Journal of cancer policy · 2026
Country-level right-to-health and health-system indicators and five-year net survival from adult brain tumours: An ecological analysis using CONCORD-3 data.
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Lawson McLean Aaron, Kahr Julian, Kamp Marcel A, Neumeister Anne, Senft Christian
Аннотация
BACKGROUND: Country-level right-to-health and health-system indicators, mapped to availability, accessibility, acceptability and quality (AAAQ) domains, are used to evaluate equitable cancer outcomes, but their disease-specific validity is uncertain. Adult brain tumours are a stringent test case: no validated screening exists, glioblastoma drives much brain-tumour mortality, and survival depends on neurosurgical and radiotherapy access, neuropathology and molecular classification.
METHODS: Ecological analysis of five-year net survival from CONCORD-3 (adult C71 brain tumours, diagnosed 2010-14) and histology-resolved secondary outcomes (glioblastoma, diffuse and anaplastic astrocytoma, oligodendroglioma). Exposures were 14 country-level right-to-health, AAAQ-mapped, health-system and macroeconomic indicators (10 continuous, 4 binary). Pearson and Spearman correlations used bootstrap 95% confidence intervals and, per continuous non-GDP indicator, ordinary least-squares regression adjusted for log-GDP per capita (HC3 standard errors). Significance used analytic p values with Benjamini-Hochberg false-discovery-rate (FDR) correction across the full family (96 tests). Sensitivity analyses used high-income and European subsets and income-group adjustment.
RESULTS: Of 68 countries, 57 had adult brain survival data and 43 entered the primary analysis after excluding less reliable estimates. No association survived FDR correction at either level (smallest within-outcome q = 0.36; smallest full-family q = 0.59); the largest correlations were morphine consumption (r = +0.28, 95% CI +0.01 to +0.53), GDP per capita (+0.26, -0.03 to +0.54) and current health expenditure per capita (+0.23, -0.12 to +0.53). After log-GDP adjustment, no non-GDP indicator retained a significant association.
CONCLUSION: Generic country-level AAAQ-mapped indicators did not capture neuro-oncology pathway performance and showed no FDR-robust association with adult brain tumour survival; disease-specific pathway indicators are likely required.
POLICY SUMMARY: Policy frameworks relying on macro-indicators may misallocate accountability for brain tumour outcomes. Harmonised neuro-oncology pathway indicators (time to imaging and resection, completeness of molecular diagnosis, fidelity of evidence-based chemoradiation, neuro-palliative care integration) should be considered for international cancer-system and right-to-health monitoring.
METHODS: Ecological analysis of five-year net survival from CONCORD-3 (adult C71 brain tumours, diagnosed 2010-14) and histology-resolved secondary outcomes (glioblastoma, diffuse and anaplastic astrocytoma, oligodendroglioma). Exposures were 14 country-level right-to-health, AAAQ-mapped, health-system and macroeconomic indicators (10 continuous, 4 binary). Pearson and Spearman correlations used bootstrap 95% confidence intervals and, per continuous non-GDP indicator, ordinary least-squares regression adjusted for log-GDP per capita (HC3 standard errors). Significance used analytic p values with Benjamini-Hochberg false-discovery-rate (FDR) correction across the full family (96 tests). Sensitivity analyses used high-income and European subsets and income-group adjustment.
RESULTS: Of 68 countries, 57 had adult brain survival data and 43 entered the primary analysis after excluding less reliable estimates. No association survived FDR correction at either level (smallest within-outcome q = 0.36; smallest full-family q = 0.59); the largest correlations were morphine consumption (r = +0.28, 95% CI +0.01 to +0.53), GDP per capita (+0.26, -0.03 to +0.54) and current health expenditure per capita (+0.23, -0.12 to +0.53). After log-GDP adjustment, no non-GDP indicator retained a significant association.
CONCLUSION: Generic country-level AAAQ-mapped indicators did not capture neuro-oncology pathway performance and showed no FDR-robust association with adult brain tumour survival; disease-specific pathway indicators are likely required.
POLICY SUMMARY: Policy frameworks relying on macro-indicators may misallocate accountability for brain tumour outcomes. Harmonised neuro-oncology pathway indicators (time to imaging and resection, completeness of molecular diagnosis, fidelity of evidence-based chemoradiation, neuro-palliative care integration) should be considered for international cancer-system and right-to-health monitoring.