and C) are closely linked and as such will need to take place
concurrently with close collaboration between lead researchers. Please consider the potential for data
sharing and related arrangements between lead researchers working on different elements in your
application.
Applications covering one or two elements only of this brief are welcome, please demonstrate your
experience and willingness to collaborate with other research teams on this project within your
application.
We highly encourage prospective applicants to contact the ICBP team ([email protected]) as soon as possible
with any questions or clarifications on the brief and application process.
Additional notes
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This brief sets out the key deliverables and minimum dataset requested by the ICBP; applicants are
welcome to suggest additional, policy relevant analyses and outputs for the partnership’s consideration.
Findings from all three studies in this brief will underpin the research programme for ‘phase 2’ of the ICBP
and may benefit other future studies. Please consider data sharing arrangements for other researchers,
subject to appropriate governance and approvals, as part of your application.
Successful applicants will be responsible for collecting data from all ICBP jurisdictions; please consider
relevant logistics in your proposal.
This commissioned project will be funded by all participating ICBP partners, through a range of funding
sources (predominantly government funding sources).
Funding will be administered through Cancer Research UK and will be in the form of a contract with a clear
reporting structure including all agreed milestones. Successful applicants will be required to attend
scheduled international project calls/meetings and provide regular written and/or verbal updates for the
ICBP Programme Board. The ICBP team will support and facilitate these processes.
References
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Allemani C et al. (2015) Global surveillance of cancer survival 1995-2009: analysis of individual data for
25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2).The Lancet 385: 9771010.
Butler J, Foot C, Bomb M et al. 2013. The International Cancer Benchmarking Partnership: An international
collaboration to inform cancer policy in Australia, Canada, Denmark, Norway, Sweden and the United
Kingdom. Health Policy, 112:148–155
Coleman M P et al. (2010) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–
2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry
data; The Lancet 377: 127-138
Coleman M P. (2014) Cancer survival: global surveillance will stimulate health policy and improve equity. The
Lancet 383: 8-14, 564-573
Hiom S C. (2015) Diagnosing cancer earlier: reviewing the evidence for improving cancer survival. Br J Cancer.
112, S1-S5.
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Ironmonger L et al. (2015) An evaluation of the impact of large-scale interventions to raise public awareness of
a lung cancer symptom. Br J Cancer. J112:207-16.
Maringe C et al. (2012) Stage at diagnosis and ovarian cancer survival: Evidence from the International Cancer
Benchmarking Partnership; Gynaecologic Oncology 127: 75-82
Maringe C et al. (2013) Stage at diagnosis and colorectal cancer survival in six high-income countries: a
population-based study of patients diagnosed during 2000-7. Acta Oncologica 52: 919-32
Rashbass J & Peake M (2014). The evolution of cancer registration. Eur J Cancer Care 23:757-759
Vedsted P & Olesen F. (2015) A differentiated approach to referrals from general practice to support early
cancer diagnosis – the Danish three-legged strategy. Br J Cancer 112: S1 – S65:69
Walters S et al. (2013a) Comparability of stage data in cancer registries in six countries: lessons from the
International Cancer Benchmarking Partnership. Int J Cancer.132:676-85.
Walters S et al. (2013b) Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway,
Sweden and the United Kingdom: a population-based study, 2004-2007; Thorax 68(6): 551-64
Walters S et al. (2013c) Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway,
Sweden and the United Kingdom: a population-based study, 2004-2007; Br J of Cancer 108: 1195–1208
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