Index of cancer survival for CCGs in England: adults diagnosed in 2003 to 2018 and followed up to 2019
Published 25 March 2021
Applies to England
© Crown copyright 2021
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This publication is available at https://www.gov.uk/government/statistics/cancer-survival-index-for-clinical-commissioning-groups-2003-to-2018/index-of-cancer-survival-for-ccgs-in-england-adults-diagnosed-in-2003-to-2018-and-followed-up-to-2019
Main points
The 1-year index of cancer survival for England has increased from 63.6% in 2003 to 73.9% in 2018.
The variation in the index of cancer survival between the Clinical Commissioning Groups (CCGs) narrowed, with the range in survival estimates reducing from 14.0 percentage points in 2003 to 8.9 percentage points in 2018, indicating less geographic variation across CCGs.
Trends in the estimates for Cancer Alliances (CAs) and Sustainability and Transformation Partnerships (STPs) followed the same patterns as the CCGs.
Note: All graphs can be found on the NHS index of cancer survival interactive tool.
Cancer survival between 2003 and 2018
Between 2003 and 2018, cancer survival increased and geographic variation between CCGs narrowed.
The index of cancer survival provides a single number to summarise the overall pattern of cancer survival. Figure 1 shows the CCG variation in the index of cancer survival across time. The chart shows that the index of cancer survival has increased throughout the time period for all CCGs, while the difference in survival between CCGs has decreased. Overall, the England cancer survival has increased by 10.3 percentage points, from 63.6% in 2003 to 73.9% in 2018.
The range in 1-year index of cancer survival estimates (the gap between the highest and lowest CCGs) has narrowed from 14.0 percentage points in 2003 to 8.9 percentage points in 2018, which means there is now less geographic variation in cancer survival by CCG in England.
Figure 1: Index of cancer survival for CCGs in England compared to index of cancer survival for the whole of England, 2003 and 2018
Although the index of cancer survival has increased in England and for all CAs, STPs and CCGs, the rate of improvement has varied across individual CCGs. Table 1 shows the 5 largest and smallest changes for CCGs – that is, those with the largest or smallest percentage point increases in the index of cancer survival between 2003 and 2018.
Even though a CCG may be in the most or least improved categories, it does not mean that these CCGs have the highest or lowest survival in 2018. The index has been designed to compare levels of survival over time for individual CCGs – interpretation should focus on overall trends rather than on small changes in the survival index in a particular year.
| Area name | 2003 index of cancer survival (%) | 2018 index of cancer survival (%) | Improvement |
|---|---|---|---|
| England | 63.6 | 73.9 | 10.3 |
| Most improved CCGs | |||
| NHS Waltham Forest CCG | 54.3 | 73.7 | 19.4 |
| NHS Wirral CCG | 57.9 | 76.0 | 18.1 |
| NHS Stockport CCG | 59.5 | 76.8 | 17.3 |
| NHS Southport and Formby CCG | 59.6 | 76.8 | 17.2 |
| NHS Trafford CCG | 60.4 | 77.2 | 16.8 |
| Least improved CCGs | |||
| NHS Sandwell and West Birmingham CCG | 62.5 | 69.0 | 6.5 |
| NHS Walsall CCG | 64.2 | 70.7 | 6.5 |
| NHS Coventry and Rugby CCG | 64.7 | 70.9 | 6.2 |
| NHS Birmingham and Solihull CCG | 66.3 | 71.9 | 5.6 |
| NHS Dudley CCG | 64.8 | 70.2 | 5.4 |
| NHS Vale of York CCG | 68.3 | 72.7 | 4.4 |
Table 1: Most and least improved CCGs for index of cancer survival in England, 2003 to 2018
Figure 2 shows maps of the 1-year index of cancer survival by CCG for 2003 and 2018 in England, respectively. In 2003, CCGs with the lowest index of cancer survival, particularly below 60%, were generally from north-west England, London or south-east England. By 2018, there was less geographical variation in the index of cancer survival, with the index above 68% for all CCGs.
Figure 2: Map of the 1-year index of cancer survival for CCG in England 2003 and 2018
Since 2003, the 1-year index of cancer survival increased for all CAs. Between 2003 and 2018, the range of the 1-year index of cancer survival for CAs narrowed from 8.2 percentage points to 4.6 percentage points.
For patients diagnosed in 2018, the 1-year index of cancer survival for STPs ranged from 70.4% to 77.6%, compared with 58.0% to 67.7% in 2003.
Geographic variations for breast, colorectal and lung cancers: 2003 to 2018
Estimates of 1-year age-standardised net survival for breast cancer (women) and age-sex-standardised net survival for colorectal and lung cancers are presented in this section.
Lung cancer net survival in England showed the most improvement from 2003 to 2018, with net survival estimates increasing by 17.1 percentage points. There was a 5.9 percentage point increase for colorectal cancer and a 3.2 percentage point increase for breast cancer net survival estimates during this time.
Figure 3: Range in 1-year net survival estimates (%) for breast, colorectal and lung cancers, for CCGs in England, 2003 and 2018
Figure 3 displays the minimum, median and maximum net survival estimates for CCGs in 2003 and 2018. For 2018, net survival estimates for breast cancer showed less variation between CCGs than for colorectal and lung cancer. Compared with 2003, the CCG range in net survival estimates has decreased for breast cancer (from a range of 12.0 percentage points in 2003 to 4.5 percentage points in 2018) and colorectal cancer (from 19.4 percentage points in 2003 to 18.3 percentage points in 2018) but increased for lung cancer (from 18.3 percentage points in 2003 to 19.7 percentage points in 2018).
Differences in cancer survival between CCGs may be partially related to differences in the proportion of patients diagnosed at an early stage. For instance, if a CCG has a higher proportion of cancer patients diagnosed at early stages, this will mean they have higher survival rates. More detail on survival rates by stage can be found in the cancer survival in England bulletin.
Interpretation of these statistics
The index of cancer survival – what it is
The index of cancer survival provides a convenient, single number that summarises the overall pattern of cancer survival for each calendar year. It combines the net survival estimates for each sex, age group and:
- breast cancer diagnosed in women
- colorectal cancer
- lung cancer
- all other invasive cancers combined, excluding both prostate and non-melanoma skin cancers
Research of population-based cancer survival trends in England and Wales found that survival for most cancers is either stable or rising steadily year on year. This trend is visible in the index of cancer survival. The index is designed to reflect real progress in cancer outcomes by long-term monitoring of progress in overall cancer survival. It provides a summary measure of cancer survival that takes account of shifts in the pattern of cancers in each geography.
More information on methodology can be found in the quality and methodology information report which also contains important information on:
- the strengths and limitations of the data and how it compares with related data
- uses and users of the data
- how the output was created
- the quality of the output including the accuracy of the data
Net survival
Net survival is an estimate of the probability of survival from the cancer alone excluding other potential causes of death. It is a variant of relative survival that is preferred as a measure of cancer survival in adults because it is an unbiased estimator. Net survival estimates the survival of cancer patients compared with the background mortality that patients would have experienced if they had not been diagnosed with cancer. Further details can be found in the cancer survival QMI.
Points to consider when interpreting these estimates
For geographic areas with small populations, like most CCGs, some fluctuations in survival estimates between consecutive years should be expected, as reported in cancer survival indicators for Clinical Commissioning Groups in England. These fluctuations primarily occur due to the small numbers of cancer diagnoses and deaths each year within the population.
Interpretation should focus on long-term trends, rather than the survival estimate for a particular year. Areas for which the index of cancer survival is consistently lower than average may warrant further investigation.
The aim of this publication is to present data that can support the monitoring of long-term improvements in cancer control. These estimates can indicate the potential for improvement in the management of cancer, from early detection through to referral, investigation, treatment and care. Survival estimates should not be used as the sole indicator of an area’s performance in cancer outcomes. To gain a more complete picture of the cancer burden in a geographical area, these estimates should be used alongside other information available, such as cancer incidence and mortality data.
Data is provided for a 16-year period because the method used requires data over a long period in order to give robust estimates and so that each area has a baseline against which to assess progress over time. Survival is estimated using the most up-to-date boundaries at publication – in 2020, the number of CCGs fell from 191 to 135 and the number of CAs increased from 20 to 21. A CCG, STP or CA is not responsible for trends in cancer survival that pre-date its existence.
These survival estimates are based on patients living within defined CCG boundaries at the point of diagnosis. However, the structure of CCGs means they are responsible for patients registered at primary care (GP) practices within their boundary. This may result in some differences between the patients included in these survival estimates and the patients for which the CCG is responsible. This potential limitation is discussed in the article: Dismantling the signposts to public health? NHS data under the Health and Social Care Act 2012.
The survival estimates must be interpreted with care. They do not reflect the survival prospects for any individual cancer patient; they represent the net survival for all cancer patients in each area, in a given period of time, diagnosed with a specified type of cancer.
Data included in this analysis
The data used in these analyses was extracted from the National Cancer Registration Dataset on 22 July 2020.
All adults (aged 15 to 99 years) who were diagnosed with a first, primary, invasive malignancy (International Classification of Diseases, Tenth Revision (ICD10) C00-C97) were eligible for inclusion. Patients diagnosed with malignancy of the skin (C44) other than melanoma were excluded. Cancer of the prostate (C61) was also excluded from the index because the widespread introduction of prostate-specific antigen (PSA) testing since the early 1990s has led to difficulty in the interpretation of survival trends, as explained in the publication Excess cases of prostate cancer and estimated over diagnosis associated with PSA testing in East Anglia.
Things you need to know about this release
This publication focuses on trends in the index of cancer survival for adults (aged 15 to 99 years). All figures are estimates of net survival. Net survival is the survival of cancer patients compared with the expected survival of the general population. The net survival estimates summarise the trends of cancer survival in an area between 2003 and 2018.
All the survival results and an assessment of the data quality, including details of the number of eligible cases and exclusions, are provided in the index of cancer survival data tables.
These cancer survival estimates are designated as National Statistics, a subset of official statistics. They are assessed by the UK Statistics Authority as being compliant with its Code of Practice for Statistics.
The index is age-sex-site-standardised and combines survival estimates for:
- breast cancer (women only)
- colorectal (bowel) cancer
- lung cancer
- all other invasive cancers; excluding both non-melanoma skin cancer and prostate cancer
The individual trends for breast, colorectal and lung cancer are also presented in this publication. These individual estimates are age-standardised (breast cancer) or age-sex-standardised (colorectal and lung cancers). Age-specific estimates are also provided for the index. Age- and sex-specific estimates are provided for breast, colorectal and lung cancers.
The geographies (as at April 2020) covered by this publication are:
The trends estimated in this publication come from a regression model. The data in the model is from adults diagnosed with cancer between 2003 and 2018. Patients are followed up to 31 December 2019 to see if or when they died in that period. The publication models the trend for each area separately. This means interpretation should focus on overall trends rather than on small changes in the survival index in a particular year.
It was sometimes impossible to produce robust estimates of survival for one or more of the age groups, most often because of the relatively small number of patients diagnosed in the youngest age group (15 to 44 years). In this situation, the missing value for a CCG is replaced by the corresponding value for their ‘parent’ CA or, if that is also missing, the missing value for both the CCG and CA is replaced by the value for England. Similarly, any missing values for STPs are replaced by the value for England. Details of cases where replacements are necessary are available in the data tables.
Links to other related statistics
Other statistics related to cancer are available in:
- cancer survival in England provides national estimates of adult cancer survival for 31 cancer sites, including survival by stage at diagnosis where possible, geographic patterns of cancer survival and cancer survival for children
- cancer registration statistics, England provides the number of cancer diagnoses and age-standardised registration rate for all cancer sites
- conditional crude probabilities of death in England, provides probabilities of death, split by cancer and non-cancer causes for adult cancer patients in England
- information on the contents and uses of all the cancer publications in the article Cancer statistics explained: different data sources and when they should be used
The issue of comparability of cancer survival statistics across the UK has been discussed at the UK and Ireland Association of Cancer Registries (UKIACR) Executive Board, and a consensus has been made to use the International Cancer Survival Standard (ICSS) weights in cancer survival analysis (as well as the same exclusions in data) in England, Scotland, Wales, Northern Ireland and the Republic of Ireland, so that results are comparable across all countries in the UK and Ireland. Statistics on cancer around the UK are produced in:
- Scotland by the Scottish Cancer Registry and Intelligence Service
- Wales by the Welsh Cancer Intelligence and Surveillance Unit
- Northern Ireland by the Northern Ireland Cancer Registry
Authors
Responsible statisticians: Roger Hill and Marta Emmett.
Production team: John Broggio, Marta Emmett, Sophie Finnigan, Thomas Higgins, Roger Hill, Ann Saxton, Kwok Wong, Dian Xu.
For queries relating to this bulletin contact ncrasenquiries@phe.gov.uk
Acknowledgements
Data for this work is based on patient-level information collected by the NHS, as part of the care and support of cancer patients. The data is collated, maintained and quality assured by the National Cancer Registration and Analysis Service, PHE.