OBJECTIVES: To undertake a pragmatic, comparative analysis of cancer care pathways to identify drivers of improving cancer survival across Europe, using colon cancer as a case study. METHODS: We conducted a review of data from international, European and UK cancer databases and registries, focusing on the identification of variations in overall and colon cancer care and survival. Additionally, we investigated variation in national access to, as well as utilisation and speed of adoption of, biologic cancer treatments, a recognised source of improving cancer outcomes worldwide. RESULTS: Overall, outcomes for many tumour types continue to improve across Europe, including in regions with historically low survival such as Eastern Europe. Data on general cancer treatment reveal that the rate of innovative drug use in the UK has increased since 2009, just prior to the establishing of the Cancer Drugs Fund (CDF). Since the advent of the CDF, the UK has risen internationally from 11^th place to 7^th in terms of cancer survival rate; however, this improvement still leaves the UK as one of the lowest ranked European countries. Patients with colon cancer are ~20% less likely to receive biologics than those in other European countries; this may explain the results of other studies showing that survival rates in the UK continue to lag behind those in central Europe in the CDF/biologics era. CONCLUSIONS: Although survival rates continue to improve, there remain geographical disparities in some cancer types despite major advances in care pathways and treatment. The UK in particular continues to lag behind other countries. The CDF provides a vital service, giving patients access to innovative, life-extending treatments. The threat of losing this access route has serious implications for UK cancer treatment, which is already among the least successful in Europe.