Abstract
If cancer survival is reported to be worsening over time or inferior compared to other countries, politicians and health-care workers may get blamed because suboptimal care is presumed to be the cause. Yet, a variety of reasons exist for cancer survival statistics to change for the worse, of which deterioration of care is only one. Another explanation is that the improved diagnosis of premalignant lesions causes survival statistics to reflect only the most aggressive cancers—those with the poorest prognosis. In addition, deleterious changes in the distribution of prognostic factors and in the distribution of sociodemographic characteristics may negatively affect survival proportions. In this article, we identify the pitfalls that might be encountered in comparisons of published, population-based survival data from different time periods or populations.
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References
Karim-Kos, H. E. et al. Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. Eur. J. Cancer 44, 1345–1389 (2008).
Jemal, A. et al. Cancer statistics, 2007. CA Cancer J. Clin. 57, 43–66 (2007).
Dickman, P. W. & Adami, H. O. Interpreting trends in cancer patient survival. J. Intern. Med. 260, 103–117 (2006).
Welch, H. G., Schwartz, L. M. & Woloshin, S. Are increasing 5-year survival rates evidence of success against cancer? JAMA 283, 2975–2978 (2000).
Brenner, H., Gondos, A. & Arndt, V. Recent major progress in long-term cancer patient survival disclosed by modeled period analysis. J. Clin. Oncol. 25, 3274–3280 (2007).
Pokhrel, A. & Hakulinen, T. How to interpret the relative survival ratios of cancer patients. Eur. J. Cancer 44, 2661–2667 (2008).
Kiemeney, L. A. et al. Bladder cancer incidence and survival in the south-eastern part of The Netherlands, 1975–1989. Eur. J. Cancer 30 (Pt A), 1134–1137 (1994).
Berrino, F. The EUROCARE study: strengths, limitations and perspectives of population-based, comparative survival studies. Ann. Oncol. 14 (Suppl. 5), V9–V13 (2003).
Robinson, D., Sankila, R., Hakulinen, T. & Moller, H. Interpreting international comparisons of cancer survival: the effects of incomplete registration and the presence of death certificate only cases on survival estimates. Eur. J. Cancer 43, 909–913 (2007).
Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N. Engl. J. Med. 324, 1685–1690 (1991).
Hoffman, H. T. et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope 116, 1–13 (2006).
Lambert, E. H. et al. The increasing use of intravesical therapies for stage T1 bladder cancer coincides with decreasing survival after cystectomy. BJU Int. 100, 33–36 (2007).
Coebergh, J. W. et al. Leukaemia incidence and survival in children and adolescents in Europe during 1978–1997. Report from the Automated Childhood Cancer Information System project. Eur. J. Cancer 42, 2019–2036 (2006).
Aareleid, T. & Brenner, H. Trends in cancer patient survival in Estonia before and after the transition from a Soviet republic to an open-market economy. Int. J. Cancer 102, 45–50 (2002).
Ciccolallo, L. et al. Survival differences between European and US patients with colorectal cancer: role of stage at diagnosis and surgery. Gut 54, 268–273 (2005).
Janssen-Heijnen, M. L. & Coebergh, J. W. Trends in incidence and prognosis of the histological subtypes of lung cancer in North America, Australia, New Zealand and Europe. Lung Cancer 31, 123–137 (2001).
Pinheiro, P. S., van der Heijden, L. H. & Coebergh, J. W. Unchanged survival of gastric cancer in the southeastern Netherlands since 1982: result of differential trends in incidence according to Lauren type and subsite. Int. J. Cancer 84, 28–32 (1999).
Berrino, F. & Gatta, G. Variation in survival of patients with head and neck cancer in Europe by the site of origin of the tumors. Eur. J. Cancer 34, 2154–2161 (1998).
van de Poll-Franse, L. V. et al. Less aggressive treatment and worse overall survival in cancer patients with diabetes: a large population based analysis. Int. J. Cancer 120, 1986–1992 (2007).
Janssen-Heijnen, M. L. et al. Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach. Crit. Rev. Oncol. Hematol. 55, 231–240 (2005).
Zaborskis, A., Sumskas, L., Maser, M. & Pudule, I. Trends in drinking habits among adolescents in the Baltic countries over the period of transition: HBSC survey results, 1993–2002. BMC Public Health 6, 67 (2006).
Zatonski, W. & Jha, P. The health transformation in Eastern Europe after 1990: a second look. Cancer Center and Institute of Oncology, Warsaw [online], (2009).
Parkin, D. M. The global health burden of infection-associated cancers in the year 2002. Int. J. Cancer 118, 3030–3044 (2006).
Coleman, M. P., Babb, P., Sloggett, A., Quinn, M. & De Stavola, B. Socioeconomic inequalities in cancer survival in England and Wales. Cancer 91, 208–216 (2001).
Woods, L. M., Rachet, B. & Coleman, M. P. Origins of socio-economic inequalities in cancer survival: a review. Ann. Oncol. 17, 5–19 (2006).
Sant, M. et al. EUROCARE-3: survival of cancer patients diagnosed 1990–94—results and commentary. Ann. Oncol. 14 (Suppl. 5), V61–V118 (2003).
Verdecchia, A. et al. Recent cancer survival in Europe: a 2000–02 period analysis of EUROCARE-4 data. Lancet Oncol. 8, 784–796 (2007).
Linos, A. & Riza, E. Comparisons of cervical cancer screening programs in the European Union. Eur. J. Cancer 36, 2260–2265 (2000).
Anttila, A. et al. Cervical cancer screening programs and policies in 18 European countries. Br. J. Cancer 91, 935–941 (2004).
Acknowledgements
This work was performed within the framework of the research project 'Progress against cancer in The Netherlands since the 1970s' (Dutch Cancer Society grant 715,401), and was co-funded by the Comprehensive Cancer Center South, Eindhoven, The Netherlands.
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de Vries, E., Karim-Kos, H., Janssen-Heijnen, M. et al. Explanations for worsening cancer survival. Nat Rev Clin Oncol 7, 60–63 (2010). https://doi.org/10.1038/nrclinonc.2009.184
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DOI: https://doi.org/10.1038/nrclinonc.2009.184
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