Additional Year Of Survival Research Articles

Conditional survival estimates for ependymomas reveal the dynamic nature of prognostication

BackgroundTraditional survival analysis is frequently used to assess the prognosis of ependymomas (EPNs); however, it may not provide additional survival insights for patients who have survived for several years. Thus, the conditional survival (CS) pattern of this disease is yet to be further investigated. This study aimed to evaluate the improvement of survival over time using CS analysis and develop a CS-based nomogram model for real-time dynamic survival estimation for EPN patients.MethodsData on patients with EPN were collected from the Surveillance, Epidemiology, and End Results (SEER) database. In order to construct and validate the model effectively, the selected patients were randomly divided at 7:3 ratio. CS is defined as the probability of surviving for a specified time period (y years) after initial diagnosis, given that the patient has survived x years. The CS pattern of EPN patients were explored. Then, the least absolute shrinkage and selection operator (LASSO) regression method with tenfold cross-validation was employed to identify prognostic predictors. Multivariate Cox regression was employed to develop a CS-based nomogram model, and we used this model to quantify EPN patient risk. Finally, the performance of the prediction model was also evaluated and verified.ResultsIn total, 1829 patients diagnosed with EPN were included in the study, with 1280 and 549 patients in the training and validation cohorts, respectively. The CS analysis demonstrated that patients' OS saw gradual improvements over time. With each additional year of survival post-diagnosis, the 10-year survival rate of EPN patients saw an increase, updating from 74% initially to 79%, 82%, 85%, 87%, 89%, 91%, 93%, 96%, and 98% (after surviving for 1–9 years, respectively). The LASSO regression model, which implements tenfold cross-validation, identified 7 significant predictors (age, tumor grade, tumor site, tumor extension, tumor size, surgery and radiotherapy) to develop a CS-based nomogram model. And further risk stratification was conducted based on nomogram model for these patients. Furthermore, this survival prediction model was successfully validated.ConclusionThis study described the CS pattern of EPN patients and highlighted the gradual improvement of survival observed over time for long-term survivors. We also developed the first novel CS-nomogram model that enabled individualized and real-time prognosis prediction. But patients must be counselled that individual circumstances may not always accurately reflect the findings of the nomogram.

Is surgical treatment of hepatocellular carcinoma at high-volume centers worth the additional cost?

BackgroundCase volume has been associated with improved outcomes for patients undergoing treatment for hepatocellular carcinoma, often with higher hospital expenditures. We sought to define the cost-effectiveness of hepatocellular carcinoma treatment at high-volume centers. MethodsPatients diagnosed with hepatocellular carcinoma from 2013 to 2017 were identified from Medicare Standard Analytic Files. High-volume centers were defined as the top decile of facilities performing hepatectomies in a year. A multivariable generalized linear model with gamma distribution and a restricted mean survival time model were used to estimate costs and survival differences relative to high-volume center status. The incremental cost-effectiveness ratio was used to define the additional cost incurred for a 1-year incremental gain in survival. ResultsAmong 13,666 patients, 8,467 (62.0%) were treated at high-volume centers. Median expenditure was higher ($19,148, interquartile range $15,280–$29,128) among patients treated at high-volume centers versus low-volume centers ($18,209, interquartile range $14,959–$29,752). Despite similar median length-of-stay (6 days, interquartile range 4–9), a slightly higher proportion of patients were discharged to home from high-volume centers (n = 4,903, 57.9%) versus low-volume centers (n = 2,868, 55.2%) (P = .002). A 0.14-year (95% confidence interval 0.06–0.22) (1 month and 3 weeks) survival benefit was associated with an incremental cost of $1,070 (95% confidence interval $749–$1,392) among patients undergoing surgery at high-volume centers. The incremental cost-effectiveness ratio for treatment at a high-volume center was $7,951 (95% confidence interval $4,236–$21,217) for an additional year of survival, which was below the cost-effective threshold of $21,217. ConclusionSurgical care at high-volume centers offers the potential to deliver cancer care in a more cost-effective and value-based manner.

Conditional survival of elderly primary central nervous system lymphoma.

Recent studies have reported that overall survival of elderly patients with primary central nervous system lymphoma (PCNSL), who have the highest incidence of this disease, had failed to benefit from the advancements in treatment strategies over the past decades. This highlights the necessity for intensified research to guide treatment decisions for this specific patient population. The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) was used to extract data of elderly PCNSL patients (age ≥ 60) who were divided into training and validation groups at the ratio of 7:3, for our analysis. Conditional survival [CS(y|x)] was defined as the probability at survival additional y years given that the patient had not died of PCNSL at a specified period of time (x years) after initial diagnosis. The CS pattern of elderly PCNSL patients was analyzed. The least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression analysis were applied to develop a novel CS-based nomogram. A total of 3315 elderly patients diagnosed with CNS lymphoma between 2000 and 2019 were extracted from the SEER database, of whom 2320 patients were divided into the training group and 995 into the internal validation group. CS analysis revealed a noteworthy escalation in the 5-year survival rate among elderly PCNSL patients for every additional year of survival. The rates progressed from an initial 21-49%, 63%, and 75%, culminating in an impressive 88% and the survival improvement over time was nonlinear. The LASSO regression identified nine predictors and multivariate Cox regression was used to successfully construct the CS-based nomogram model with favorable prediction performance. CS of elderly PCNSL patients was dynamic and increased over time. Our newly-established CS-based nomogram can provide a real-time dynamic survival estimation, allowing clinicians to better guide treatment decision for these patients.

Cost-effectiveness of concurrent radiation with cetuximab or chemotherapy in older patients with oropharyngeal cancer.

Aim: To assess the cost-effectiveness of definitive therapies for nonmetastatic oropharyngeal cancer (OPC). Materials & methods: Using the Surveillance, Epidemiology and End Results-Medicare dataset, patients diagnosed between2000 and2011 were identified. The cost-effectiveness of chemoradiation (CRT) versus radiotherapy (RT), cetuximab plus RT (cetuximab-RT) versus RT and cetuximab-RT versus CRT were estimated. Results: The incremental cost-effectiveness ratio for CRT compared with RT from 2000 to2005 was US$56,650 (95% CI: US$4,522-$288,688) per additional year of survival. CRT was dominated by RT from 2006 to2011. Cetuximab-RT was dominated by RT and CRT. Conclusion: CRT had a favorable value from2000to 2005 but was dominated by RT from 2006 to2011. The value of cetuximab-RT compared with RT/CRT was not favorable with similar/inferior survival and substantial incremental costs.

Secondarily estimated cure fraction and five-year recurrence-free conditional survival probabilities among patients undergoing surgical resection for hepatocellular carcinoma presenting with minor gross vascular invasion

BackgroundSurgical resection (SR) has been selectively applied in hepatocellular carcinoma (HCC) presenting with minor gross vascular invasion (mGVI) which is defined when tumor invasion is confined to second-order portal branches or segmental branches of hepatic vein. However, little data of long-term outcomes are available for supporting the role of SR as a potentially curable therapeutic option for HCC presenting with mGVI. This study is aimed to estimate a statistical cure fraction and the improvement of recurrence-free conditional survival (RFCS) over time among patients undergoing SR for HCC presenting with mGVI.MethodsThe literature search was conducted focusing on previous studies that investigated the long-term survival rates of patients after SR for HCC presenting with mGVI. The reference cohort was extracted from a study including patients undergoing SR for HCC without vascular invasion. A non-mixture cure model was adopted to estimate the statistical cure fraction. The 5-year RFCS probabilities were also calculated.ResultsThree retrospective studies were secondarily analyzed. The probability of being statistically cured after SR for HCC presenting with mGVI was 7.3% (95% confidence interval, 4.4%–11.2%) in the mGVI group, lower than that of the reference cohort (hazard ratio, 1.81; 95% confidence interval, 1.59–2.05). The estimated 5-year RFCS probabilities improved with each additional year of survival. Moreover, 1 year after SR, the 5-year RFCS probabilities of patients with HCC presenting with mGVI was essentially the same as that of the reference cohort.ConclusionsThis study shows that a cure can be expected in around seven percent of patients undergoing SR for HCC presenting with mGVI. Furthermore, recurrence-free survival expectancy improves dramatically over time among those patients who do not have recurrence. Overall, these findings suggest that SR should be considered as a potentially curable treatment for patients with HCC presenting with mGVI.

Is Improved Survival in Early-Stage Pancreatic Cancer Worth the Extra Cost at High-Volume Centers?

Volume of operative cases may be an important factor associated with improved survival for early-stage pancreatic cancer. Most high-volume pancreatic centers are also academic institutions, which have been associated with additional healthcare costs. We hypothesized that at high-volume centers, the value of the extra survival outweighs the extra cost. This retrospective cohort study used data from the California Cancer Registry linked to the Office of Statewide Health Planning and Development database from January 1, 2004 through December 31, 2012. Stage I-II pancreatic cancer patients who underwent resection were included. Multivariable analyses estimated overall survival and 30-day costs at low- vs high-volume pancreatic surgery centers. The incremental cost-effectiveness ratio (ICER) and incremental net benefit (INB) were estimated, and statistical uncertainty was characterized using net benefit regression. Of 2,786 patients, 46.5% were treated at high-volume centers and 53.5% at low-volume centers. There was a 0.45-year (5.4 months) survival benefit (95% CI 0.21-0.69) and a $7,884 extra cost associated with receiving surgery at high-volume centers (95% CI $4,074-$11,694). The ICER was $17,529 for an additional year of survival (95% CI $7,997-$40,616). For decision-makers willing to pay more than $20,000 for an additional year of life, high-volume centers appear cost-effective. Although healthcare costs were greater at high-volume centers, patients undergoing pancreatic surgery at high-volume centers experienced a survival benefit (5.4 months). The extra cost of $17,529 per additional year is quite modest for improved survival and is economically attractive by many oncology standards.

The effect of the Mediterranean Diet on lifespan: a treatment-effect survival analysis of a population-based prospective cohort study in Southern Italy.

The Mediterranean diet (MedDiet) is associated with good health. We aimed to estimate the effect of levels of adherence to the MedDiet on lifespan by performing treatment effects survival analysis. A sample of 5250 subjects aged ≥18 years were randomly selected from the electoral list of Castellana Grotte and Putignano (Apulian Region, Italy). Cohorts were enrolled in 2005-06 and followed-up until December 2018. The adherence to the MedDiet was measured by the relative Mediterranean score (rMED) and categorized as high, medium and low. Time-to-death (all-causes) as estimated by average treatment effect on the treated (ATET), potential outcome mean (POM) and relative efficiency of exposure were the outcomes. A total of 4896 subjects were included. The median follow-up time was 12.82 (inter quartile range (IQR) 12.22-13.05), 12.91 (IQR 12.21-13.27) and 12.84 (IQR 12.19-13.03) years for high, medium and low rMED subjects respectively. By December 2018, 453 (9.25%) had died. There was a strong effect of medium and low rMED {ATET, -5.10 [95% confidence interval (CI) -9.39, -0.80] and -8.91 (95%CI -13.37, -4.45), respectively}. High rMED has an important effect on mean age at death [POM 90.16 (95% CI 86.06, 94.25)]. The relative effect size for medium and low rMED subjects was a lower lifespan of 5.62% (95% CI 1.01, 10.3) and 9.90% (95% CI 5.30, 5.30), respectively. We observed an important benefit in additional years of survival from adherence to MedDiet in this southern Italian cohort. Further investigation corroborating our findings in other population groups in other geographic regions will be an important contribution to promoting health and longevity.

Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient.

Conventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility. A multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively. Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation (P < .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non-small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively. Median survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient > 0.50).

Yttrium-90 Radioembolization Is Cost Effective in Intrahepatic Cholangiocarcinoma: A SEER Medicare Population Study

PurposeTo analyze the cost-effectiveness of radioembolization in the treatment of intrahepatic cholangiocarcinoma (ICC) using the Surveillance, Epidemiology, and End Results (SEER) Medicare cancer database. Materials and MethodsCost as measured by total treatment-related reimbursement in patients diagnosed with ICC who received chemotherapy alone or chemotherapy and yttrium-90 radioembolization was assessed in the SEER Medicare cancer database (1999–2012). Survival analysis was performed, and incremental cost-effectiveness ratios were generated. ResultsThe study included 585 patients. Average age at diagnosis was 71 years (standard deviation: 9.9), and 52% of patients were male. Twelve percent of patients received chemotherapy with radioembolization (n = 72), and 88% of patients (n = 513) received only chemotherapy. Median survival was 1043 days (95% confidence interval [CI]: 894–1244) for chemotherapy plus radioembolization and 811 days (95% CI: 705–925) for chemotherapy alone (P = .02). Patients who received combination therapy were slightly younger (71 vs 69 years, P = .03). No significant differences were observed between treatment groups in age at treatment, sex, race, or city size. Multivariable analysis showed a hazard ratio for progression for combination therapy versus chemotherapy alone of 0.76 (95% CI: 0.59–0.97, P = .029). The incremental cost-effectiveness ratio, a measure of cost of each added year of life, was $50,058.65 per year (quartiles: $11,454.63, $52,763.28). ConclusionsCombination therapy of ICC with chemotherapy and radioembolization is associated with higher median survival and can be a cost-effective treatment, with a median cost of $50,058.65 per additional year of survival.

3:00 PM Abstract No. 261 Radioembolization is cost effective in intrahepatic cholangiocarcinoma: a SEER-Medicare population study

To analyze cost effectiveness of radioembolization in the treatment of intrahepatic cholangiocarcinoma (ICC) using the Surveillance, Epidemiology, and End Results (SEER) Medicare cancer database. Cost as measured by total treatment related reimbursement in patients diagnosed with intrahepatic cholangiocarcinoma who received chemotherapy alone or chemotherapy and Y90 radioembolization was assessed in the SEER-Medicare cancer database (1999-2012). Survival analysis was performed and incremental cost effectiveness ratios were generated. The study included 585 patients. Average age at diagnosis was 71 years (SD: 9.9), with 52% male. Twelve percent of patients received chemotherapy with radioembolization (n = 72) and 88% of patients (n = 513) received only chemotherapy. Median survival was 1043 days (95% CI: 894-1244) for chemotherapy plus radioembolization and 811 days (95% CI: 705-925) for chemotherapy alone (p = 0.02). Patients receiving combination therapy were slightly younger (71 vs 69 years, p = 0.03). There was no difference in age at treatment, sex, race, or city size between treatment groups. Multivariable analysis showed a hazard ratio for progression for combination therapy versus chemotherapy alone of 0.76 (95% CI: 0.59 - 0.97, p = 0.029). Table 1 shows cost and cost effectiveness data. The incremental cost-effectiveness ratio (ICER), a measure of cost of each added year of life, was $50,058.65 per year (quartiles: $11,454.63, $52,763.28). Combination therapy of ICC with chemotherapy and radioembolization can be a cost effective with a median cost of $50,058.65 per additional year of survival.

Patients’ preferences for adjuvant sorafenib after resection of renal cell carcinoma in the SORCE trial: what makes it worthwhile?

We sought to determine the survival benefits that patients judged sufficient to warrant adjuvant therapy with sorafenib for 1 year, or for 3 years after resection of renal cell carcinoma in the SORCE trial. SORCE participants from all sites in Australia and New Zealand, and selected sites in the UK, completed a validated preferences questionnaire at months 0, 3, 15, and 42 to elicit the minimum survival benefits they judged sufficient to warrant adjuvant sorafenib for 1 year (versus observation), or for 3 years (versus 1 year). The questionnaires used reference survival times of 5 and 15 years; and reference survival rates at 5 years of 65% and 85%. The 233 participants had a median age of 57 years (range 29-78) and 71% were male. For 1 year of sorafenib versus no adjuvant therapy, the median benefits in survival times judged sufficient to warrant treatment were an extra 9 months beyond 5 years and an extra 1 year beyond 15 years; the median benefit in survival rates were an extra 4% beyond 65% and an extra 3% beyond 85% at 5 years. For 3 years of sorafenib versus 1 year of sorafenib, the median benefit in survival time judged sufficient to warrant extended treatment was an extra 1 year beyond both 5 and 15 years. Participants randomly allocated to treatment with sorafenib judged larger benefits necessary than those allocated to placebo. Participants' preferences were not associated with their baseline characteristics or the interval from randomisation. Most participants judged an extra year of survival necessary to warrant 1 year of adjuvant sorafenib worthwhile, and an additional year of survival to warrant extending the duration of sorafenib from 1 to 3 years. Patients' preferences are important in shared decision making. NCT00492258.

Riluzole: real-world evidence supports significant extension of median survival times in patients with amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is the commonest form of motor neuron disease and is a fatal, degenerative, multisystem disorder affecting upper and/or lower motor neurons in the motor cortex, brain stem, and spinal cord. ALS is characterized by progressive atrophy of associated bulbar, limb, thoracic, and abdominal muscles and supporting cells manifesting in a range of muscular symptoms such as weakness and wasting and eventual paralysis; the majority of patients will die from respiratory failure within 2–5 years of onset. Riluzole, a synthetic benzothiazole drug with glutamine antagonist activity, is indicated for the treatment of patients with ALS and is the only drug that has been shown to slow the course of the disease and extend survival in ALS patients. The original analyses, and subsequent meta-analyses, of data obtained from randomized controlled trials (RCTs) suggest that riluzole typically extends survival by 2–3 months and increases the chance of an additional year of survival by ~9%. However, published real-world evidence (RWE) from 10 clinical ALS databases indicates that riluzole therapy may afford much greater extension of survival, and improvements in median survival times of more than 19 months have been reported in the overall ALS patient population. This article will review the available data from RCTs and RWE on riluzole therapy.

Cost-effectiveness analysis of hepatocellular carcinoma screening by combinations of ultrasound and alpha-fetoprotein among Alaska Native people, 1983–2012

BackgroundThe American Association for the Study of Liver Diseases (AASLD) recommends semi-annual hepatocellular carcinoma (HCC) screening using ultrasound (US) in persons with chronic hepatitis B (CHB) virus infection at high risk for HCC such as Asian males aged ≥40 years and Asian females aged ≥50 years.ObjectiveTo analyse the cost-effectiveness of 2 HCC screening methods in the Alaska Native (AN) health system: US-alone, or screening by alpha-fetoprotein (AFP) initially and switching to US for subsequent screenings if AFP >10 ng/mL (AFP→US).DesignA spreadsheet-based model was developed for accounting the costs of 2 hypothetical HCC screening methods. We used epidemiologic data from a cohort of 839 AN persons with CHB who were offered HCC screening by AFP/US semi-annually during 1983–2012. We assumed that compared with AFP→US, US-alone identifies 33% more tumours at an early stage (defined as a single tumour ≤5 cm or ≤3 tumours ≤3 cm in diameter). Years of life gained (YLG) attributed to screening was estimated by comparing additional years of survival among persons with early- compared with late-stage tumours. Screening costs were calculated using Medicare reimbursement rates in 2012. Future screening costs and YLG were projected over a 30-year time horizon using a 3% discount rate.ResultsThe total cost of screening for the cohort by AFP→US would have been approximately $357,000 ($36,000/early-stage tumour detected) compared to $814,000 ($59,000/early-stage tumour detected) by US-alone. The AFP→US method would have yielded an additional 27.8 YLG ($13,000/YLG) compared with 38.9 YLG ($21,000/YLG) for US-alone. Screening by US-alone would incur an additional $114,000 per extra early-tumour detected compared with AFP→US and $41,000 per extra YLG.ConclusionsAlthough US-alone HCC screening might have yielded more YLG than AFP→US, the reduced costs of the AFP→US method could expand access to HCC screening in resource constrained settings.

Estimated Cause-specific Survival Continues to Improve Over Time in Patients With Chondrosarcoma

Conditional survival measures change in the risk of mortality given that a patient has survived a defined period of time. This has yet to be reported for chondrosarcoma of bone. This information should be of interest to the clinician and helpful in counseling patients with chondrosarcoma. Our questions include the following: (1) Does the conditional survival of patients with local/regional chondrosarcoma improve with each additional year of survival? (2) Does the conditional survival of patients with metastatic chondrosarcoma improve with each additional year of survival? (3) Does tumor location, use of radiation, or patient age affect conditional survival? (4) Can chondrosarcoma ever be considered cured? We used the Surveillance, Epidemiology, and End Results Program database maintained by the National Cancer Institute to identify 2138 patients with chondrosarcoma of bone from 1973 to 2009. We used an actuarial life table analysis to explore differences in 5-year cause-specific survival estimates conditional on 1 to 5 years of survival. The cohort was stratified by grade, location (axial versus extremity), use of radiation, and age. Finally, we expanded the analysis to include survival estimates 20 years after diagnosis conditional on survival for 5 and 10 years. The estimated survival for all grades of local/regional chondrosarcoma improved from baseline with each year of survival after diagnosis. At 5 years after diagnosis, local/regional Grade 1 chondrosarcoma displayed higher conditional survival than Grade 2 and 3 local/regional chondrosarcoma (97.2% [95% confidence interval {CI}, 95.2%-98.4%] versus 92.8% [95% CI, 89.5%-95.0%], p = 0.006 and 83.8% [95% CI, 69.9%-91.7%], p = 0.012). Estimated survival improved from baseline with each year of survival for all grades of metastatic chondrosarcoma. Conditional survival estimates for Grade 3 axial tumors failed to improve from baseline to 5 years after diagnosis (52.9% versus 70.2%, p > 0.05) compared with Grade 3 extremity tumors at baseline and 5 years after diagnosis (58.1% versus 95.8%, p < 0.0001) The 20-year conditional survival estimates reveal that a cancer-specific risk of mortality exists even 10 years after diagnosis, suggesting that although the conditional survival increases considerably over time, it cannot be considered cured. The 5-year conditional survival estimate for patients with chondrosarcoma improved with each additional year of survival regardless of grade, site, age, or use of radiation. At 10 years after diagnosis, deaths attributable to cancer were still present, and patients should be aware of this small long-term risk. Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

Conditional survival of malignant melanoma in The Netherlands: 1994–2008

BackgroundCutaneous malignant melanoma causes the majority of skin cancer related deaths and features increasing incidence and mortality rates in the Netherlands. Conditional survival analysis is performed on patients who survived the preceding year(s). MethodsPatients with invasive melanoma, as recorded in the population-based Netherlands Cancer Registry, were included. To assess prognosis of melanoma survivors according to gender and Breslow thickness, conditional five-year relative survival was calculated for lymph node negative melanoma patients and conditional one-year relative survival was analysed for melanoma patients with and without nodal involvement. FindingsBetween 1994 and 2008, 40,050 patients developed a melanoma (stage I–III, of whom 6% with nodal involvement). Six to 8years after diagnosis, survival of patients with a 1–2mm (T2) thick melanoma equalised the general population. Conditional five-year relative survival for patients with >4mm thick (T4) melanomas increased from about 60% at diagnosis to 90% at 7years after diagnosis. Largest improvements were found in patients with thick melanomas and female patients with nodal involvement. InterpretationThe prognosis for melanoma survivors improved with each additional year of survival after diagnosis, except for patients with a ⩽1mm thick melanoma, who never had any excess mortality during follow-up. Conditional survival of melanoma was better amongst females, amongst those with lower Breslow thickness and nodal stage.

Actual prognosis during follow-up of survivors of B-cell non-Hodgkin lymphoma in the Netherlands

Survival rates determined at diagnosis are often too negative for cancer survivors. Conditional relative survival reflects actual prognosis during follow-up better. Data from all 54,015 patients newly diagnosed in the Netherlands with B-cell non-Hodgkin lymphoma during 1989-2008, aged 15-89 years (Netherlands Cancer Registry), were used. Five-year conditional relative survival was computed for every additional year of survival up to 16 years after diagnosis, according to entity, grade, gender, age, and Ann Arbor stage. The prognosis for survivors of indolent B-cell non-Hodgkin lymphoma improved slightly with each additional year survived up to 91%. For patients with aggressive non-Hodgkin lymphoma conditional relative survival improved strongly during the first year after diagnosis (from 48% to 68%) and gradually thereafter to 93% after 16 years. There were differences between morphological entities. Initial differences in conditional relative survival at diagnosis between groups with different disease stages became smaller with increasing number of years survived. Age remained a prognostic indicator, also after prolonged follow-up. These results help caregivers to plan optimal surveillance and inform patients about their actual prognosis during follow-up. Long-lasting excess mortality among patients with B-cell non-Hodgkin lymphoma indicates the need for additional care long after their diagnosis.

Cost effectiveness of the NHS breast screening programme: life table model

Objective To assess the overall cost effectiveness of the NHS breast screening programme, based on findings of the Independent UK Panel on Breast Cancer Screening and taking into account the...

Minimal excess mortality for long-term colon cancer survivors in the Netherlands 1989–2008

We determined conditional 5-year relative survival rates for colon cancer patients, according to age, gender and tumour stage for each additional year of survival up to 15years after diagnosis. All 89,451 patients diagnosed in the Netherlands with colon cancer stage I–III in 1989–2008 aged 15–89years were selected from the Netherlands Cancer Registry. Conditional 5-year relative survival was computed for every additional year of survival up to 15years.There was minimal excess mortality (conditional 5-year relative survival >95%) 1–4years after diagnosis of stage I patients and 4–7years after diagnosis of stage II patients, with patients aged 45–74years reaching this point later compared to both younger and elderly patients. For stage III patients, minimal excess mortality was observed 5years after diagnosis for those aged 75–89years, but it remained elevated up to 13years after diagnosis for those aged 15–44years. Initial differences in relative survival at diagnosis between age and stage groups largely disappeared with increasing number of years survived.The prognosis for colon cancer survivors improved with each additional year survived. In the first years after diagnosis conditional survival improved largely for all colon cancer patients, especially for stage III patients. There was minimal excess mortality for colon cancer patients stage I–III at some point within 15years of diagnosis, being later for more advanced stages. Quantitative insight into conditional survival for cancer patients is useful for caregivers to help plan optimal cancer surveillance and inform patients about their prognosis.

International survey on willingness‐to‐pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?

Although the threshold of cost effectiveness of medical interventions is thought to be 20 000- 30 000 UK pounds in the UK, and $50 000-$100 000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT$ 2.1 million (Taiwan), 23 000 UK pounds (UK), AU$ 64 000 (Australia), and US$ 62 000 (US). The discount rates of outcome were estimated at 6.8% (Japan), 3.7% (ROK), 1.6% (Taiwan), 2.8% (UK), 1.9% (Australia), and 3.2% (US). Based on the current study, we suggest new classification of cost-effectiveness plane and methodology for decision making.

Life expectancy estimation in cerebral palsy – a paediatrician's approach

Paediatricians involved in providing reports for cerebral palsy litigation are often asked to give an opinion on life expectancy and this article outlines the approach taken by one paediatrician. The article describes how statistical data is available, particulary from America, to guide the clinician and the Court. This data acts as the starting point. The two factors that affect life expectancy most of all in the data are mobility and feeding ability, hence tables and survival curves are provided within the publications cited so that additional years of survival can be assessed for individuals in the different functional groups. The article describes how it is the clinicians' role to assess the individual's functional capabilities and any relevant clinical issues and ‘interpret’ the data accordingly.