A groundbreaking study published in the British Journal of Cancer Reports, part of the Nature portfolio, has laid bare persistent disparities in survival rates for blood cancers across the United Kingdom from 2009 to 2019. Led by researchers from leading institutions including the University of Leeds and Queen Mary University of London, the analysis draws on vast national cancer registries to highlight how factors like age, sex, ethnicity, socioeconomic deprivation, and even rurality influence outcomes for patients with haematological malignancies—cancers originating in the blood, bone marrow, or lymph nodes.
Blood cancers, encompassing conditions such as leukaemia, lymphoma, myeloma, and myelodysplastic syndromes, affect over 40,000 people annually in the UK, making them the fifth most common cancer type. Despite advances in treatments like targeted therapies and immunotherapies, five-year net survival rates hover around 60-65%, lagging behind many comparable nations. This research, titled "Disparities in blood cancer survival in the UK 2009–2019: national cohort studies," provides the most comprehensive UK-wide breakdown to date, stratified by 25 HAEMACARE diagnostic groupings.
Understanding Blood Cancers: A Heterogeneous Group of Diseases
Haematological malignancies (blood cancers) are not a single disease but a diverse family. Acute myeloid leukaemia (AML) arises rapidly in myeloid cells, while chronic lymphocytic leukaemia (CLL) progresses slowly. Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) affect lymphoid tissues, plasma cell neoplasms like multiple myeloma target antibody-producing cells, and myeloproliferative neoplasms (MPN) involve overproduction of blood cells. Myelodysplastic syndromes (MDS) feature ineffective blood cell production.
The study's data sources—England's National Cancer Dataset Repository (NCDR), Scotland's Scottish Cancer Registry (SMR), Northern Ireland's Northern Ireland Cancer Registry (NCRAS), and Wales' Welsh Cancer Intelligence and Surveillance Unit (WCISU)—cover nearly complete populations, enabling robust net survival estimates that account for other causes of death. Researchers compared two periods: 2009-2014 and 2015-2019, revealing modest but uneven progress.
Overall Survival Trends: Modest Gains Amid Stagnation
Five-year age-standardised net survival for all blood cancers combined stood at 62.3% in England, 63.6% in Northern Ireland, 65.0% in Scotland, and 60.2% in Wales. One-year survival ranged from 76.8% (Wales) to 82.3% (Scotland), dropping to 51-52% at ten years in England, NI, and Scotland. Hodgkin lymphoma with nodular lymphocyte predominance boasted near-95% five-year survival, while AML languished at around 22-23%.
Improvements were statistically significant for all blood cancers in England (+3.8%), Northern Ireland (+5.1%), and Wales (+3%), but not Scotland. Plasma cell neoplasms saw gains of 5-10% across nations, NHL 3-14%, and mantle cell lymphoma/HL over 7% in some areas. AML, MDS, and acute lymphoblastic leukaemia (ALL) showed little change, underscoring subtype-specific challenges.
| Nation | All Blood Cancers 5-yr Survival (2015-19) | Improvement 2009-14 to 2015-19 |
|---|---|---|
| England | 62.3% | +3.8% |
| Northern Ireland | 63.6% | +5.1% |
| Scotland | 65.0% | NS |
| Wales | 60.2% | +3.0% |
Age: The Steepest Gradient
Age exerts the strongest influence, with survival plummeting as patients age. For AML, five-year survival drops from ~65% in 15-44 year-olds to ~12% in 65-74 in Northern Ireland. Similar patterns hold for ALL, myeloid malignancies, classical HL, lymphoid malignancies, and diffuse large B-cell lymphoma (DLBCL). Younger patients (15-44) often access intensive therapies unavailable to older ones due to comorbidities or frailty.
- AML: 59% difference between youngest and 65-74 groups (Scotland)
- HL: Up to 59% gap
- MDS: Dramatic declines post-65
Sex Disparities: Men Lag Behind
Men consistently fare worse, with ≥3% lower five-year survival in 15 HAEMACARE groups in England. Largest gaps in MDS (10%), MPN (9.2%), myeloid malignancies (8.3%), mantle cell lymphomas (6.2%). This holds across nations for MPN and myeloid malignancies, possibly due to diagnostic delays, lifestyle factors, or biological differences.
Photo by Andrea De Santis on Unsplash
Ethnicity: Unexpected Patterns in England
Counterintuitively, white patients had ≥3% lower survival than non-white groups in MDS, myeloid malignancies, plasma cell neoplasms, and MPN. Mixed ethnicity showed 5.4% higher survival overall; Asians and Black patients outperformed whites in several subtypes. Data limitations (England-only ethnicity recording) preclude UK-wide comparisons, but highlights need for equitable access.Read the full study here.
Socioeconomic Deprivation: A Clear Gradient
Higher deprivation correlates with poorer outcomes. Least deprived (quintile 5) vs. most deprived (quintile 1): England 65.2% vs. 58.0%; NI 68.4% vs. 58.8%; Scotland 68.7% vs. 62.3%; Wales 65.6% vs. 54.9%. Gaps ≥7% in MBN, DLBCL, lymphoid malignancies. Least deprived survival ~1.1x higher, linked to delayed diagnosis, access barriers, comorbidities.
Rurality: Wales Exception
No rural-urban differences in NI/Scotland. In Wales, rural residents had ≥3% higher survival for several groups, including all blood cancers, lymphoid/myeloid malignancies, plasma cell neoplasms, HL, MBN, AML. Possible factors: lifestyle, access to specialized care, or data quirks.
UK Lags International Peers
UK five-year survival trails Australia, Canada, Sweden (e.g., myeloid cancers <50% vs. 60% elsewhere). Blood Cancer UK's 2024 analysis estimated 940,000 life-years lost 2009-2019 due to suboptimal outcomes. If England matched top quintile survival, 6,500 extra lives saved.
Reasons: fragmented data, underfunding (blood cancers 5% research spend despite 7% deaths), diagnostic delays.
UK Universities Driving Change
The study exemplifies collaborative academic prowess: University of Leeds' Cancer Division led analysis; Queen Mary University of London's Prof. Julia Hippisley-Cox contributed epidemiological expertise; Oxford's Nuffield Department involved in prior QResearch work. Public Health Wales teams supported Welsh data. These institutions pioneer registries, trials (e.g., NCRI trials), genomics (100,000 Genomes Project).
Photo by Toa Heftiba on Unsplash
Leeds' Haematological Malignancy Diagnostic Service (world-leading) aids rapid classification. Oxford's Big Data Institute models risks. QMUL focuses primary care-cancer interfaces. Careers in oncology research booming, with postdocs, lecturers sought.University of Leeds news on the study.
Implications and Solutions
Findings inform Blood Cancer UK's Action Plan: standardize data, report blood cancers separately, NHS Outcomes Framework integration. Solutions: accelerated diagnostics (e.g., DEXUS), equitable trials access, deprivation-targeted screening. Universities key: train specialists, trial hubs (CRUK Centres), AI prognostics.
- Enhance registries for stage/treatment data
- Targeted interventions for deprived/male/older patients
- Boost research funding (UK 0.08% GDP vs. 0.6% needed)
Future Outlook: Hope Through Research
Promising: CAR-T therapies, bispecifics double myeloma survival; venetoclax transforms CLL. Trials like LAVA, FALCON at Leeds/Oxford. With equitable implementation, disparities could narrow by 2030. UK academia poised to lead, fostering PhD/postdoc talent in haematology.
This study underscores academia's role in health equity, urging policymakers to invest in university-led research for better outcomes.
