Trends in cancer patient survival in Estonia before and after the transition from a Soviet republic to an open-market economy.

Cancer patients' survival is strongly dependent on socioeconomic factors, including access to and quality of medical care. During the past decade, Estonia has undergone a major political and economic change from a Soviet republic to an open-market economy country, and the health care system was transformed from a centralised state-controlled system into a decentralised health insurance-based one. Using data from the population-based Estonian Cancer Registry, we assessed trends in cancer patient survival before and after this transition by application of period analysis, a new method of survival analysis, which allows more timely disclosure of time trends than traditional survival analysis. Our study included 83,138 patients diagnosed with 1 of the 11 most frequent malignancies in Estonia from 1969-1998. Patients were followed up to the end of 1998. Despite a moderate increase in 5- and 10-year relative survival over time, prognosis for many common forms of cancer, such as stomach, colorectal, breast and ovarian cancer, remained considerably worse than the survival rates achieved in more affluent European countries many years ago. By contrast, a very steep increase in survival rates was observed for common urologic cancers, including prostate, kidney and bladder cancer, which went along with a rise in incidence rates of these cancers over time. For prostate cancer, similar survival rates as in other European countries have now been achieved. The most likely explanation for these trends is enhanced availability and utilization of laboratory and technical diagnostic equipment. Despite recent improvement, major efforts in delivering modern cancer care to the population of Estonia will be required to close the gap that continues to exist between prognosis of cancer patients in this country and other European countries.