Life Expectancy Of Cancer Patients Research Articles

The relationship between social support and life expectancy in cancer patients during chemotherapy;an original study

Introduction: Developing patients’ tolerance in receiving treatment and enhancing their life expectancy has been increasingly recognized as the important end-points in cancer disease. Objectives: This cross-sectional study aimed at exploring the relationship between received social support and its correlation with life expectancy in cancer patients during chemotherapy. Patients and Methods: Around 210 cancer patients were selected through simple sampling procedure from the clinics of Isfahan medical science University, Iran. Sherbourne and Stewart questionnaire and Miller questionnaire were used to assess social support and life expectancy, respectively. The collected data were analyzed by independent t test and linear regression. Results: We found a significant positive correlation between total social support score and life expectancy scores. Additionally, a significant positive correlation between different aspects of social support — tangible support, emotional support and kindness—with positive social interaction and life expectancy was detected. Conclusion: Our results highlights that social support may develop life expectancy in cancer patients depending on the extent of disease; however, extensive and longitudinal studies on social support and life expectancy in cancer patients should be performed.

Cancer patients in the intensive care unit

Over the past 20 years, demographic changes and a longer life expectancy of cancer patients has significantly increased the prevalence of this patient group in the intensive care unit (ICU). A fundamental finding is that acute organ dysfunction, rather than the underlying malignancy, determines the prognosis of ICU patients. While hematologic patients often suffer from a more severe disease course, patients with solid tumors do not present an increased hospital mortality compared to the normal population. As with other indications, the decision to transfer a cancer patient to an ICU should be made as soon as possible. While early transfer is associated with reduced hospital mortality, the presence of multiorgan failure on ICU admission is associated with increased mortality. Overall, the intensive care and hospital survival of critically ill hematologic or oncologic patients has improved over the last two decades and is now as high as 50 to 60%. After surviving an intensive care stay, one fifth of all patients have a good long-term prognosis. Thus, the former paradigm of general rejection of cancer patients for ICU care is no longer justified. For optimal care of cancer patients requiring intensive care, close cooperation between hematologists/oncologists and intensive care physicians is essential.

The effect of group logotherapy on the life expectancy of cancer patients in the north of Iran: a quasi-experimental study

Introduction: Cancer as a formidable diagnosis causes the loss of life expectancy in patients. This study was conducted to determine the effectiveness of logotherapy on the life expectancy of cancer patients in the 5th Azar Hospital of Gorgan, Iran. Material and methods: This quasi-experimental study with two groups (intervention group and control group) was conducted on 40 cancer patients referred to Gorgan’s 5 Azar hospital in Golestan province in the north of Iran from 1 March 2019 to 1 December 2019. The samples were selected by simple random sampling method. The Snyder’s Hope Scale (AHS) was used for data collection. In the logotherapy group, eight 60–90 minute-long sessions were performed in 4 groups included 5 participants. The data were analyzed by SPSS-16 statistical software using descriptive statistics (mean table and standard deviation) and inferential statistics (paired t-test and ANOVA test). Results: The result of the paired t-test showed no significant difference before and after the intervention in the control group (p = 0.67), but this test showed a significant difference in the intervention group before and after the intervention (p = 0.01). The ANOVA test also showed a significant difference between the two groups (p < 0.01). Conclusion: Considering the effectiveness of logotherapy on increasing the life expectancy of cancer people, it is recommended that relevant authorities should try to use this low-cost method to address the problems related to the meaning of life and life expectancy in cancer patients, and change the attitude of patients towards life expectancy.

Immune checkpoint inhibitor myocarditis: a systematic case study

Myocarditis is a life-threatening complication of immune checkpoint inhibitor therapy. Over the past ten years, drugs in this group have been used in the treatment of a wide range of hematological diseases and solid tumors. With steadily growing life expectancy of cancer patients, problems associated with treatment complications are increasingly coming to the fore. Since 2016, publications have appeared on cases of autoimmune myocarditis during checkpoint inhibitor therapy (CIT), among which there are quite a few single-center retrospective and observational studies. At the same time, the problem of diagnosis and treatment of immune checkpoint inhibitor myocarditis remains unresolved.This paper presents a review on the problem of immune checkpoint inhibitor myocarditis, as well as the results of a systematic analysis of PubMed database publications.

Patient-Derived Tumor Organoids for Drug Repositioning in Cancer Care: A Promising Approach in the Era of Tailored Treatment.

Simple SummaryCurrently, organoid research is having a growing impact in oncology. Tumor organoids, directly derived from patients’ specimens, can easily be expanded and cryopreserved. For that reason, they are becoming an indispensable ally in clinics for quicker diagnosis and prognosis of malignancies. Patient-derived cancer organoids are used as a platform to predict the efficacy of standard-of-care, as well as novel drugs. Therefore, this approach might be further utilized for validating off-label molecules, in order to widen the cancer care offer.Malignancies heterogeneity represents a critical issue in cancer care, as it often causes therapy resistance and tumor relapse. Organoids are three-dimensional (3D) miniaturized representations of selected tissues within a dish. Lately, organoid technology has been applied to oncology with growing success and Patients Derived Tumor Organoids (PDTOs) constitute a novel available tool which fastens cancer research. PDTOs are in vitro models of cancer, and importantly, they can be used as a platform to validate the efficacy of anti-cancer drugs. For that reason, they are currently utilized in clinics as emerging in vitro screening technology to tailor the therapy around the patient, with the final goal of beating cancer resistance and recurrence. In this sense, PDTOs biobanking is widely used and PDTO-libraries are helping the discovery of novel anticancer molecules. Moreover, they represent a good model to screen and validate compounds employed for other pathologies as off-label drugs potentially repurposed for the treatment of tumors. This will open up novel avenues of care thus ameliorating the life expectancy of cancer patients. This review discusses the present advancements in organoids research applied to oncology, with special attention to PDTOs and their translational potential, especially for anti-cancer drug testing, including off-label molecules.

Armamentarium of anticancer analogues of curcumin: Portray of structural insight, bioavailability, drug-target interaction and therapeutic efficacy

Cancer represents one of the leading health-care issues around the globe. The overall life expectancy of cancer patients remains dismal regardless of enduring investigations and advances in the management of a disease. Thus the focus is always on the discovery of potential and less toxic alternatives of anticancer agents. Natural compounds from plant and animal kingdoms are grabbing eyeballs around the world owing to their relatively safer and huge unexplored therapeutic potential. One such natural compound is curcumin, which is a yellow polyphenolic compound procured from the plant “Curcuma longa Linn” and used widely as a spice in Indian households. Curcumin has proved its worth in various pathological conditions at preclinical stages. Despite the enormous therapeutic potential, low bioavailability and rapid metabolism are the roadblocks in the journey of curcumin to be a successful clinical candidate. This review is an earnest attempt to provide a summarized account of all the strategies to overcome obstacles of limited bioavailability and improving the therapeutic efficacy of curcumin.Special emphasis is laid on the structural insights into the development of novel curcumin based synthetic analogues endowed with anticancer potential and their docking analysis. Important aspects related to a possible mechanism of action and future prospects in designing of novel curcumin based anticancer analogues are also roofed in this article.

Cáncer, tratamiento onco-hematológico y toxicidad cardiovascular

The increased availability of new cancer treatments in recent years has led to improved prognosis and increased life expectancy for cancer patients, but at the expense of increased cardiovascular risk. For this reason, multidisciplinary teams need to be formed for the joint evaluation of these patients to optimise the cardiovascular health and overall survival of these patients and minimise interruptions to onco-haematological treatments. A wide range of cardiovascular toxicities are associated with the various cancer treatments. The structured control of cardiovascular risk before, during and after oncological treatment will enable strategies for the prevention, early detection and early treatment of cardiotoxicities.

Impact of area-level socioeconomic status and accessibility to treatment on life expectancy after a cancer diagnosis in Queensland, Australia

AimsThis study quantifies geographic inequities in loss of life expectancy (LOLE) by area-level socioeconomic status (SES) and accessibility to treatment. MethodsAnalysis was conducted using a population-based cancer-registry cohort (n = 371,570) of Queensland (Australia) residents aged 50−89 years, diagnosed between 1997–2016. Flexible parametric survival models were used to estimate LOLE by area-level SES and accessibility for all invasive cancers and the five leading cancers. The gain in life years that could be achieved if all cancer patients experienced the same relative survival as those in the least disadvantaged-high accessibility category was estimated for the 2016 cohort. ResultsFor all invasive cancers, men living in the most disadvantaged areas lost 34 % of life expectancy due to their cancer diagnosis, while those from the least disadvantaged areas lost 25 %. The corresponding percentages for women were 33 % and 23 %. Accessibility had a lower impact on LOLE than SES, with patients from low accessibility areas losing 0–4 % more life expectancy than those from high accessibility areas. For cancer patients diagnosed in 2016 (n = 24,423), an estimated 101,387 life years will be lost. This would be reduced by 19 % if all patients experienced the same relative survival as those from the least disadvantaged-high accessibility areas. ConclusionThe impact of a cancer diagnosis on remaining life expectancy varies by geographical area. Establishing reasons why area disadvantage impacts on life expectancy is crucial to inform subsequent interventions that could increase the life expectancy of cancer patients from more disadvantaged areas.

Abstract 2059: Exploiting machine learning in local treatment strategies in cancer patients with bone metastases: A real world clinical trial

Abstract With rising life expectancy in cancer patients with bone metastases, the need for local treatment (LT) is expanding. Machine learning (ML) could create reasonable generalizations, the purpose of this article was to evaluate the use of ML model in LT strategies. Patients were treated by an interdisciplinary team in Shanghai Sixth People's Hospital. Visual analog scale (VAS) and Quality of Life (QoL) Questionnaire Bone Metastases Module scores were analyzed before, 1 week, 1, 3, and 6 months after treatments. ML models were used to calculate LT probability, and confusion matrix was used to calculate the accuracy, precision, recall and F1 score of models. ML models were further used to calculate pathological fracture (PF) probability in lung cancer patients. Of 386 patients enrolled between 2016 and 2017, 101 patients underwent LT. Significant improved VAS and pain domains scores were observed in 27 surgery patients at 1, 3 and 6m, while functional domains scores at 3 and 6m. All five scores improved significantly in 46 percutaneous osteoplasty patients at 1w, 1 and 3m. Significant improved VAS and pain domains scores were observed in 28 radiation patients at 1 and 3m, while functional domains scores at 3m. Compared with team decision-making, decision tree was superior to support vector machine and Bayesian neural networks in model building. The VAS scale, primary cancer, Frankel classification, Mirels score, C-terminal telopeptide of type I collagen (CTx), age, mid-fragment of osteocalcin (MID), character of bone metastases, CA153, and visceral metastases were included in the DT model. In 386 patients, the values of decision tree for the accuracy, precision, recall and F1 score were 86.53%, 78.44%, and 64.90% and 0.69 respectively. 124 lung cancer patients were used to calculate PF probability by decision tree. We also put driving gene mutation and five differentially expressed proteins into the model. The VAS scale, character of bone metastases, age, driving gene mutation, C-terminal telopeptide of type I collagen (CTx), mid-fragment of osteocalcin (MID) and enolase 1 (ENO1) were included in the DT model. The sensitivity, specificity and accuracy of DT model was 90.52%, 87.19% and 77.72%. Appropriate LT provided significant pain relief and improvement in QoL. The ML model is effective in helping physicians determine which patient may be the candidate for LT. Citation Format: Hui Zhao, zhiyu wang, jing Sun, yifeng Gu, mengdi Yang, guangyu Yao. Exploiting machine learning in local treatment strategies in cancer patients with bone metastases: A real world clinical trial [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2059.

Analytical Challenges in Development of Chemoresistance Predictors for Precision Oncology.

Chemoresistance, i.e., tumor insensitivity to chemotherapy, shortens life expectancy of cancer patients. Despite the availability of new treatment options, initial systemic regimens for solid tumors are dominated by a set of standard chemotherapy drugs, and alternative therapies are used only when a patient has demonstrated chemoresistance clinically. Chemoresistance predictors use laboratory parameters measured on tissue samples to predict the patient's response to chemotherapy and help to avoid application of chemotherapy to chemoresistant patients. Despite thousands of publications on putative chemoresistance predictors, there are only about a dozen predictors that are sufficiently accurate for precision oncology. One of the major reasons for inaccuracy of predictors is inaccuracy of analytical methods utilized to measure their laboratory parameters: an inaccurate method leads to an inaccurate predictor. The goal of this study was to identify analytical challenges in chemoresistance-predictor development and suggest ways to overcome them. Here we describe principles of chemoresistance predictor development via correlating a clinical parameter, which manifests disease state, with a laboratory parameter. We further classify predictors based on the nature of laboratory parameters and analyze advantages and limitations of different predictors using the reliability of analytical methods utilized for measuring laboratory parameters as a criterion. Our eventual focus is on predictors with known mechanisms of reactions involved in drug resistance (drug extrusion, drug degradation, and DNA damage repair) and using rate constants of these reactions to establish accurate and robust laboratory parameters. Many aspects and conclusions of our analysis are applicable to all types of disease biomarkers built upon the correlation of clinical and laboratory parameters.

Metabolic Escape Routes of Cancer Stem Cells and Therapeutic Opportunities.

Although improvement in early diagnosis and treatment ameliorated life expectancy of cancer patients, metastatic disease still lacks effective therapeutic approaches. Resistance to anticancer therapies stems from the refractoriness of a subpopulation of cancer cells—termed cancer stem cells (CSCs)—which is endowed with tumor initiation and metastasis formation potential. CSCs are heterogeneous and diverge by phenotypic, functional and metabolic perspectives. Intrinsic as well as extrinsic stimuli dictated by the tumor microenvironment (TME)have critical roles in determining cell metabolic reprogramming from glycolytic toward an oxidative phenotype and vice versa, allowing cancer cells to thrive in adverse milieus. Crosstalk between cancer cells and the surrounding microenvironment occurs through the interchange of metabolites, miRNAs and exosomes that drive cancer cells metabolic adaptation. Herein, we identify the metabolic nodes of CSCs and discuss the latest advances in targeting metabolic demands of both CSCs and stromal cells with the scope of improving current therapies and preventing cancer progression.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) in cancer patients

This literature review focuses on the latest advances in the study of osteonecrosis of the jaw in cancer patients taking bisphosphonates. Prescribing bisphosphonates for the treatment of metastatic bone disease is justifiable and unavoidable measure. The action of bisphosphonates leads to increase in bone tissue strength, but significantly suppressing normal bone remodelling, essential for repair, and becomes vulnerable to mechanical trauma and bacterial invasion. The unique anatomical and physiological features of the jaw bones determine their selective damage. The disease is characterized by progressive jaw necrosis, chronic inflammation of the surrounding tissues complicated by a pathological fracture and persistent oroantral fistula, which aggravates chronic pain and leads to a deterioration in the quality of life of patients. The occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a multifactorial process. Most often, it occurs in patients with long term treatment with zoledronic acid preparations against after tooth extraction. The fact of an increase in the incidence of osteonecrosis is undeniable for objective reasons, the main of which are an increase in cancer, an increase in the life expectancy of cancer patients and their need for bisphosphonate therapy. In the article, it was analyzed the latest scientific reports on the causes of the disease, risk factors and the pathogenesis of the disease. Data on the frequency of jaw osteonecrosis in different countries are presented. It was shown promising developments and summarizes information on existing methods for diagnosing jaw bisphosphonate osteonecrosis. Questions about the key approaches in the treatment of the disease, as well as about new experimental techniques, are examined. The main problems of the prevention of bisphosphonate-related osteonecrosis of the jaws are formulated.

Defining the role of microglia in breast‐to‐brain metastasis

A diagnosis of brain metastasis is devastating to cancer patients, with survival measured in only months. Due to prolonged life expectancy of cancer patients, the frequency of brain metastasis is increasing, with the highest incidences occurring when the primary site is the lung, breast, and melanoma. Treatment of brain metastatic lesions is challenging; differences in the brain microenvironment and the encompassing blood‐brain barrier are two major obstacles to successful systemic therapy. A unique player in the brain tumor microenvironment (TME) are microglia, the resident innate immune cells of the central nervous system. How microglia influence metastatic tumor progression in the brain, and their therapeutic potential in this setting remain to be elucidated. To first characterize the role of microglia in a model of breast‐to‐brain metastasis, we deplete them using the orally available colony stimulating factor 1 receptor (CSF1R) inhibitor, PLX5622, which readily crosses the blood‐brain barrier. Brain metastatic development of a C57BL/6 syngeneic breast cancer line is monitored, and the resulting TME characterized histologically. Further, we utilize in vitro assays to investigate direct communication between microglia and neoplastic cells, measuring tumor cell migration and invasion, and microglial polarization. We also employ PLX5622 therapeutically, after the development of brain metastasis to understand whether dynamic elimination of microglia may be a viable therapy. Understanding microglia’s role in the development of metastatic disease and how these cells may be targeted therapeutically is critical to improving the treatment of brain metastasis.Support or Funding InformationThis work is supported by NIH IRACDA K12GM102779.

ОСНОВНЫЕ ТЕНДЕНЦИИ ЗАБОЛЕВАЕМОСТИ И ПЕРВИЧНОЙ ИНВАЛИДНОСТИ ВСЛЕДСТВИЕ ЗЛОКАЧЕСТВЕННЫХ НОВООБРАЗОВАНИЙ ВЗРОСЛОГО НАСЕЛЕНИЯ ТОМСКОЙ ОБЛАСТИ ЗА ПЕРИОД С 2015 ПО 2019 ГГ.

The article presents results of the analysis of indicators of cancer incidence and primary disability due to malignant neoplasms among adult population of the Tomsk region in dynamics for 2015 - 2019, which indicate an upward trend (by 30.7%) exceeding the average indicators for the Russian Federation and the Siberian Federal District. Increased prevalence of malignant neoplasms among adult population of the Tomsk region over the period under study is due to better detection of malignant neoplasms (a 8.7% increase), as well as implementation of the new and improved methods of special anticancer treatment aimed at complete recovery and increased life expectancy of cancer patients. Malignant neoplasms were more often detected among urban population aged 65 and over (64.8%). The incidence rate of malignant neoplasms in the region progressed from 433.8 to 626.1 per 10 000 population due to increased detection of malignant neoplasms at the early stages (by 2.9%). The rate of advanced cases over the study period decreased by 1.5%. Since 2014, malignant neoplasms have been taking the lead in the structure of adults recognized as disabled for the first time. Indicators of primary disability in the adult population for the period 2015 - 2018 decreased, followed by the increase in 2019, however, the disability rate in all adult age groups remained below the similar indicators in Russia and the Siberian Federal District. Women, persons of the retirement age, and urban dwellers prevailed in this contingent of the disabled. The share of people of working age decreased from 38.4% to 35.2%. The share of people of the retirement age increased from 61.6% to 64.8%, respectively. Group II disability was the most often established, in dynamics, the share of the disabled with groups II and III decreased. There was a significant increase from 20.4% to 31.9% in the share of citizens who, during the initial examination, were established as group I. The main localizations of malignant neoplasms resulting in disability in 2015 - 2017 included mammary gland, larynx, trachea, bronchi and lungs, and female genital organs; and stomach and large intestine - in 2018 - 2019. The share of malignant neoplasms with multiple localizations increased from 1.8% to 5.2%.

Development of a new assessment for cardio-oncology and its international trend

Cardiac safety assessments play a key role in drug development. New non-clinical cardiac safety risk assessments, such as the use of iPSC-derived cardiomyocytes, have been validated by several consortiums both in Japan and abroad. The emerging multidisciplinary field of cardio-oncology has been recognized more important. The success of new cancer therapies has improved life expectancy of cancer patients, hence more attention has been paid to cardiotoxicities associated with existing and new anti-cancer therapies, such as cardiomyocyte injury and heart failure, vascular injury and hypertension or thrombosis, which accelerated coronary artery disease. In addition to the well-studied proarrhythmia risk, some cardiotoxicities, such as contractility impairment, are expected to be evaluated by iPSC-derived cardiomyocytes. Here we developed a novel imaging-based in vitro contractility assay using iPSC-derived cardiomyocytes. In the review, we would like to discuss the current status and future perspectives in the assessment of cardiac contractile function by anti-cancer agents.

Treatment of spine metastases in cancer: a review.

As a consequence of the improvements in diagnostic technology along with gains in life expectancy of cancer patients, the incidence of spine metastases has increased. Spine metastases can affect the patient’s quality of life and negatively impact on their prognosis. Multidisciplinary treatments involve surgery, chemotherapy, radiosurgery and radiotherapy. Spine metastases should be treated using a multidisciplinary and integrated approach that involves spinal surgeons, medical oncologists and radiologists. More research is required to elucidate the pathological mechanisms involved in the aetiology of spine metastasis. This review describes the current situation regarding the diagnosis of spine metastasis, what is understood about the pathological development of spine metastasis and the evolution of the multidisciplinary treatments that are available for patients with spine metastases.

Chapitre 9. Oncofertility and prepubescent girls: A ‘right to an open future’?.

Chemotherapy and radiotherapy have increased the life expectancy of cancer patients but may cause premature ovarian failure and irreversible loss of fertility. In the context of childhood cancers, it is now acknowledged that possible negative effects of treatment on future reproductive autonomy are a major concern. While a few options are open to patients post-puberty, the only option currently open to prepubescent girls is cryopreservation of ovarian tissue and subsequent transplantation. Yet, this procedure raises ethical concerns related to its experimental nature and to risks involved in surgery and general anesthesia. In addition, the risk of malignant cells being reintroduced in the future following autologous transplantation of the ovarian tissue is still poorly evaluated. A number of ethical issues arise surrounding this procedure. While the girl’s future reproductive autonomy is at stake, it is important to also consider risks associated with the procedure. Fertility preservation through cryopreservation of ovarian tissue thus raises a conflict between the principles of beneficence and non-maleficence. We argue that the ethical complexity surrounding fertility preservation for prepubescent girls should be resolved by applying the principle of “the child’s right to an open future”. We propose to consider ‘beneficence’ through the lens of the reproductive autonomy and her potentialin becoming a genetic parent.

The use of quality indicators (QIs) to evaluate the oncologic care in CCCN: a systematic review

Abstract Due to the increase of life expectancy for cancer patients, it has become necessary to implement complete and economically sustainable clinical care pathways that integrate different professional competences. The Comprehensive Cancer Care Network (CCCN) model consists of multiple specialized structures that cooperate for cancer patients care. Quality Indicators (QIs) represent valid and reliable tools of evaluation that allow a standardized comparison among different structures. The aim of this systematic review was to highlight a wide and complete description of the implemented QIs within the CCCNs and to identify and analyze methodologies used for the development of QIs. The literature was performed investigating two databases (PubMed and Scopus) and the search identified 7342 studies. After duplicate removal, title and abstract screening, and full text evaluation, 46 studies were included in the study. Most QIs were implemented in USA, Germany and Italy where the CCCN approach seems to be well defined. Eighty -two QIs concerned diagnosis, 260 concerned treatment, 7 concerned prevention, 29 about follow up, 71 about palliative care, 12 concerned rehabilitation and 7 research. The majority of the identified QIs belonged to the process domain, followed by the structure ones. Excluding QIs related to the management of cancer in general, the most represented organs resulted breast, colorectum and lung. Overall, it can be stated that the most represented categories of QIs concerned diagnosis and treatment. Furthermore, also the palliative care domain appeared very represented. Regarding the methodology of the QIs development, a consensus approach among experts and the Delphi method were the most frequently used methodologies. Only a few studies included the participation of patients for the implementation of the QIs. This systematic review provides a synthesis of existing QIs related to the setting of integrated oncological care Key messages The CCCN has been recognized as an ideal model for structuring the process of care that guarantees a complete and integrated approach for the management of oncological patients. Quality Indicators represent valid and reliable tools that should be used to perform a standardized comparison among different healthcare systems and to guarantee a homogeneous quality of care.

Changes in life expectancy for cancer patients over time since diagnosis

The aims of this study were to provide life expectancy (LE) estimates of cancer patients at diagnosis and LE changes over time since diagnosis to describe the impact of cancer during patients' entire lives. Cancer patients' LE was calculated by standard period life table methodology using the relative survival of Italian patients diagnosed in population-based cancer registries in 1985–2011 with follow-up to 2013. Data were smoothed using a polynomial model and years of life lost (YLL) were calculated as the difference between patients' LE and that of the age- and sex-matched general population. The YLL at diagnosis was highest at the youngest age at diagnosis, steadily decreasing thereafter. For patients diagnosed at age 45 years, the YLL was above 20 for lung and ovarian cancers and below 6 for thyroid cancer in women and melanoma in men. LE progressively increased in patients surviving the first years, decreasing thereafter, to approach that of the general population. YLL in the long run mainly depends on attained age. Providing quantitative data is essential to better define clinical follow-up and plan health care resource allocation. These results help assess when the excess risk of death from tumour becomes negligible in cancer survivors.

Illustration of different modelling assumptions for estimation of loss in expectation of life due to cancer

BackgroundThe life expectancy of cancer patients, and the loss in expectation of life as compared to the life expectancy without cancer, is a useful measure of cancer patient survival and complement the more commonly reported 5-year survival. The estimation of life expectancy and loss in expectation of life generally requires extrapolation of the survival function, since the follow-up is not long enough for the survival function to reach 0. We have previously shown that the survival of the cancer patients can be extrapolated by breaking down the all-cause survival into two component parts, the expected survival and the relative survival, and make assumptions for extrapolation of these functions independently. When extrapolating survival from a model including covariates such as calendar year, age at diagnosis and deprivation status, care has to be taken regarding the assumptions underlying the extrapolation. There are often different alternative ways for modelling covariate effects or for assumptions regarding the extrapolation.MethodsIn this paper we describe and discuss different alternative approaches for extrapolation of survival when estimating life expectancy and loss in expectation of life for cancer patients. Flexible parametric models within a relative survival setting are used, and examples are presented using data on colon cancer in England.ResultsGenerally, the different modelling assumptions and approaches give small differences in the estimates of loss in expectation of life, however, the results can differ for younger ages and for conditional estimates.ConclusionSensitivity analyses should be performed to evaluate the effect of the assumptions made when modelling and extrapolating survival to estimate the loss in expectation of life.