ICBP Research Publications

This paper provides a good summary of the reasons why the ICBP was established in 2009, the structure of the partnership and early findings. International research collaborations can be complex, and a consideration of the benefits and difficulties of these kinds of partnerships is also discussed.

Read more about the Partnership in the Health Policy journal

The ICBP: An international collaboration to inform policy (2013)

Colon and Rectal Cancer Survival (2010-2014)

This study aimed to provide the most recent estimates of colon and rectal cancer survival across the ICBP countries by age and stage at diagnosis

Liver Cancer Incidence and Survival

This study reports trends in liver cancer subtypes survival and incidence across the ICBP countries and to understand variations in coding practises

Oesophageal Trends (1995-2014)

This study aimed to provide an overview of oesophageal cancer survival by histological subtype across the ICBP countries

Oesophageal and Gastric Trends (2012-2014)

This study aimed to provide international comparisons of oseophageal and gastric cancer survival by stage at diagnosis and histological subtype across the ICBP countries

Reclassifying small-cell and non-small cell lung cancers

This study explored  how variations in small-cell and non-small cell lung cancer may influence international differences in survival across the ICBP countries

Lung Trends (2010-2014)

This study reports on international trends in lung cancer incidence and survival for the two main histological subtypes (non-small cell and small cell). It investigates sub-type specific survival differences by country, age group and sex.

Oseo-gastric and Pancreatic Staging Conversion Algorithm

In this study, the researchers present the development of an internationally validated TMN to SEER staging algorithm for oesophageal, gastric and pancreatic cancers.

CanStaging+ Tool

In this study, researchers describe the first internationally validated, open-source Cancer staging tool. Based on International Cancer Benchmarking Partnership data, CanStaging+ addresses unmet needs in staging accuracy, completeness and comparability. The tool can be visited at https://canstaging.org/tool

Leadership

This study explores how international caner survival might be influenced by the role of leadership in systems providing cancer care.

Immortals 

In this study, the authors outline a methodology to explore the presence of ‘immortals’ - wrongly assumed long-term survivors on the cancer registry database , whose deaths have been missed - that can be utilised by cancer registries for a preliminary check to detect whether a significant proportion of missed deaths (e.g. failure of matching and/or tracking) 
 
Registry Lessons Learned 

Based on experiences in the ICBP, IARC researchers outline five recommendations to improve the completeness and accuracy of cancer registry data including using multiple sources, inputting more patient details, and having more stringent tracking of death information 
 

Pancreatic Stage and Age

By comparing the stage distribution of patients diagnosed with pancreatic cancer between 2012-2014 , the role of stage at diagnosis in international cancer survival differences can be explored.

Ovarian Cancer Time Intervals

Compares ovarian cancer patient characteristics and routes to diagnosis via survey of cancer patients, their primary care practitioners and cancer treatment specialists 

Referral Pathways

This study has generated novel insight into the structure and organisation of primary care referral pathways for the management of suspected cancer across the ICBP countries.

This study compares emergency presentations internationally using linked cancer registry and hospital admission data and shows that international variation in the proportion of emergency presentations is a possible contributor to international variation in colon, stomach, liver, lung, ovarian and pancreatic cancer survivals. Comparisons between jurisdictions are limited to those within the same definition bracket.

Please follow this link to hear from Georgios Lyratzopoulos, lead co-author, at a Lancet Oncology podcast.

Chemotherapy use and radiotherapy use and time to start treatment were explored for over 780,000 patients who were diagnosed with oesophageal, colon, rectal, lung, liver, pancreatic, ovarian or stomach cancer in 2012-2017, across 4 countries (Australia, Canada, Norway and the UK). Linked data from cancer registries and hospital records was used to establish the proportion of patients who receive chemotherapy and radiotherapy. The study found that there were large international differences observed in the use of both chemotherapy and radiotherapy for all eight types of cancer.

This is the first study to systematically compare the evolution (1995-2014) of cancer policies across high-income countries to develop an index of cancer policy consistency over time. This index was linked to previous ICBP survival data from the same period for relatively common cancers (lung, colon, rectum) and those that are hard to treat (ovarian, pancreas, stomach, and oesophagus) 

Core:

Data from population-based cancer registries was used to estimate 1-year and 5-year cancer survival for breast, colorectal, lung and ovarian cancer patients diagnosed between 1995 and 2007. Relative survival improved in all studied ICBP jurisdictions during this time, but survival outcomes varied.

Benchmarking cancer survival 1995-2007 (2011)

Differences in how a cancer’s stage is recorded means it can be difficult to compare internationally. Stage information for studied cancer types was mapped into ‘localised, regional and distant’ categories to allow for data to be compared.

Comparability of ICBP stage data (2012)

By comparing the stage distribution of patients diagnosed with ovarian cancer between 2004 and 2007, the role of stage at diagnosis in international cancer survival differences can be explored.

Ovarian cancer survival and stage at diagnosis (2012)

By comparing the stage distribution of patients diagnosed with breast cancer between 2000 and 2007, the role of stage at diagnosis in international cancer survival differences can be explored.

Breast cancer survival and stage at diagnosis (2013)

By comparing the stage distribution of patients diagnosed with colon or rectal cancer between 2000 and 2007, the role of stage at diagnosis in international cancer survival differences can be explored.

Colorectal cancer survival and stage at diagnosis (2013)

By comparing the stage distribution of patients diagnosed with lung cancer between 2004 and 2007, the role of stage at diagnosis in international cancer survival differences can be explored.

Lung cancer survival and stage at diagnosis (2013)

Additional:

Following from previous ICBP research into ovarian cancer survival in Manitoba, local researchers explored the features of these types of cancer over a 20 year period, and assessed the most recent data available.

Ovarian cancer in Manitoba between 1992-2011 (2017)

Core:

In similar health systems, differences in cancer survival may be down to the attitudes and awareness of the general population. This research shows that across participating jurisdictions, awareness and beliefs are similar, but people report different reasons for not going to their doctor with worrying symptoms.
International variation in awareness and beliefs about cancer (2014)

To see if international variation in cancer survival could be explained by different beliefs and awareness about cancer in the general population, a telephone survey was carried out in people over 50 years of age.

The Awareness and Beliefs about Cancer tool (2013)

Additional:

Many cancer patients report not going to a doctor because they did not realise a symptom was 'suspicious'. The authors examined how long members of the population would report waiting to visit a doctor if they had specific symptoms, and if they were associated with low awareness of these symptoms as indicative of cancer.
Recognition of cancer warning signs in adult UK population (2013)

Awareness and recognition of symptoms of ovarian cancer were explored in the general population. Lower awareness of these symptoms was reported when the symptoms related to eating difficulties and changes in bladder or bowel habits.
Ovarian cancer symptom awareness (2014)

This study reports on the responses of the ABC survey from around 2,000 participants in New South Wales. The authors report misunderstanding about the use of screening tests for bowel cancer, with many respondents incorrectly believing screening should only occur when experiencing symptoms.

Beliefs about bowel cancer screening in New South Wales (2014)

The ABC survey responses from around 3,000 members of the Danish general population was assessed. The authors report finding a strong socioeconomic gradient in cancer awareness, suggesting targeting and tailoring of public health messages to this group.
Danish cancer awareness (2014)

Respondents in Denmark were most likely to report ‘worry about what the doctor might find’ and ‘worry about wasting the doctor’s time’ as reasons for not going to see their doctor. The authors found having a lower socioeconomic background was associated with negative cancer beliefs.
Barriers to healthcare seeking in Denmark (2014)

Cancer outcomes in Denmark and Sweden were shown to be different in the original ICBP cancer survival benchmark, yet the neighbouring countries have similar healthcare systems, economies and culture. The study supports previous findings of modest public awareness to many established cancer risk factors.
Awareness of risk factors in Denmark and Sweden (2014)

There are differences in cancer survival outcomes between Sweden and Denmark, with Sweden having higher survival for breast, colorectal and lung cancers. The authors report a higher symptom awareness and shorter anticipated delay in Denmark, which does not explain survival differences between jurisdictions.
Awareness of symptoms in Denmark and Sweden (2015)

The responses from members of the general public surveyed with the ABC tool were compared for Denmark, Sweden, Norway and Northern Ireland. The authors in particular wanted to understand awareness of risk factors and symptoms of malignant melanoma. They report low awareness of ‘sunburn in childhood’ as a risk factor and differences across jurisdictions in awareness.
Awareness of sunburn in childhood, sunbed use and change of moles (2015)

An analysis of the almost 7,000 respondents in participating UK nations (England, Wales and Northern Ireland) showed that smokers held more pessimistic beliefs about cancer. This is important as it means people who smoke may be less likely to go to their doctor when they have symptoms.

Effect of smoking on beliefs about cancer in the UK (2015)

Socioeconomic differences in positive and negative attitudes towards cancer were compared in respondents from England, Wales and Northern Ireland. There was strong agreement across all respondents towards the positively framed statements in the survey, but differences across socioeconomic groups in the negatively framed statements.

Socioeconomic inequalities and attitudes towards cancer in the UK (2015)

The Awareness and Beliefs about Cancer measure has been translated into several languages, including Danish. The authors report validity testing exercises and analyses carried out to confirm the Danish ABC is accepted and understood by the target audience – the Danish general population.
Measurement properties of Danish ABC measure (2017)

The authors compared the relationship between reported barriers to attending primary care and anticipated help seeking (how long respondents said they would wait before going to visit their doctor) for ICBP cancer types. They found that respondents associated barriers to a longer wait to visit their doctor, meaning more work should be done to understand why people put off going to their doctor.
Perceived barriers to clinical presentation (2017)

Responses from the general population in Denmark who participated in the original study were compared based on whether they, or someone close, had been diagnosed with cancer, or not at all. The authors suggest that cancer beliefs are impacted by a person’s experience of cancer and negative beliefs should be addressed and reframed within populations.
Cancer beliefs in cancer survivors, relatives and people with no experience of cancer (2017)

Core:

In order to assess how comparable ICBP healthcare systems are, the authors compared several characteristics of the participating jurisdictions. They found many similarities but also differences in centralisation, patient movement, access to secondary care and list systems.
How might healthcare systems influence speed of diagnosis (2014)

In order to explore differences in the readiness of primary care physicians (PCPs) to investigate for cancer, an online survey was developed. The survey asks a set of direct questions about the health system the PCP operates in, as well as five clinical scenarios asking how they would manage the patient.
Development of survey instrument to investigate primary care (2014)

Almost 2,800 primary care physicians (PCPs) took part in an online survey to understand how they would manage patients presenting with symptoms (if they would investigate or refer). These responses were then compared to 1- and 5-year survival across jurisdictions and studied ICBP cancer type.
Role of the primary care context in cancer survival (2015)

Additional:

When surveys were sent to primary care physicians in New South Wales, Australia, different incentives were given in order to increase the response rate. The local team then analysed the impact of the different incentives on the response rate, and recommend which is the most cost-effective.
Unconditional vs conditional incentives and survey response rates in NSW (2014)

This paper explores whether cancer guidelines and adherence to them by primary care practitioners (PCPs) differs between participating jurisdictions. The authors also explore if the guidelines impact on how likely the PCP is to act on presenting cancer-related symptoms.

Variation in international adherence to referral guidelines (2016)

Primary care physicians in Manitoba, Ontario and British Columbia (Canada) all took part in this research, and so the local team compared their responses to the survey. The explore differences in access to diagnostic tests and wait times for results across provinces.
Primary care access to and wait times for cancer diagnostics (2016)

The core survey was also carried out by primary care practitioners in New Zealand, to understand the context in which these doctors work, their access to tests, and how they would respond to patients presenting with symptoms.
Investigations and referral in primary care in New Zealand (2017)

Core:

To understand how patients move through their cancer journey, internationally validated surveys were sent to recently diagnosed breast, colorectal, lung and ovarian cancer patients and their doctors. The surveys asked questions about when symptoms were first noticed, which tests patients received and when.
Methods for an international investigation of routes to cancer diagnosis (2016)

Additional:

The surveys used in previous research exploring the patient’s cancer journey included free text questions These questions invited patients to describe their experience of being diagnosed with cancer within their health system, in this case Wales.
Patient perspectives on delays in diagnosis and treatment of cancer in Wales (2016)

Core:

It is thought that patients who die shortly after a cancer diagnosis may be more likely to be living with one or more health conditions (comorbidities) which could affect their chances of surviving. This is the first study to try to make international comparisons of commonly used measures of comorbidity derived from routine, population-based administrative health datasets for lung cancer patients.

Comorbidity measures from routine health datasets (2017)

This ICBP study found that in the incidence of colon and rectal cancer in adults younger than 50 years has increased substantially over the latest available 10-year period in several high-income countries, going against a decline or stabilisation trend in the incidence of colorectal cancers within the overall populations of high-income countries.

Changes in colorectal cancer incidence in seven high-income countries: a population-based study (2019)

This is the flagship study of ICBP Phase 2 research, providing a comprehensive overview of cancer survival across ICBP countries and a comparative assessment of the corresponding incidence and mortality trends.

Cancer survival, incidence and mortality benchmark 1995-2014 (2019)

This study examined colon and rectal cancer survival by age and stage at diagnosis across the ICBP countries, to dissect the potential role of early detection and treatment in survival differences.

Colon and rectal cancer survival by age and stage (2020)

This study explored ovarian cancer survival differences by age and stage at diagnosis across the ICBP countries.

Ovarian cancer survival by age and stage (2020)

This paper reports trends in oesophageal cancer incidence and survival for the two main histological subtypes (adenocarcinoma and squamous cell carcinoma). It investigates sub-type specific survival differences by period of diagnosis, country, age group and sex.

Oesophageal cancer survival analysis – histological subtype (2020)

This study aimed to understand the role of stage at diagnosis in the observed age disparities in colon cancer survival across the ICBP countries (for people aged 50-99 years).

Age disparities in colon cancer survival

These studies explore whether differences in cancer registry practices between the ICBP countries play a role in the observed international variation in cancer survival. The study team investigated the impact of including or excluding death certificate-initiated cancer cases (DCI); the role of cancer registry completeness in cancer survival estimates; and the impact of using different definitions of date of cancer incidence.

Definitions of date of cancer incidence (2020)

Cancer registry completeness (2020)

This study involved a comparison of clinical practice guidelines, and an exploration of patterns of care relating to the treatment of ovarian cancer patients. This was in order to provide further understanding of what may be driving the international differences seen in survival, particularly in women aged 65-74 years.

Differences in ovarian cancer treatment (2020)

This paper explores differences in the provision of PET-CT services across ICBP countries, to gain an insight into the variation of a key diagnostic and staging tool.

International variation in PET-CT service provision (2020)

This study explored key stakeholder perceptions of the role of health system capacity necessary for cancer care, that may be influencing cancer survival across the ICBP countries.

Role of health service capacity

This study developed a conceptual logic model to highlight the complex interactions of health system factors along the cancer patient pathway. This can be used as a tool for health systems to identify where to focus efforts and system improvements.

Understanding the link between health systems and cancer survival

This ICBP worked with their network of cancer surgeons to develop key recommendations for cancer surgery specifically, to reduce the impacts of COVID-19.

New approaches to cancer care in a COVID-19 world