Trends over 48 years in a one-number index of survival for all cancers combined, England and Wales (1971–2018): a population-based registry study

Background: Trends in cancer survival are a key indicator of progress in the effectiveness of the health system in managing cancer. We aimed to provide long-term trends in a one-number index of survival for all cancers combined, to support national cancer policy. Methods: We examined long-term trends in a one-number index of net survival (Cancer Survival Index) for all cancers combined in adults in England and Wales. Net survival includes all cancer patients, regardless of whether cancer was the cause of their death. We estimated net survival up to 10 years after diagnosis for 10,769,854 adults diagnosed with a first, primary, invasive cancer during 1971–2018 and followed up to 2019, using anonymised individual records from the National Disease Registration Service for England and the Welsh Cancer Intelligence and Surveillance Unit. We examined trends in the Cancer Survival Index (CSI) at one, five, seven and 10 years after diagnosis, using the entire data set. We present results for selected periods: 1971–72, 1980–81, 1990–91, 2000–01, 2005–06, 2010–11 and 2018. Findings: During the 48 years 1971–2018, the CSI for England and Wales rose substantially, at all intervals up to 10 years after diagnosis. For patients diagnosed in 1971–72, the CSI was 46.5% at 1 year after diagnosis. For patients diagnosed in 2018, the index is 49.8% at 10 years after diagnosis. The CSI has remained about 10% higher for women than men since the early 1970s. The speed of improvement has slowed down: between 2000–01 and 2005–06, the 10-year CSI rose by 4.0%. Ten years later, the increase between 2010–11 and 2015–16 was only 1.4%. Interpretation: The slow-down since 2010 of long-term trends in the CSI for all cancers combined in England and Wales is likely to be at least partly explained by longer waits for diagnosis and treatment. A long-term national cancer plan to bring cancer survival trends back towards the best in the world is essential. Funding: Cancer Research UK.