Abstract
BackgroundInformation on the underlying cause of death of cancer patients is of interest because it can be used to estimate net survival. The population-based Geneva Cancer Registry is unique because registrars are able to review the official cause of death. This study aims to describe the difference between the official and revised cause-of-death variables and the impact on cancer survival estimates.MethodsThe recording process for each cause of death variable is summarised. We describe the differences between the two cause-of-death variables for the 5,065 deceased patients out of the 10,534 women diagnosed with breast cancer between 1970 and 2009. The Kappa statistic and logistic regression are applied to evaluate the degree of concordance. The impact of discordance on cause-specific survival is examined using the Kaplan Meier method.ResultsThe overall agreement between the two variables was high. However, several subgroups presented a lower concordance, suggesting differences in calendar time and less attention given to older patients and more advanced diseases. Similarly, the impact of discordance on cause-specific survival was small on overall survival but larger for several subgroups.ConclusionEstimation of cancer-specific survival could therefore be prone to bias when using the official cause of death. Breast cancer is not the more lethal cancer and our results can certainly not be generalised to more lethal tumours.
Highlights
Information on the underlying cause of death of cancer patients is of interest because it can be used to estimate net survival
It is codified in The International Classification of Diseases (ICD), which was designed to classify causes of death for statistical tabulation and research
We evaluated the impact of such disagreement on the cause-specific survival estimates
Summary
Information on the underlying cause of death of cancer patients is of interest because it can be used to estimate net survival. Two main data designs can be distinguished, the causespecific and the relative survival designs, according to the availability of information on cause of death Such information is rarely available in routine, population-based data and net survival is commonly estimated within the relative survival framework. High-quality information on the cause of death is required for each individual patient This information is commonly available only in clinical trials or hospital series, but the cause-specific approach is sometimes used on population-based data from cancer registries, where the underlying cause of death is derived from death certificates. The underlying cause of death is the “disease or injury which initiated the train of morbid events leading directly to death” or the “circumstances of the accident or violence which produced the fatal injury” It is codified in The International Classification of Diseases (ICD), which was designed to classify causes of death for statistical tabulation and research. The validity and accuracy of the reported underlying cause of death may be incorrect if the clinician’s certification does not accurately reflect the clinical history of events leading to death
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