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Showing content from https://pubmed.ncbi.nlm.nih.gov/20937991/ below:

Improved estimates of cancer-specific survival rates from population-based data

. 2010 Oct 20;102(20):1584-98. doi: 10.1093/jnci/djq366. Epub 2010 Oct 11. Improved estimates of cancer-specific survival rates from population-based data

Affiliations

Affiliation

¹ Data Analysis and Interpretation Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6116 Executive Blvd, Ste 504, Bethesda, MD 20892-8315, USA. howladern@mail.nih.gov

PMID: 20937991
PMCID: PMC2957430
DOI: 10.1093/jnci/djq366

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Improved estimates of cancer-specific survival rates from population-based data

Nadia Howlader et al. J Natl Cancer Inst. 2010.

. 2010 Oct 20;102(20):1584-98. doi: 10.1093/jnci/djq366. Epub 2010 Oct 11. Affiliation

¹ Data Analysis and Interpretation Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6116 Executive Blvd, Ste 504, Bethesda, MD 20892-8315, USA. howladern@mail.nih.gov

PMID: 20937991
PMCID: PMC2957430
DOI: 10.1093/jnci/djq366

Item in Clipboard

Abstract

Background: Accurate estimates of cancer survival are important for assessing optimal patient care and prognosis. Evaluation of these estimates via relative survival (a ratio of observed and expected survival rates) requires a population life table that is matched to the cancer population by age, sex, race and/or ethnicity, socioeconomic status, and ideally risk factors for the cancer under examination. Because life tables for all subgroups in a study may be unavailable, we investigated whether cause-specific survival could be used as an alternative for relative survival.

Methods: We used data from the Surveillance, Epidemiology, and End Results Program for 2,330,905 cancer patients from January 1, 1992, through December 31, 2004. We defined cancer-specific deaths according to the following variables: cause of death, only one tumor or the first of multiple tumors, site of the original cancer diagnosis, and comorbidities. Estimates of relative survival and cause-specific survival that were derived by use of an actuarial method were compared.

Results: Among breast cancer patients who were white, black, or of Asian or Pacific Islander descent and who were older than 65 years, estimates of 5-year relative survival (107.5%, 106.6%, and 103.0%, respectively) were higher than estimates of 5-year cause-specific survival (98.6%, 95% confidence interval [CI] = 98.4% to 98.8%; 97.4%, 95% CI = 96.2% to 98.2%; and 99.2%, 95% CI = 98.4%, 99.6%, respectively). Relative survival methods likely underestimated rates for cancers of the oral cavity and pharynx (eg, for white cancer patients aged ≥65 years, relative survival = 54.2%, 95% CI = 53.1% to 55.3%, and cause-specific survival = 60.1%, 95% CI = 59.1% to 60.9%) and the lung and bronchus (eg, for black cancer patients aged ≥65 years, relative survival = 10.5%, 95% CI = 9.9% to 11.2%, and cause-specific survival = 11.9%, 95% CI = 11.2 % to 12.6%), largely because of mismatches between the population with these diseases and the population used to derive the life table. Socioeconomic differences between groups with low and high status in relative survival estimates appeared to be inflated (eg, corpus and uterus socioeconomic status gradient was 13.3% by relative survival methods and 8.8% by cause-specific survival methods).

Conclusion: Although accuracy of the cause of death on a death certificate can be problematic for cause-specific survival estimates, cause-specific survival methods may be an alternative to relative survival methods when suitable life tables are not available.

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Figures
Figure 1

Five-year cause-specific survival vs relative…

Figure 1

Five-year cause-specific survival vs relative survival for 100 cancer sites by age at…

Figure 1

Five-year cause-specific survival vs relative survival for 100 cancer sites by age at diagnosis. A) Age at diagnosis of 50–64 years. B) Age at diagnosis of 65 years or older. The data source was 13 registries from the Surveillance, Epidemiology, and End Results Program. Patient diagnosed between 1992 and 2004 and followed through 2005. Red dots = cancer sites for which the difference between cause-specific survival and relative survival is greater than 3 percentage points and the 95% confidence intervals do not overlap; black dots = cancer sites for which the difference between cause-specific survival and relative survival is less than 3 percentage points and the 95% confidence intervals overlap.

Figure 2

Five-year non–Hodgkin lymphoma cancer survival…

Figure 2

Five-year non–Hodgkin lymphoma cancer survival by age at diagnosis, 1992–2004. Red line =…

Figure 2

Five-year non–Hodgkin lymphoma cancer survival by age at diagnosis, 1992–2004. Red line = relative survival; blue line = cause-specific survival with non–Hodgkin lymphoma deaths; green line = cause-specific survival with cancer and AIDS death; brown line = cause-specific survival with all malignant cancer deaths.

Figure 3

Five-year cause-specific survival probabilities for…

Figure 3

Five-year cause-specific survival probabilities for selected cancer sites by race and ethnicity. Data…

Figure 3

Five-year cause-specific survival probabilities for selected cancer sites by race and ethnicity. Data source is Surveillance, Epidemiology, and End Results (SEER-13, 1992–2004). A) Female breast cancer. B) Prostate cancer. C) Colon and rectum cancer (men and women). D) Lung and bronchus (men and women). Note that the y-axis in panel D is different from those in panels A, B, or C. Means (dots) and 95% confidence intervals (error bars) of the estimates are shown.