5-year Relative Survival Estimates Research Articles

Trends in lung cancer survival in the Nordic countries 1990–2016: The NORDCAN survival studies

ObjectivesThe aim of this study was to evaluate if the previously reported improvements in lung cancer survival were consistent across age at diagnosis and by lung cancer subtypes. Materials and methodsData on lung cancers diagnosed between 1990 and 2016 in Denmark, Finland, Iceland, Norway and Sweden were obtained from the NORDCAN database. Flexible parametric models were used to estimate age-standardized and age-specific relative survival by sex, as well as reference-adjusted crude probabilities of death and life-years lost. Age-standardised survival was also estimated by the three major subtypes; adenocarcincoma, squamous cell and small-cell carcinoma. ResultsBoth 1- and 5-year relative survival improved continuously in all countries. The pattern of improvement was similar across age groups and by subtype. The largest improvements in survival were seen in Denmark, while improvements were comparatively smaller in Finland. In the most recent period, age-standardised estimates of 5-year relative survival ranged from 13% to 26% and the 5-year crude probability of death due to lung cancer ranged from 73% to 85%. Across all Nordic countries, survival decreased with age, and was lower in men and for small-cell carcinoma. ConclusionLung cancer survival has improved substantially since 1990, in both women and men and across age. The improvements were seen in all major subtypes. However, lung cancer survival remains poor, with three out of four patients dying from their lung cancer within five years of diagnosis.

Survival trends for patients diagnosed with cutaneous malignant melanoma in the Nordic countries 1990-2016: The NORDCAN survival studies

BackgroundThe survival in patients diagnosed with cutaneous malignant melanoma (CMM) has improved in the Nordic countries in the last decades. It is of interest to know if these improvements are observed in all ages and for both women and men. MethodsPatients diagnosed with CMM in the Nordic countries in 1990–2016 were identified in the NORDCAN database. Flexible parametric relative survival models were fitted, except for Iceland where a non-parametric Pohar-Perme approach was used. A range of survival metrics were estimated by sex, both age-standardised and age-specific. ResultsThe 5-year relative survival improved in all countries, in both women and men and across age. While the improvement was more pronounced in men, women still had a higher survival at the end of the study period. The survival was generally high, with age-standardised estimates of 5-year relative survival towards the end of the study period ranging from 85% in Icelandic men to 95% in Danish women. The age-standardised and reference-adjusted 5-year crude probability of death due to CMM ranged from 5% in Danish and Swedish women to 13% in Icelandic men. ConclusionAlthough survival following CMM was relatively high in the Nordic countries in 1990, continued improvements in survival were observed throughout the study period in both women and men and across age.

Timely Estimates of 5-Year Relative Survival for Patients With Cervical Cancer: A Period Analysis Using Cancer Registry Data From Taizhou, Eastern China.

ObjectivesWhile timely assessment of long-term survival for patients with cervical cancer is essential for the evaluation of early detection and screening programs for cervical cancer, those data are extremely scarce in China. We aimed to timely and accurately assess long-term survival for patients with cervical cancer in eastern China, using cancer registry data from Taizhou, eastern China.MethodsPatients diagnosed with cervical cancer during 2004–2018 from four cancer registries with high-quality data from Taizhou, eastern China were included. A period analysis was used to calculate the 5-year relative survival (RS) overall and on stratification by sex, age at diagnosis, and region. Additionally, the projected 5-year relative survival (RS) of patients with cervical cancer during 2019–2023 was evaluated, using a model-based period analysis.ResultsOverall 5-year RS for patients with cervical cancer during 2014–2018 reached 90.9%. When stratified by age at diagnosis, we found a clear age gradient for 5-year RS, declining from 95.6% for age <45 years to 68.7% for age >74 years, while urban areas had higher 5-year RS compared to rural areas (92.9 vs. 88.6%). We found a clear increasing trend of 5-year RS during 2004–2018 overall and on stratification by region and age at diagnosis. The projected overall 5-year RS is expected to reach 94.2% for the period 2019–2023.ConclusionsWe found that, for the first time in China, using period analysis, the most up-to-date (during 2014–2018) 5-year RS for patients with cervical cancer reached 90.9%. Our data have important implications for the timely evaluation of early detection and screening programs for patients with cervical cancer in eastern China.

Assessing the impact of including variation in general population mortality on standard errors of relative survival and loss in life expectancy

BackgroundA relative survival approach is often used in population-based cancer studies, where other cause (or expected) mortality is assumed to be the same as the mortality in the general population, given a specific covariate pattern. The population mortality is assumed to be known (fixed), i.e. measured without uncertainty. This could have implications for the estimated standard errors (SE) of any measures obtained within a relative survival framework, such as relative survival (RS) ratios and the loss in life expectancy (LLE). We evaluated the existing approach to estimate SE of RS and the LLE in comparison to if uncertainty in the population mortality was taken into account.MethodsThe uncertainty from the population mortality was incorporated using parametric bootstrap approach. The analysis was performed with different levels of stratification and sizes of the general population used for creating expected mortality rates. Using these expected mortality rates, SEs of 5-year RS and the LLE for colon cancer patients in Sweden were estimated.ResultsIgnoring uncertainty in the general population mortality rates had negligible (less than 1%) impact on the SEs of 5-year RS and LLE, when the expected mortality rates were based on the whole general population, i.e. all people living in a country or region. However, the smaller population used for creating the expected mortality rates, the larger impact. For a general population reduced to 0.05% of the original size and stratified by age, sex, year and region, the relative precision for 5-year RS was 41% for males diagnosed at age 85. For the LLE the impact was more substantial with a relative precision of 1286%. The relative precision for marginal estimates of 5-year RS was 3% and 30% and for the LLE 22% and 313% when the general population was reduced to 0.5% and 0.05% of the original size, respectively.ConclusionsWhen the general population mortality rates are based on the whole population, the uncertainty in the estimates of the expected measures can be ignored. However, when based on a smaller population, this uncertainty should be taken into account, otherwise SEs may be too small, particularly for marginal values, and, therefore, confidence intervals too narrow.

Cancer Incidence and Survival Trends by Subtype Using Data from the Surveillance Epidemiology and End Results Program, 1992-2013.

Background: Cancers are heterogeneous, comprising distinct tumor subtypes. Therefore, presenting the burden of cancer in the population and trends over time by these tumor subtypes is important to identify patterns and differences in the occurrence of these subtypes, especially to generalize findings to the U.S. general population.Methods: Using SEER Cancer Registry Data, we present incidence rates according to subtypes for diagnosis years (1992-2013) among men and women for five major cancer sites: breast (female only), esophagus, kidney and renal pelvis, lung and bronchus, and thyroid. We also describe estimates of 5-year relative survival according to subtypes and diagnosis year (1992-2008). We used Joinpoint models to identify years when incidence rate trends changed slope. Finally, recent 5-year age-adjusted incidence rates (2009-2013) are presented for each subtype by race and age.Results: Hormone receptor-positive and HER2-negative was the most common subtype (about 74%) of breast cancers. Adenocarcinoma made up about 69% of esophagus cases among men. Adenocarcinoma also is the most common lung subtype (43% in men and 52% in women). Ninety percent of thyroid subtypes were papillary. Distinct incidence and survival patterns emerged by these subtypes over time among men and women.Conclusions: Histologic or molecular subtype revealed different incidence and/or survival trends that are masked when cancer is considered as a single disease on the basis of anatomic site.Impact: Presenting incidence and survival trends by subtype, whenever possible, is critical to provide more detailed and meaningful data to patients, providers, and the public. Cancer Epidemiol Biomarkers Prev; 26(4); 632-41. ©2016 AACR.

Survival of European adolescents and young adults diagnosed with cancer in 2000–07: population-based data from EUROCARE-5

Data from EUROCARE have consistently shown lower survival for adolescents and young adults (AYAs; aged 15-24 years) than for children (0-14 years) for most cancers that affect both groups, and modest survival improvements up to 2000-02. AYAs have longer survival than that of adults for most cancers. We used the latest definition of AYAs (aged 15-39 years) and provided estimates of 5-year relative survival for European AYAs with cancer diagnosed in 2000-07, compared with children and adults (40-69 years) with cancer, and assessed survival improvements over time. We analysed data from population-based cancer registries of 27 European countries participating in EUROCARE-5. We used the so-called complete method to estimate 5-year, population-weighted relative survival for 19 cancers affecting AYAs and children, and for 27 cancers affecting AYAs and adults. We assessed relative-survival differences between children versus AYAs, and between AYAs versus adults, using the Z test. We used the period approach to estimate 5-year relative survival over time for children and AYAs, and used a generalised linear model to model survival time trends (1999-2007) and to assess the significance of changes over time. We analysed 56 505 cancer diagnoses in children, 312 483 in AYAs, and 3 567 383 in adults. For all cancers combined, survival improved over time for AYAs (from 79% [95% CI 78·1-80·5] in 1999-2002 to 82% [81·1-83·3] in 2005-07; p<0·0001) and children (from 76% [74·7-77·1] to 79% [77·2-79·4]; p<0·0001). Survival improved significantly in children and AYAs for acute lymphoid leukaemia (p<0·0001) and non-Hodgkin lymphoma (p<0·0001 in AYAs and p=0·023 in children). Survival improved significantly in AYAs only for CNS tumours (p=0·0046), astrocytomas (p=0·040), and malignant melanomas (p<0·0001). Survival remained significantly worse in AYAs than in children for eight important cancers: acute lymphoid leukaemias, acute myeloid leukaemias, Hodgkin's lymphomas, non-Hodgkin lymphomas, astrocytomas, Ewing's sarcomas, and rhabdomyosarcomas (p<0·0001 in all cases), and osteosarcomas (p=0·011). Notwithstanding the encouraging results for some cancers, and overall, we showed poorer survival in AYAs than in children for the eight important cancers. Recent European initiatives to improve outcomes in AYAs might reduce the survival gap between children and AYAs, but this reduction can only be verified by future population-based studies. Italian Ministry of Health, European Commission.

On-going improvement and persistent differences in the survival for patients with colon and rectum cancer across Europe 1999–2007 – Results from the EUROCARE-5 study

BackgroundPrevious population-based studies revealed major variation in survival for patients with colorectal cancer (CRC) in Europe by age and between different countries and regions, but also a sustained improvement in survival for patients with CRC in recent years. This EUROCARE-5 paper aims to update available knowledge from previous studies and to provide the latest survival estimates for CRC patients from Europe. MethodsThe study analysed data of patients diagnosed with CRC from population-based cancer registries diagnosed in 29 European countries. Estimates of 1-year and 5-year relative survival (RS) were derived for patients diagnosed in 2000–2007 by European region, country and age at diagnosis. Additionally to these cohort estimates, time trends in 5-year RS were obtained for the calendar periods 1999–2001 and 2005–2007, using the period analysis methodology. ResultsEuropean average 5-year RS for patients diagnosed with colon and rectum cancer was 57% and 56%, respectively. The analyses showed persistent differences in cancer survival across Europe with lowest survival for CRC patients observed in Eastern Europe. The analyses further showed a strong gradient in age-specific survival. Even though the study revealed sustained improvement in patient survival between 1999–2001 and 2005–2007 (absolute increase of 4 and 6 percentage points for colon and rectum, respectively), the differences in the survival for CRC patients observed at the beginning of the millennium persisted over time. ConclusionAlthough survival for CRC patients in Europe improved markedly in the study period, significant geographic variations and a strong age gradient still persisted. Enhanced access to effective diagnostic procedures and treatment options might be the keys to reducing the existing disparities in the survival of CRC patients across Europe.

Survival from Acute Lymphoblastic Leukemia (ALL) in Adult Patients in the United States and Sweden: Evidence of Recent Improvement

IntroductionThe improvement in pediatric ALL survival rates observed since the 1970xs has been achieved through a series of carefully conducted randomized controlled, multi-institutional clinical trials. Alas, despite more precise risk stratification and widespread implementation of aggressive treatment protocols results in adults (including young adults) lag behind those in children. For example, a recent study estimated the overall 5-year relative survival of adult ALL patients diagnosed in 2002-06 in Germany and the United States (US) at 43.4% and 35.5%, respectively. While survival was better in younger patients, with 5-year relative survival ratios of 59.2% (Germany) and 54.9% (US) in patients aged 15-24 years, the lack of curative treatment for the majority of adult patients is obvious. In recognition of a recent shift of the treatment for younger adult ALL patients in Sweden, with increasing use of pediatric protocols up to age 45 as well as introduction of imatinib for patients with Philadelphia-positive ALL, we compared the overall and age specific relative survival of adult ALL patients in Sweden and the US Surveillance, Epidemiology and End Results (SEER) database with emphasis on temporal trends.MethodsWe used data from the SEER 9 database (which covers approximately 9% of the US population) and the nationwide Swedish cancer register to determine the survival of adults (aged 18-84) diagnosed with ALL in the period 1980-2011. To improve comparability with Sweden, the SEER data were restricted to whites (82% of all patients). We studied temporal trends in relative survival for four predefined age groups: 18-29, 30-44, 45-64, and 65-84 years at diagnosis. Relative survival was estimated using flexible parametric models with year of diagnosis modelled as a restricted cubic spline with 3 degrees of freedom. Separate models were fitted for Sweden and the SEER data, each containing age, year, and an age by year interaction. The effects of age and year were allowed to be non-proportional. Model goodness of fit was assessed by comparing the model-based estimates of relative survival to empirical (life table) estimates. Because patients diagnosed in 2010 could only be followed up until the end of 2011, the estimates of 5-year relative survival for these patients are based on statistical prediction. We therefore also compared 1-year survival, which could be directly estimated.ResultsOur analysis included 3,539 and 1,391 patients with ALL in the US and Sweden, respectively. The mean ages were similar in the two countries, 48.1 (US) and 51.6 (Sweden); as was the distribution in the four age groups. In both countries we saw a trend towards better survival in patients diagnosed in recent years, as well as an age gradient with better relative survival for younger patients. However, a larger temporal improvement was noted in patients younger than 45 years at diagnosis in Sweden than in the US (p<0.05). Strikingly, in Sweden the 5-year RSR of patients aged 18-29 at diagnosis improved from 0.56 (95% CI, 0.43-0.66) for those diagnosed in 2000 to 0.82 (95% CI, 0.63-0.92) for those diagnosed in 2010. The corresponding estimates for the SEER data were 0.51 (95% CI, 0.44-0.57) and 0.53 (95% CI, 0.39-0.65) for patients diagnosed in 2000 and 2010, respectively. Similar results were seen for patients age 30-45 at diagnosis.ConclusionsThe survival of adult patients with ALL has improved gradually in both the US and Sweden during the past decades. The most dramatic improvement was seen in patients age 18-29 and 30-44 years diagnosed in the most recent years in Sweden, with 5-year relative survival of 82% and 66%, respectively. As we lack detailed clinical data including information on treatment and supportive care, we are unable to confidently identify what factors account for the important differences in survival between the two countries. However, the widespread and standardized implementation of a pediatric ALL protocol adapted for adults in Sweden seems a likely success factor. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Breast Cancer Survival in Germany: A Population-Based High Resolution Study from Saarland

Population-based survival studies of breast cancer patients are commonly restricted to age- and stage-specific analyses. This study from Germany aimed at extending available population-based survival data on further prognostic cancer characteristics such as tumor grade, hormone receptor status and human epidermal growth factor receptor type 2 (HER2/neu) expression. Data from the population-based Saarland Cancer Registry including female patients diagnosed with invasive breast cancer between 2000 and 2009 were included. Period analysis methodology and regression modelling were used to obtain estimates of 5-year relative survival and tumor related excess risks in 2005-2009. Overall age standardized 5-year relative survival was 83%. In addition to age and stage, tumor grade and hormone receptor status were independent predictors of 5-year relative survival. Detailed analyses by age, stage, morphology, tumor grade, hormone receptor status and HER2/neu expression consistently revealed lower survival of patients with high grade, hormone receptor negative or HER2/neu positive cancers and patients aged 70 years or older. This high resolution study extends available population-based survival data of breast cancer patients. Particular efforts should be made to overcome the persisting large survival deficits, which were observed for elderly patients in all clinical subgroups.

Survival and cure of acute myeloid leukaemia in England, 1971‐2006: a population–based study

The 5-year relative survival of adults diagnosed with acute myeloid leukaemia (AML) was less than 10% during the 1970s and 1980s in England. This population-based study estimated the 5-year relative survival and 'cure' for 48380 adult patients diagnosed with AML in England during 1971-2006. Relative survival and cure mixture models were used to produce estimates of 5-year relative survival and the percentage 'cured'. 'Cure' was defined as the proportion of a group of survivors for whom there is no excess mortality compared with the general population. The 5-year relative survival and the percentage 'cured' increased for patients aged under 70years at diagnosis during 1971-2006, but advancing age was associated with poorer outcome. During the study period a dramatic increase in 5-year relative survival occurred in those aged 15-24years, from 7% to 53%. The percentage 'cured' was less than 10% for all ages in 1975, but increased to 45% for those aged 15-24years in 2000. Cure could not be estimated for patients over 70years, because survival was consistently low (<5%). The long-term outcome of patients with AML has improved substantially, particularly in younger patients. The potential exists for further increasing levels of 'cure'.

Survival from colorectal cancer in Germany in the early 21st century.

Background:Colorectal cancer is the most common cancer in Germany and the second most common cause of cancer-related deaths in both men and women. The aim of this study is to provide detailed analysis of recent developments in survival of colorectal cancer patients using newly available data on a national basis.Methods:We included data from 11 German cancer registries covering a population of 33 million inhabitants. Period analysis and modelled period analysis were used to provide most up-to-date estimates of 5-year relative survival in 2002–2006.Results:The analysis was based on records of 164 996 colorectal cancer patients. Five-year relative survival was 63.0% overall, decreased with age and was significantly higher among women than among men in patients under 75 years. Overall age-adjusted 5-year relative survival increased from 60.6 to 65.0% over the period 2002–2006. Significant increase in survival was only observed in patients with localised or regional disease. Highest subsite-specific survival was observed in patients with cancer in descending (67.7%) and ascending (66.5%) colon.Conclusion:Survival of patients with colorectal cancer continued to increase in the early 21st century in Germany, with 5-year relative survival reaching 65% in 2006. However, lack of progress still persisted in patients with advanced disease.

Survival of European patients with central nervous system tumors

We present estimates of population-based 5-year relative survival for adult Europeans diagnosed with central nervous system tumors, by morphology (14 categories based on cell lineage and malignancy grade), sex, age at diagnosis and region (UK and Ireland, Northern, Central, Eastern and Southern Europe) for the most recent period with available data (2000-2002). Sources were 39 EUROCARE cancer registries with continuous data from 1996 to 2002. Survival time trends (1988 to 2002) were estimated from 24 cancer registries with continuous data from 1988. Overall 5-year relative survival was 85.0% for benign, 19.9% for malignant tumors. Benign tumor survival ranged from 90.6% (Northern Europe) to 77.4% (UK and Ireland); for malignant tumors the range was 25.1% (Northern Europe) to 15.6% (UK and Ireland). Survival decreased with age at diagnosis and was slightly better for women (malignant tumors only). For glial tumors, survival varied from 83.5% (ependymoma and choroid plexus) to 2.7% (glioblastoma); and for non-glioma tumors from 96.5% (neurinoma) to 44.9% (primitive neuroectoderm tumor/medulloblastoma). Survival differences between regions narrowed after adjustment for morphology and age, and were mainly attributable to differences in morphology mix; however UK and Ireland and Eastern Europe patients still had 40% and 30% higher excess risk of death, respectively, than Northern Europe patients (reference). Survival for benign tumors increased from 69.3% (1988-1990) to 77.1% (2000-2002); but survival for malignant tumors did not improve indicating no useful advances in treatment over the 14-year study period, notwithstanding major improvement in the diagnosis and treatment of other solid cancers.

Improved Estimates of Cancer-Specific Survival Rates From Population-Based Data

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. 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. 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). 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.

Up-to-date estimates of breast cancer survival for the years 2000–2004 in 11 European countries: The role of screening and a comparison with data from the United States

Introduction We investigated survival in breast cancer patients by age group, focussing on those covered by screening programmes, using data from 12 European population-based cancer registries participating in the European Network for Indicators on Cancer Survival Working Group. Methods We calculated period estimates of 5-year relative survival for 2000–2004 and examined the change in survival estimates for four age groups between 1990–1994 and 2000–2004. Trends in age specific incidence, survival and mortality were additionally compared to those in the United States based on results from the Surveillance Epidemiology and End Results (SEER) programme. Results Breast cancer survival uniformly increased particularly in areas with lower breast cancer survival for patients diagnosed in 1990–1994. With the exception of Geneva, Scotland and Estonia, the rise in survival was always larger among the younger age groups than in the 70+ age group and the age-gradient widened over time. The 5-year relative survival of patients aged 70 and above in the European registries was at least 7 percentage points lower than the 5-year relative survival of patients in the same age group in the US in 2000–2004. During the study period, incidence increased in all age groups and populations with a few exceptions, an observation paralleled by declining mortality. Conclusions Results showed that some of the geographical differences in overall survival are even larger when considering age groups, in particular between Western and Eastern European countries. Furthermore, some of the differences in survival within the Northern and Western European areas could be due to variations in the implementation of screening programmes rather than economic inequalities.

Measuring the effect of including multiple cancers in survival analyses using data from the Canadian Cancer Registry

Background: In survival analyses using cancer registry data, second and subsequent primary cancers diagnosed in individuals are typically excluded. However, this approach may lead to biased comparisons of survival between cancer registries, or over time within a single registry. Purpose: To examine the impact of including multiple primary cancers in the derivation of survival estimates using data from a population-based national cancer registry. Methods: Five-year relative survival estimates for persons aged 15–99 years at diagnosis were derived using all eligible primary cases from the Canadian Cancer Registry (CCR)—a population-based registry containing information on cases diagnosed from 1992 onward—and then again using first primary cases only. Any pre-1992 cancer history of persons on the CCR was obtained by using auxiliary information. Results: The inclusion of multiple cancers resulted in lower estimates of 5-year relative survival for virtually all cancers studied. The effect was somewhat attenuated by age-standardization (e.g., from 1.3% to 1.0% for all cancers combined), and was greatest for bladder cancer (−2.4%) followed by oral cancer (−1.9%)—cancers that had the first and third lowest proportions of first cancers, respectively. For the majority of cancers the difference was less than 1.0%. Cancers for which there was virtually no difference (e.g., lung, pancreatic, ovarian and liver) tended to be those with a poor prognosis. Conclusion: Inclusion of second and subsequent primary cancers in the analysis tended to lower estimates of relative survival, the extent of which varied by cancer and age and depended in part on the proportion of first primary cancers.

Expected Long-Term Survival of Patients Diagnosed with Multiple Myeloma in 2006–2010

Background: New therapeutic options have led to substantial increases in survival expectations of patients with multiple myeloma (MM) in recent years. In the past, the impact of these innovations on long-term survival of MM patients on the population level has been disclosed only with substantial delay, partly due to delayed availability of data from population-based cancer registries.Methods: Using data from the 1973–2005 database of the Surveillance, Epidemiology, and End Results (SEER) Program, we employed a novel model-based projection method to project 5-and 10-year relative survival expectations of MM patients in the United States diagnosed in 2006 to 2010, after conducting an empirical evaluation of the method using data from patients diagnosed between 1996 and 2000 (the last cohort for which 5-year follow up is available through SEER) and earlier years.Results: Preliminary empirical evaluation of the method using historical data indicates good performance in projection of age specific and overall 5- and 10-year relative survival. Model based projection of survival produced survival estimates that matched observed survival estimates more closely than cohort analysis or period analysis, the standard methods of survival analysis, in 21 out of 24 cases. The average difference from observed was −1.27 percentage units for model based projection, −3.71 percentage units for period analysis, and −4.23 percentage units for cohort analysis. Five-year relative survival projections for patients diagnosed in 2006–2010 at ages 15–49 and 50–59 are 61.4% and 52.0% (see table), respectively, and exceed the most up-to-date estimates obtained from traditional cohort analysis by 9.5 and 6.9 percent units, respectively. Ten-year relative survival projections for patients in these age groups are 47.1% and 30.4%, exceeding the most up-to-date estimates from traditional cohort analysis by 13.5 and 9.6 percent units, respectively. By contrast, survival projections remain much lower and hardly exceed estimates from traditional survival analysis for older patients.Conclusions: The use of model based projection results in more up-to-date estimates of survival than standard methods of survival analysis. Patients diagnosed with multiple myeloma in 2006–2010 have much higher long-term survival expectations than suggested by previously available survival statistics.Table: Most up-to-date estimates of 5-year and 10-year relative survival of patients diagnosed with multiple myeloma obtained by different methods.AgeCohort estimates*Period estimates for 2001–2005 periodProjections for patients diagnosed in 2006–2010PESEPESEPESE5-year relative survival15+32.10.734.20.736.11.015–4951.92.356.42.261.43.150–5945.11.748.01.652.02.360–6933.81.436.51.436.72.070–7927.41.226.71.227.91.780+13.21.414.11.416.41.910-year relative survival15+14.10.616.60.618.00.815–4933.62.240.32.447.13.250–5920.81.627.01.730.42.360–6912.41.015.01.215.41.470–798.81.08.90.99.91.180+6.41.65.91.46.61.4* The most up-to-date cohort estimates of 5-year survival pertain to patients diagnosed in 1996–2000, and the most up-to-date cohort estimates of 10-year survival pertain to patients diagnosed in 1991–1995.

Period estimates of cancer patient survival are more up-to-date than complete estimates even at comparable levels of precision

Background and Objective Period analysis provides more up-to-date estimates of cancer patient survival than traditional methods, but there is a trade-off between up-to-dateness and precision. Our objective was to compare the performance of period and complete analysis in terms of up-to-dateness and precision of survival estimates. Study Design and Setting Five-year relative survival data actually observed for patients diagnosed with 1 of 20 common forms of cancer in Finland in 36 overlapping 5-year periods between 1958–1962 and 1993–1997 were compared with period estimates and various variants of complete estimates of 5-year relative survival potentially available during these periods. Results At comparable levels of up-to-dateness, survival estimates from period analysis were more precise than survival estimates from complete analysis. At comparable levels of precision, period analysis provided more up-to-date survival estimates than did complete analysis. Conclusion These results further encourage more widespread use of period analysis as a standard tool for up-to-date monitoring of cancer patient survival by population-based cancer registries.

Use of period analysis for providing more up-to-date estimates of long-term survival rates: empirical evaluation among 370 000 cancer patients in Finland

Providing up-to-date estimates of cancer patient survival rates is an important task of cancer registries. A few years ago, a new method of survival analysis, denoted period analysis, was proposed to enhance the recency of long-term survival estimates. The aim of this paper is to provide a comprehensive empirical evaluation of the use of this method. Using data from the nationwide Finnish Cancer Registry, we compare 5-year and 10-year relative survival rates of 371 849 patients diagnosed with one of the 16 most common forms of cancer in Finland at various time intervals between 1953 and 1992 with the most up-to-date estimates of 5-year or 10-year relative survival that might have been obtained in those time intervals by traditional methods of survival analysis and by period analysis of survival. Survival rates strongly increased over time for most forms of cancer. For these cancers, traditional estimates of 5- and 10-year survival rates would have severely lagged behind the survival rates later observed for newly diagnosed patients, and period analysis would consistently have provided much more up-to-date estimates of survival rates. We conclude that period analysis should be implemented as a standard tool for providing up-to-date estimates of long-term survival rates by cancer registries.

Use of period analysis for providing more up-to-date estimates of long-term survival rates: empirical evaluation among 370 000 cancer patients in Finland

Providing up-to-date estimates of cancer patient survival rates is an important task of cancer registries. A few years ago, a new method of survival analysis, denoted period analysis, was proposed to enhance the recency of long-term survival estimates. The aim of this paper is to provide a comprehensive empirical evaluation of the use of this method.Using data from the nationwide Finnish Cancer Registry, we compare 5-year and 10-year relative survival rates of 371 849 patients diagnosed with one of the 16 most common forms of cancer in Finland at various time intervals between 1953 and 1992 with the most up-to-date estimates of 5-year or 10-year relative survival that might have been obtained in those time intervals by traditional methods of survival analysis and by period analysis of survival.Survival rates strongly increased over time for most forms of cancer. For these cancers, traditional estimates of 5- and 10-year survival rates would have severely lagged behind the survival rates later observed for newly diagnosed patients, and period analysis would consistently have provided much more up-to-date estimates of survival rates.We conclude that period analysis should be implemented as a standard tool for providing up-to-date estimates of long-term survival rates by cancer registries.