Conditional 5-year Relative Survival Research Articles

Survival and quality-of-life outcomes in early-stage NSCLC patients: a literature review of real-world evidence.

Assess the long-term survival and quality-of-life outcomes in early-stage NSCLC (eNSCLC) patients. Review of long-term survival and quality-of-life after curative treatment in eNSCLC patients in observational studies. Disease-free proportion decreased in stage III vsstage I patients. Recurrence-free proportion decreased with age and disease stage. Advanced stage and vascular invasion increased risk of late recurrence. Conditional 5-year relative survival rates did not exceed 87%, indicating higher mortality in eNSCLC survivors. Lower conditional survival rates and relative survival rates were associated with older age and advanced disease. Survivors of eNSCLC had poorer physical quality-of-life. Despite curative-intent therapy, survivors of eNSCLC still face significant risks of recurrence, excess mortality, and diminished quality-of-life.

Conditional survival for high-risk early-stage cervical cancer patients with lymph node metastasis after hysterectomy

Background: To estimate conditional survival (CS) for high-risk early-stage cervical cancer patients with lymph node metastasis after hysterectomy. Methods: 1964 T1-2N1M0 cervical cancer patients who underwent primary hysterectomy from 2004 to 2015 were extracted from the Surveillance, Epidemiology, and End Result (SEER) Program. Univariate and multivariate cox regression analysis were used to identify independent risk factors. 5-year conditional disease-specific survival (CDS5) and 5-year conditional relative survival (CRS5) were estimated. CDS5 and CRS5 stratified by risk factors were further calculated. Results: CDS5 and CRS5 increased from 71.0% and 73.7% at 0-year to 89.2% and 91.7% at 5-year, respectively. Inversely, the actuarial disease-specific survival and RS dropped from 71.0% and 73.7% at 5-year to 63.3% and 67.6% at 10-year, respectively. Patients with unfavorable factors had a bigger gap between actuarial survival and CS. Both CDS5 and CRS5 curves across stratas of each prognostic factor had a tendency to level off with time elapsing. Notably, CRS5 couldn't exceed 95% even after 5-year follow-up except for patients with grade I disease (CRS5 at 5-year: 100%) or tumor size less than 2 cm (CRS5 at 5-year: 96%). Conclusion: CS increased over time while actuarial survival decreased as time passed. Patients with unfavorable factors had bigger improvement in CS than those with favorable factors. Excess mortality still existed in these patients after 5-year follow-up compared to the general population except for patients with grade I disease or tumor size <2 cm, who might gradually decrease follow-up times after 5-year.

Long-term Patterns of Excess Mortality among Endometrial Cancer Survivors

Abstract Purpose of the study: Examining long-term patterns of mortality among cancer survivors compared to the general population may inform planning for surveillance and follow-up care. We investigated excess mortality after endometrial cancer using conditional relative survival estimates and standardized mortality ratios (SMRs). Methods: Women diagnosed with endometrial cancer during 2000–2017 (N = 183,153) were identified in the Surveillance, Epidemiology, and End Results (SEER) database. SMRs were calculated as observed deaths among endometrial cancer survivors over expected deaths among demographically similar women in the general U.S. population. Five-year relative survival was estimated at diagnosis and each additional year survived up to 12 years post-diagnosis, conditional on survival up to that year. Results: For the full cohort, 5-year relative survival was 87.7%, 96.2%, and 97.1% at 1, 5, and 10 years post- diagnosis. respectively. Conditional 5-year relative survival first exceeded 95%, reflecting minimal excess mortality compared to the general population, at 4 years post-diagnosis overall, but occurred later for Black women (8 years) compared to White (4 years), and also later for women with regional/distant stage, grade 3 disease, or non- endometrioid histology. The overall SMR for all-cause mortality decreased from 5.90 (95% CI: 5.81–5.99) in the first year after diagnosis to 1.16 (95% CI: 1.13–1.19) at 10+ years; SMRs were consistently higher for non-White women and those with higher stage or grade disease. Conclusions: Overall, endometrial cancer survivors had only a small survival deficit beyond 4 years post- diagnosis. However, excess mortality was greater in magnitude and persisted longer into survivorship for Black women and those with more advanced disease.

Anastomotic leak after surgery for colon cancer and effect on long-term survival.

An anastomotic leak after surgery for colon cancer is a recognized complication but how it may adversely affect long-term survival is less clear because data are scarce. The aim of the study was to investigate the long-term impact of Grade C anastomotic leak in a large, population-based cohort. Data on patients undergoing resection for Stage I-III colon cancer between 2008 and 2012 were collected from the Swedish, Norwegian and Danish Colorectal Cancer Registries. Overall relative survival and conditional 5-year relative survival, under the condition of surviving 1 year, were calculated for all patients and stratified by stage of disease. A total of 22985 patients were analysed. Anastomotic leak occurred in 849 patients (3.7%). Five-year relative survival in patients with anastomotic leak was 64.7% compared with 87.0% for patients with no leak (P<0.001). Five-year relative survival among the patients who survived the first year was 88.6% vs 81.3% (P=0.003). Stratification by cancer stage showed that anastomotic leak was significantly associated with decreased relative survival in patients with Stage III disease (P=0.001), but not in patients with Stage I or II (P=0.950 and 0.247, respectively). Anastomotic leak after surgery for Stage III colon cancer was associated with significantly decreased long-term relative survival.

Epidemiologic and Clinical Analysis of Cervical Cancer Using Data from the Population-Based Osaka Cancer Registry.

Cervical cancer screening rate is extremely low and the governmental recommendation of HPV vaccine has been suspended for 5 years in Japan. Here, we utilized data from the Osaka Cancer Registry, collected between 1976 and 2012, to evaluate cervical cancer trends in Japan. Age-adjusted incidence, relative survival, and conditional survival rates were calculated using multiple imputation methods and period analyses in 25,826 cervical cancer cases. Association of survival rates and clinical factors, including patients' age, clinical stage, and treatment procedures, were also analyzed. A trend for significantly decreasing age-adjusted incidence of cervical cancer (per 100,000) began in 1976 but reversed after 2000, increasing significantly to date (annual percent change = 3.8, 95% confidence interval, 2.7-4.8; age-adjusted rate: 28.0 in 1976, 9.1 in 2000, 14.1 in 2012). The 10-year relative survival rate improved significantly after 2002, especially in cases of "localized" and "adjacent organs" disease; this was likely due to the introduction of concurrent chemotherapy and radiation. The conditional 5-year relative survival rate improved significantly yearly until the fourth survival year. In the surgery-based group, we observed no age-dependent differences in outcomes. Unexpectedly, however, prognosis for younger age groups was poorer in the radiation-based treatment group. These results indicate that although relative survival rates have recently increased, treatment for more advanced cases with distant metastasis requires further improvement. In addition, this study is the first to suggest that age might be an important predictor of radiotherapy resistance in cervical cancer.Significance: A large-cohort analysis of cervical cancer cases reveals that age-adjusted incidence in Japan has increased since 2000 and that age may negatively correlate with resistance to radiotherapy.

Optimistic, realistic, and pessimistic illness perceptions; quality of life; and survival among 2457 cancer survivors: the population-based PROFILES registry.

Threatening illness perceptions (IPs) have been associated with poorer health outcomes. However, to the authors' knowledge, it remains unclear whether threatening IPs that are consistent with disease severity are equally harmful. The aim of the current study was to: 1) identify subgroups of cancer survivors based on IPs and prognosis; and 2) assess the health-related quality of life (HRQOL) and survival associated with these subgroups. The authors used survey data from the population-based Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship (PROFILES) registry, which were collected between 2008 and 2015 and included 2457 cancer survivors who were <5 years after their cancer diagnosis (colon, rectal, prostate, endometrial, or ovarian cancer or non-Hodgkin lymphoma). Clinical and survival data were collected through the Netherlands Cancer Registry. Subgroups were defined by IPs (Brief Illness Perception Questionnaire) and prognosis (conditional 5-year relative survival) into survivors with 1) IPs consistent with prognosis ("realistic"); 2) less threatening IPs than expected based on prognosis ("optimistic"); and 3) more threatening IPs than expected based on prognosis ("pessimistic"). Compared with survivors with realistic IPs (1230 survivors), those with optimistic IPs (582 survivors) were found to have a higher HRQOL (P < .01 on all European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 [EORTC QLQ-C30] scales) and a lower all-cause mortality (hazard ratio, 0.72; P < .01), whereas those with pessimistic IPs (645 survivors) had a lower HRQOL (P < .01 on all scales) and a higher all-cause mortality (hazard ratio, 1.52; P < .01). Optimistic IPs are associated with better HRQOL and survival, even if they may appear to be unrealistic with respect to cancer survivors' prognosis. Survivors with pessimistic IPs appear to have the worst outcomes. Therefore, efforts are needed to provide better support to patients with pessimistic IPs to improve their outcomes. Cancer 2018;124:3609-17. © The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Advance and stagnation in the treatment of patients with lymphoma and myeloma: Analysis using population-based cancer registry data in Japan from 1993 to 2006.

There have been significant advances in the treatment of patients with lymphoma and myeloma. Although the improvements in survival outcome have been clearly addressed by clinical trials, these studies includes patients who are otherwise healthy and would be eligible for trials that the actual improvement in survival in the general patient population over time is yet to be elucidated. Therefore, we reviewed the cancer-registry data of patients with lymphoma and myeloma in Japan from 1993 to 2006 and estimated relative survival (adjusted for competing causes of death in same-age members of the general population) according to three periods of diagnosis (1993-1997, 1998-2002 and 2003-2006). We also estimated conditional 5-year relative survival (5-year survival rate of patients who have survived 5 years). A total of 26,141 patients were reviewed and analyzed. Relative survival improved in Hodgkin lymphoma (HL, N = 853, +20% improvement), diffuse large B-cell lymphoma (DLBCL, N = 4,919, +14% improvement) and follicular lymphoma (FL, N = 1,333, +13% improvement). In contrast, we found no significant improvement in survival since 1993 in peripheral T-cell lymphoma (PTCL, N = 667, +4% improvement), adult T-cell leukemia/lymphoma (ATLL, N = 2,166, -5% improvement) or multiple myeloma (MM, N = 4,914, -2% improvement). Conditional 5-year survival of HL, DLBCL, FL, PTCL, ATLL and MM was 88, 87, 79, 63, 53 and 45%, respectively. Relative survival of patients with HL, DLBCL and FL significantly improved from 1993 to 2006 in Japan; in contrast, no improvement was seen in other diseases, suggesting unmet need of novel treatment strategies.

Conditional survival for long-term colorectal cancer survivors in the Netherlands: who do best?

AimWith the increase in the number of long-term colorectal cancer (CRC) survivors, there is a growing need for subgroup-specific analysis of conditional survival. MethodsAll 137,030 stage I–III CRC patients diagnosed in the Netherlands between 1989 and 2008 aged 15–89years were selected from the Netherlands Cancer Registry. We determined conditional 5-year relative survival rates, according to age, subsite and tumour stage for each additional year survived up to 15years after diagnosis as well as trends in absolute risks for and distribution of causes of death during follow-up. ResultsMinimal excess mortality (conditional 5-year relative survival >95%) was observed 1year after diagnosis for stage I colon cancer patients, while for rectal cancer patients this was seen after 6years. For stage II and III CRC, minimal excess mortality was seen 7years after diagnosis for colon cancer, while for rectal cancer this was 12years. The differences in conditional 5-year relative survival between colon and rectal cancer diminished over time for all patients, except for stage III patients aged 60–89years. The absolute risk to die from CRC diminished sharply over time and was below 5% after 5years. The proportion of patients dying from CRC decreased over time after diagnosis while the proportions of patients dying from other cancers, cardiovascular disease and other causes increased. ConclusionPrognosis for CRC survivors improved with each additional year survived, with the largest improvements in the first years after diagnosis. Quantitative insight into conditional relative survival estimates is useful for caregivers to inform and counsel patients with stage I–III colon and rectal cancer during follow-up.

Patients with prostate cancer continue to have excess mortality up to 15 years after diagnosis

To estimate the population-based conditional 5-year relative survival rates for patients with prostate cancer (PCa). All 98 672 patients, aged 45-89 years, diagnosed in the Netherlands with PCa (clinical T stage 1-4) in the period 1989-2008 were selected from the Netherlands Cancer Registry and followed up until 2010. The conditional 5-year relative survival rate was estimated for every subsequent year of survival up to 15 years after diagnosis. The conditional 5-year relative survival rate decreased with survival time from diagnosis. Excess mortality (conditional 5-year relative survival rate <95%) for patients with clinical T1 stage only became manifest 5 years after diagnosis and increased to almost 10% after 10 years. Patients with more advanced disease (cT2-cT4) were found to have an excess mortality rate of 6-12% at diagnosis, which increased to 15-22% after 10 years. Excess mortality occurred earlier for the older age groups. The 5-year relative survival rate at diagnosis was <90% for all age groups of patients with cT3/cT4 disease and excess mortality for this group increased to >20% for those who had already survived for 5 years since diagnosis. Patients with PCa were found to have excess mortality within 10 years of diagnosis. Excess mortality was found at an earlier timepoint for patients with a more advanced stage and for older age groups. Quantitative insight into conditional survival is useful for caregivers to help plan optimum cancer treatment and surveillance and to inform patients about their actual prognosis during follow-up, taking the current condition of the patient into account.

Socioeconomic deprivation and cancer survival in Germany: An ecological analysis in 200 districts in Germany

Although socioeconomic inequalities in cancer survival have been demonstrated both within and between countries, evidence on the variation of the inequalities over time past diagnosis is sparse. Furthermore, no comprehensive analysis of socioeconomic differences in cancer survival in Germany has been conducted. Therefore, we analyzed variations in cancer survival for patients diagnosed with one of the 25 most common cancer sites in 1997-2006 in ten population-based cancer registries in Germany (covering 32 million inhabitants). Patients were assigned a socioeconomic status according to the district of residence at diagnosis. Period analysis was used to derive 3-month, 5-year and conditional 1-year and 5-year age-standardized relative survival for 2002-2006 for each deprivation quintile in Germany. Relative survival of patients living in the most deprived district was compared to survival of patients living in all other districts by model-based period analysis. For 21 of 25 cancer sites, 5-year relative survival was lower in the most deprived districts than in all other districts combined. The median relative excess risk of death over the 25 cancer sites decreased from 1.24 in the first 3 months to 1.16 in the following 9 months to 1.08 in the following 4 years. Inequalities persisted after adjustment for stage. These major regional socioeconomic inequalities indicate a potential for improving cancer care and survival in Germany. Studies on individual-level patient data with access to treatment information should be conducted to examine the reasons for these socioeconomic inequalities in cancer survival in more detail.

Small but significant excess mortality compared with the general population for long-term survivors of breast cancer in the Netherlands

Coinciding with the relatively good and improving prognosis for patients with stage I-III breast cancer, late recurrences, new primary tumours and late side-effects of treatment may occur. We gained insight into prognosis for long-term breast cancer survivors. Data on all 205 827 females aged 15-89 diagnosed with stage I-III breast cancer during 1989-2008 were derived from the Netherlands Cancer Registry. Conditional 5-year relative survival was calculated for every subsequent year from diagnosis up to 15 years. For stage I, conditional 5-year relative survival remained ~95% up to 15 years after diagnosis (a stable 5-year excess mortality rate of 5%). For stage II, excess mortality remained 10% for those aged 15-44 or 45-59 and 15% for those aged 60-74. For stage III, excess mortality decreased from 35% at diagnosis to 10% at 15 years for those aged 15-44 or 45-59, and from ~40% to 30% for those aged ≥60. Patients with stage I or II breast cancer had a (very) good long-term prognosis, albeit exhibiting a small but significant excess mortality at least up to 15 years after diagnosis. Improvements albeit from a lower level were mainly seen for patients who had been diagnosed with stage III disease. Caregivers can use this information to better inform (especially disease-free) cancer survivors about their actual prognosis.

Conditional survival of cancer patients: an Australian perspective

BackgroundEstimated conditional survival for cancer patients diagnosed at different ages and disease stage provides important information for cancer patients and clinicians in planning follow-up, surveillance and ongoing management.MethodsUsing population-based cancer registry data for New South Wales Australia, we estimated conditional 5-year relative survival for 11 major cancers diagnosed 1972–2006 by time since diagnosis and age and stage at diagnosis.Results193,182 cases were included, with the most common cancers being prostate (39,851), female breast (36,585) and colorectal (35,455). Five-year relative survival tended to increase with increasing years already survived and improvement was greatest for cancers with poor prognosis at diagnosis (lung or pancreas) and for those with advanced stage or older age at diagnosis. After surviving 10 years, conditional 5-year survival was over 95% for 6 localised, 6 regional, 3 distant and 3 unknown stage cancers. For the remaining patient groups, conditional 5-year survival ranged from 74% (for distant stage bladder cancer) to 94% (for 4 cancers at different stages), indicating that they continue to have excess mortality 10–15 years after diagnosis.ConclusionThese data provide important information for cancer patients, based on age and stage at diagnosis, as they continue on their cancer journey. This information may also be used by clinicians as a tool to make more evidence-based decisions regarding follow-up, surveillance, or ongoing management according to patients' changing survival expectations over time.

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.

Long-Term Excess Mortality for Survivors of Non-small Cell Lung Cancer in the Netherlands

Most patients diagnosed with non-small cell lung cancer (NSCLC) die within the first few years after diagnosis. However, only little is known about those who have survived these first years. We aimed to study conditional 5-year relative survival rates for NSCLC patients during long-term follow-up. All 12,148 patients aged 45 to 74 years diagnosed with stage I-III NSCLC between 1989 and 2008 in the Netherlands were derived from the Netherlands Cancer Registry. Conditional 5-year relative survival was calculated for every additional year survived up to 15 years. Conditional 5-year relative survival rapidly improved with every year survived up to 4 to 5 years after diagnosis. However, a significant excess mortality of 20 to 40% remained. Conditional 5-year relative survival for those aged 45 to 59 years did not exceed 80% for survivors with stage I or II disease and remained just more than 70% for those with stage III disease. For those aged 60 to 74 years, these proportions were 70%, 65%, and 60%, respectively. A significant excess mortality remains in lung cancer after years which may be explained by excess risk of death due to smoking-related comorbidity in these patients. Caregivers should use this information for planning optimal cancer surveillance and informing cancer survivors about their actual prognosis.

When do I know I am cured? Using conditional estimates to provide better information about cancer survival prospects

Free to read on journal website (must create free account first) Summary Objective: To report the latest conditional survival estimates for patients with cancer in Queensland, Australia. Design, setting and participants: Descriptive study of state-wide population-based data from the Queensland Cancer Registry on patients aged 15–89 years who were diagnosed with invasive cancer between 1982 and 2007. Main outcome measure: Conditional 5-year relative survival for the 13 most common types of invasive cancer, and all cancers combined. Results: The prognosis for patients with cancer generally improves with each additional year that they survive. A significant excess in mortality compared with the general population ceases to occur within 10 years after diagnosis for survivors of stomach, colorectal, cervical and thyroid cancer and melanoma, with these groups having a conditional 5-year relative survival of at least 95% after 10 years. For the remaining cancers we studied (pancreatic, lung, breast, prostate, kidney, and bladder cancer, non-Hodgkin lymphoma, and leukaemia), conditional 5-year relative survival estimates (at 10 years after diagnosis) ranged from 82% to 94%, suggesting that patients in these cohorts continue to have poorer survival compared with the age-matched general population. Conclusions: Estimates of conditional survival have the potential to provide useful information for cancer clinicians, patients and their carers as they are confronted by personal and surveillance-related decisions. This knowledge may be effective in building realistic hope and helping people manage uncertainty about the future. We suggest that measures of conditional survival be incorporated into routine statistical reporting in Australia.

When do I know I am cured? Using conditional estimates to provide better information about cancer survival prospects

To report the latest conditional survival estimates for patients with cancer in Queensland, Australia. Descriptive study of state-wide population-based data from the Queensland Cancer Registry on patients aged 15-89 years who were diagnosed with invasive cancer between 1982 and 2007. Conditional 5-year relative survival for the 13 most common types of invasive cancer, and all cancers combined. The prognosis for patients with cancer generally improves with each additional year that they survive. A significant excess in mortality compared with the general population ceases to occur within 10 years after diagnosis for survivors of stomach, colorectal, cervical and thyroid cancer and melanoma, with these groups having a conditional 5-year relative survival of at least 95% after 10 years. For the remaining cancers we studied (pancreatic, lung, breast, prostate, kidney, and bladder cancer, non-Hodgkin lymphoma, and leukaemia), conditional 5-year relative survival estimates (at 10 years after diagnosis) ranged from 82% to 94%, suggesting that patients in these cohorts continue to have poorer survival compared with the age-matched general population. Estimates of conditional survival have the potential to provide useful information for cancer clinicians, patients and their carers as they are confronted by personal and surveillance-related decisions. This knowledge may be effective in building realistic hope and helping people manage uncertainty about the future. We suggest that measures of conditional survival be incorporated into routine statistical reporting in Australia.

Conditional relative survival in head and neck squamous cell carcinoma: Permanent excess mortality risk for long‐term survivors

Dynamic predictions on head and neck cancer survival could offer, besides improved patient counseling, insight into long-term effects of tumor- and patient-based characteristics on survival. Theoretically, there could be a certain time period after diagnosis after which the patient returns to a population risk on survival. In all, 7255 patients with a primary head and neck squamous cell carcinoma (HNSCC) aged 25 to 90 years, diagnosed between January 1980 and January 2004 in The Netherlands, were included. Conditional 5-year relative survival for every additional year survived was computed. The overall conditional relative prognosis reached a plateau after approximately 4 years; a permanent 20% to 25% excess mortality for long-term HNSCC survivors remained. Conditional 5-year relative survival for patients with HNSCC remains poorer compared to age- and sex-matched counterparts in the general population, even when alive at 15 years after diagnosis. We assume that this is caused by an excess comorbidity in these patients, mainly due to smoking and alcohol abuse.

Clinical Relevance of Conditional Survival of Cancer Patients in Europe: Age-Specific Analyses of 13 Cancers

When cancer survivors wish to receive accurate information on their current prognosis during follow-up, conditional 5-year relative survival may be most suitable. We have estimated conditional 5-year relative survival for 13 cancers using a large European database-European Network for Indicators on Cancer (EUNICE)-of 10 dedicated long-standing cancer registries across Europe. Patients age 15 years and older diagnosed between 1985 and 2004 were included. Conditional 5-year relative survival for each age group was computed for every additional year survived up to 10 years. Period analysis with follow-up period 2000 to 2004 was used. All patients with cutaneous melanoma or colorectal, endometrial, or testis cancer and younger patients with stomach, glottis, cervix, ovary, or thyroid cancer or non-Hodgkin's lymphoma exhibited hardly any excess mortality (conditional 5-year relative survival > 95%) given that they were alive at a defined time point within 10 years of initial diagnosis. However, patients with supraglottis, lung, breast, and kidney cancer, as well as older patients with most cancers exhibited substantial excess mortality (conditional 5-year relative survival < 90%). Initial differences in relative survival at diagnosis between age groups largely disappeared with time since initial diagnosis for melanoma, or stomach, colorectal, corpus uteri, or testicular cancer but persisted for patients diagnosed with other tumors. Differences between stage groups became smaller over time or disappeared. Conditional relative survival shows clinically relevant variations according to time since diagnosis, type of cancer, and age, and can help serve as a guide for cancer survivors in planning for their future and for doctors in planning schedules for surveillance.

The cancer survival gap between elderly and middle-aged patients in Europe is widening

The present study is aimed to compare survival and prognostic changes over time between elderly (70–84 years) and middle-aged cancer patients (55–69 years). We considered seven cancer sites (stomach, colon, breast, cervix and corpus uteri, ovary and prostate) and all cancers combined (but excluding prostate and non-melanoma skin cancers). Five-year relative survival was estimated for cohorts of patients diagnosed in 1988–1999 in a pool of 51 European populations covered by cancer registries. Furthermore, we applied the period-analysis method to more recent incidence data from 32 cancer registries to provide 1- and 5-year relative survival estimates for the period of follow-up 2000–2002. A significant survival improvement was observed from 1988 to 1999 for all cancers combined and for every cancer site, except cervical cancer. However, survival increased at a slower rate in the elderly, so that the gap between younger and older patients widened, particularly for prostate cancer in men and for all considered cancers except cervical cancer in women. For breast and prostate cancers, the increasing gap was likely attributable to a larger use of, respectively, mammographic screening and PSA test in middle-aged with respect to the elderly. In the period analysis of the most recent data, relative survival was much higher in middle-aged patients than in the elderly. The differences were higher for breast and gynaecological cancers, and for prostate cancer. Most of this age gap was due to a very large difference in survival after the 1st year following the diagnosis. Differences were much smaller for conditional 5-year relative survival among patients who had already survived the first year. The increase of survival in elderly men is encouraging but the lesser improvement in women and, in particular, the widening gap for breast cancer suggest that many barriers still delay access to care and that enhanced prevention and clinical management remain major issues.

Testicular cancer: Trends in mortality are well explained by changes in treatment and survival in the southern Netherlands since 1970

The aim of this study was to interpret changes in mortality from testicular cancer (TC) against the background of changes in treatment and survival in the south of The Netherlands. Five-year moving average standardised mortality rates were calculated. Primary treatment and relative survival were analysed according to histology, stage and year of diagnosis. The mortality rate dropped in the period 1979–1986 and then flattened out. The types of treatment that patients received did not change significantly over time and were according to the guidelines. Ten-year relative survival for seminoma TC patients improved from 81% (67–91%) in 1970–1979 to 95% (88–100%) in 2000–2002; for non-seminoma TC patients these rates were 54% (38–68%) and 92% (85–99%), respectively. Conditional 5-year relative survival for seminoma and non-seminoma TC patients 5 years after diagnosis was 99% and 96%, respectively. In conclusion, there was an enormous increase in relative survival and a significant decrease in mortality.