Cancer mortality in Greece during the financial crisis

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).

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).

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 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 ≥ 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 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.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.