Modelling population-based cancer survival trends using join point models for grouped survival data

Survival Trends Among Adolescents and Young Adults Diagnosed With Cancer in the United States: Comparisons With Children and Older Adults

PURPOSE

Although data from 1975 to 1997 revealed a gap in cancer survival improvement in adolescents and young adults (AYAs; 15-39 years) compared with children and older adults, more recent studies have reported improvements in AYA cancer survival overall. The current analysis provides an update of 5-year relative survival and cancer survival trends among AYAs compared with children and older adults.

METHODS

We obtained data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program for 17 regions to obtain recent (2010-2018) 5-year relative survival estimates by cancer type, stage, sex, and race/ethnicity by age group. In addition, we calculated 5-year relative survival trends during 2000-2014.

RESULTS

Across 33 common AYA cancers, AYAs and children had high 5-year relative survival (86%) and experienced similar survival improvements over time (average absolute change: AYAs, 0.33%; children 0.36%). Among AYAs, 73% of cancers had improvement in 5-year relative survival since 2000. Despite this overall progress, we identified cancers where survival was worse in AYAs than younger or older patients and cancers that have had either a lack of improvement (osteosarcoma and male breast) or decreases in survival (cervical and female bladder) over time. Furthermore, males had inferior survival to females for all cancers, except Kaposi sarcoma and bladder cancer, and non-Hispanic Black/African American AYAs experienced worse survival than other racial/ethnic groups for many cancers considered in this study.

CONCLUSION

Future studies should focus on identifying factors affecting survival disparities by age, sex, and race/ethnicity. Differences in biology, clinical trial enrollment, delivery of treatment according to clinical guidelines, and supportive and long-term survivorship care may account for the survival disparities we observed and warrant further investigation.

Increase in the Life Expectancy of Patients with Cancer in the United States

BACKGROUND

Cancer is becoming more of a chronic disease due to improvements in treatment and early detection for multiple cancer sites. To gain insight on increased life expectancy due to these improvements, we quantified trends in the loss in expectation of life (LEL) due to a cancer diagnosis for six cancer sites from 1975 through 2018.

METHODS

We focused on patients diagnosed with female breast cancer, chronic myeloid leukemia (CML), colon and rectum cancer, diffuse large B-cell lymphoma (DLBCL), lung cancer, or melanoma between 1975 and 2018 from nine Surveillance, Epidemiology, and End Results cancer registries. Life expectancies for patients with cancer ages 50+ were modeled using flexible parametric survival models. LEL was calculated as the difference between general population life expectancy and life expectancy for patients with cancer.

RESULTS

Over 2 million patients were diagnosed with one of the six cancers between 1975 and 2018. Large increases in life expectancy were observed between 1990 and 2010 for female breast, DLBCL, and CML. Patients with colon and rectum cancer and melanoma had more gradual improvements in life expectancy. Lung cancer LEL only began decreasing after 2005. Increases in life expectancy corresponded with decreases in LEL for patients with cancer.

CONCLUSIONS

The reported gains in life expectancy largely correspond to progress in the screening, management, and treatment of these six cancers since 1975.

IMPACT

LEL provides an important public health perspective on how improvements in treatment and early detection and their impacts on survival translate into changes in cancer patients' life expectancy.

Epidemiologic trends of and factors associated with overall survival in patients with neuroendocrine tumors over the last two decades in the USA

Background

Updated epidemiological data of neuroendocrine tumors are currently lacking. Thus, we performed epidemiological and survival analyses on a large cohort of patients with neuroendocrine tumors and developed a new nomogram to predict survival.

Methods

This population-based study examined 112,256 patients with neuroendocrine tumors between 2000 and 2018 using data from the Surveillance, Epidemiology, and End Results program.

Results

The age-adjusted incidence per 100,000 persons of neuroendocrine tumors increased from 4.90 in 2000 to 8.19 in 2018 (annual percentage change, 3.40; 95% confidence interval, 3.13-3.67), with the most significant increases in grade 1, localized stage, and appendix neuroendocrine tumors. The age-adjusted mortality rate increased 3.1-fold from 2000 to 2018 (annual percentage change, 4.14; 95% confidence interval, 3.14-5.15). The 1-, 5-, and 10-year relative survival rates for all neuroendocrine tumors were 80.5%, 68.4%, and 63.5%, respectively. Multivariate analyses showed that male sex; older age; Black, American Indian, and Alaska Native populations; earlier year of diagnosis; lung neuroendocrine tumors; higher grades; and later stage were associated with a worse prognosis and that disease stage and grade were the most important risk factors for prognosis. Furthermore, we established a nomogram to predict the 3-, 5-, and 10-year survival rates, and its discrimination ability was better than that of the TNM classification.

Conclusions

The incidence, prevalence, and mortality rate of neuroendocrine tumors continued to increase over the last two decades. Additionally, the nomogram could accurately quantify the risk of death in patients with neuroendocrine tumors and had good clinical practicability.

The net effect of wealth on health-Investigating noncommunicable diseases mortality in the context of regional affluence

The wealth-health relationship is not unambiguous and constant. Greater wealth affects individual and population health in opposite ways. Increased risk factors especially raise the probability of noncommunicable diseases (NCDs) impacting a population. Conversely, better healthcare and awareness reduce the chances of developing these diseases or increase the likelihood of treatment and cure. Therefore, this paper aims to assess and quantify the hard-to-grasp overall impact of prosperity on mortality from selected NCDs, allowing us to capture the relevant differences between European regions. In particular, we attempt to estimate the net effect of affluence and the health economic threshold of the GDP-mortality relationship, by developing a dedicated analytical tool based on joinpoint regression and forecasting methods. Our results show that in the case of most investigated diseases in more impoverished regions, a clear pattern reflects mortality rising with prosperity. After crossing the health economic threshold of around 20 thousand euros per capita, the trend changes by stabilising or reversing. The research we present shows that health policy should be more diversified locally to enable health convergence at the national and European regional levels. Moreover, health policy should evolve to prioritise mental and neurological disorders, by improving the resource allocation and increasing public awareness.

Survival trends for patients with retinoblastoma between 2000 and 2018: What has changed?

INTRODUCTION

Retinoblastoma (RB) is the most common primary intraocular cancer of childhood. Over the last few decades, a variety of techniques and treatment modalities emerged that improved the survival and ocular salvage rate of patients with RB. We investigated the relative survival trends of patients with RB from 2000 to 2018 by using the Surveillance, Epidemiology, and End Results (SEER) database.

DESIGN

Retrospective database review.

METHODS

We extracted data from SEER 18 from 2000 to 2018. All patients with clinically diagnosed RB during the study period were included. We utilized SEER*Stat 8.3.9 and JPSurv software to estimate relative 5- and 10-year survival rates and trends and generated descriptive analyses with IBM SPSS.

MAIN OUTCOME MEASURES

Patient survival rates at 5- and 10-year after RB diagnosis.

RESULTS

RB was diagnosed in 1479 patients within the SEER 18 Program during our study period. The cohort comprised 776 (52.5%) males, 615 (41.6%) non-Hispanic whites, 487(32.9%) Hispanics, 1030 (69.6%) patients with unilateral disease, and 1087 (73.5%) patients with localized disease. Relative survival trends at 5- and 10-year significantly declined over the study periods (-0.42%, and -0.50% annually, respectively) but the decline was not significant in unilateral and bilateral RB cases separately.

CONCLUSIONS

Five- and ten-year relative survival trends declined from 2000 to 2018 and were significantly decreasing. Further studies that include more patients are needed to identify the factors contributing to reduced survival of patients with RB over time.

Global pattern and trend of cervical cancer incidence from 1993 to 2012: Joinpoint regression and age-period-cohort analysis

Background

Cervical cancer ranks fourth in global cancer incidence and mortality among women. A comparison of the global trends in cervical cancer would help us to identify high focus regions and serves an opportunity to evaluate the impact of the screening programs. Hence, the current study was done to assess the global trend in the incidence of cervical cancer from 1993 to 2012 among individuals aged between 30 and 79 years.

Methods

This secondary data analysis was conducted using the World Health Organization (WHO) Cancer Incidence data of five continents plus database (America, Asia, Europe, and Oceania) on the incidence of cervical cancer. Joinpoint regression was performed to determine the average annual percent change (AAPC) in cervical cancer incidence. We performed an age-period-cohort analysis to obtain age, period, and cohort-specific deviations and rate ratio (RR).

Results

Out of the four regions studied, all the regions showed a declining trend in cervical cancer incidence. The maximum decline was found in Oceania (AAPC = -3.3%) followed by America (AAPC = -2.0%). There was a consistent rise in cervical cancer incidence across the age groups in all the four continents with the maximum burden among the elderly. All the regions showed a steady decline in the rate of cervical cancer through the periods 1998-2002 to 2007-2012. There was also a steady decline in cervical cancer incidence across the cohorts from 1923-1927 to 1978-1982 in all the regions except America.

Conclusion

To summarize, cervical cancer incidence showed a declining trend globally, with the maximum decline in the Oceania region from 1993 to 2012.

Trends in premature mortality rates among the Polish population due to cardiovascular diseases

OBJECTIVES

At the end of the 20th century, after years of negligence in the prevention of cardiovascular diseases, Poland was struggling with very high premature mortality. The period of 1991-2005 brought significant improvements since the general public introduced beneficial dietary modifications. This paper aims to analyze the changes in the rate of premature mortality due to tobacco-dependent cardiovascular diseases in Poland in 2008-2017.

MATERIAL AND METHODS

The time trends of deaths occurring under the age of 65 years caused by ischemic heart disease, cerebrovascular disease, atherosclerosis and aortic aneurysm were analyzed. Both standardized and crude premature mortality rates were used, as well as mortality rates for patients grouped into 5-year age ranges with a breakdown by gender. The joinpoint model was used to determine these time trends.

RESULTS

Premature mortality due to the analyzed cardiovascular diseases decreased linearly in 2008-2017. In the case of ischemic heart disease and cerebrovascular diseases, the decrease amounted to approx. 5% per year, both in the female and male population. However, in the case of atherosclerosis and aortic aneurysms, the rate of mortality reduction ranged 4-7% per year. The reduction concerned all the examined age groups, but with different dynamics. The most considerable annual decrease was observed in the group of patients aged 40-44 years (7.9% for females and 8.9% for males). Along with the increase in age, the dynamics of reduction decreased.

CONCLUSIONS

In 2008-2017, Poland experienced a decline in premature mortality due to tobacco-related cardiovascular diseases, particularly in the age group of 40-44 years. The decline may have been associated, among other things, with a reduction in exposure to tobacco smoke, one of the cardiovascular risk factors. Int J Occup Med Environ Health. 2022;35(1):27-38.

Characterizing Trends in Cancer Patients' Survival Using the JPSurv Software

BACKGROUND

Improvements in cancer survival are usually assessed by comparing survival in grouped years of diagnosis. To enhance analyses of survival trends, we present the joinpoint survival model webtool (JPSurv) that analyzes survival data by single year of diagnosis and estimates changes in survival trends and year-over-year trend measures.

METHODS

We apply JPSurv to relative survival data for individuals diagnosed with female breast cancer, melanoma cancer, non-Hodgkin lymphoma (NHL), and chronic myeloid leukemia (CML) between 1975 and 2015 in the Surveillance, Epidemiology, and End Results Program. We estimate the number and location of joinpoints and the trend measures and provide interpretation.

RESULTS

In general, relative survival has substantially improved at least since the mid-1990s for all cancer sites. The largest improvements in 5-year relative survival were observed for distant-stage melanoma after 2009, which increased by almost 3 survival percentage points for each subsequent year of diagnosis, followed by CML in 1995-2010, and NHL in 1995-2003. The modeling also showed that for patients diagnosed with CML after 1995 (compared with before), there was a greater decrease in the probability of dying of the disease in the 4th and 5th years after diagnosis compared with the initial years since diagnosis.

CONCLUSIONS

The greatest increases in trends for distant melanoma, NHL, and CML coincided with the introduction of novel treatments, demonstrating the value of JPSurv for estimating and interpreting cancer survival trends.

IMPACT

The JPSurv webtool provides a suite of estimates for analyzing trends in cancer survival that complement traditional descriptive survival analyses.

Premature Mortality Due to Tobacco-Related Malignancies in Poland

Introduction

Although in Poland at the turn of the 20th and 21st centuries, tobacco consumption per capita was one of the highest in the world as a result of specific political and social conditions, nicotinism was the most common preventable cause of death that reduced life expectancy by 10 years on average. The aim of this study is to determine the level of premature mortality and its trends by age and sex for tobacco-related malignancies in Poland in the years 2008–2017.

Methods

The standardised premature mortality rates as well as mortality rates for five-year age ranges according to the patients’ sex were used. The Joinpoint model was used to determine the time trends.

Results

Premature mortality due to all tobacco-dependent cancers analysed decreased in Poland throughout the analysed period in both male (2.5% per year) and female (1% per year) populations. A detailed analysis of individual diseases showed that a decrease in premature mortality was observed for almost all malignancies with the exception of malignant liver cancer among males, malignant oesophageal cancer among females and malignant lip, oral cavity and oropharyngeal cancer in both sexes. The reduction in mortality from all tobacco-related cancers in the male population was greatest between 40 and 44 years of age, reaching 5.6% year on year. Similarly, in the case of females, the decline in mortality was greater in the younger age cohorts and decreased in those aged over 50.

Conclusion

The favourable phenomenon of decreasing the level of premature mortality caused by tobacco-related malignancies may be associated, among others, with the policy of primary prevention of these diseases in the form of a widespread ban on smoking in public places, intensive information campaigns on the harmfulness of tobacco smoking and increasing taxation on tobacco products.

Time trends of major cancers incidence and mortality in Guangzhou, China 2004-2015: A Joinpoint and Age-Period-Cohort Analysis

Background

Cancer is an important focus of public health worldwide. This study aims to provide a comprehensive overview of temporal trends in incidence and mortality of leading cancer in Guangzhou, China from 2004 to 2015.

Methods

Data were collected from the population‐based registry in Guangzhou. Age‐standardized incidence rate (ASIR) and age‐standardized mortality rate (ASMR) were calculated and Joinpoint regression was used for evaluating the average annual percent changes (AAPC) among the entire study period and the estimated annual percent changes (EAPC) in time segments. The effects of age, period, and birth cohort were assessed by the age–period–cohort model.

Results

The age‐standardized incidence and mortality by the world standard population decreased significantly among males with AAPC of −1.7% (95% CI: −3.0%, 0.2%) and −2.7% (95% CI: −4.3%, −1.1%) for all malignancies during 2004–2015, while among females, the age‐standardized incidence had a non‐significant reduction with AAPC of −1.3% (95% CI: −2.8%, 0.2%) and the age‐standardized mortality demonstrated a remarkable decline (AAPC −2.0%, 95% CI: −3.6%, −0.3%). For males, the most commonly diagnosed cancers were trachea, bronchus, and lung (TBL), liver, colorectal, nasopharyngeal, stomach, and prostate cancer. For females, breast, TBL, colorectal, liver stomach, and thyroid cancer ranked the top. Unfavorable trends were observed in ASIR of colorectal, thyroid, and prostate cancer. APC models yielded different ages, periods, and birth cohort effect patterns by cancer sites.

Conclusions

Cancer burden remained a public health challenge in Guangzhou as the aging population and lifestyles changes, despite declines in incidence and mortality rates in some cancers. Surveillance of cancer trends contributed to valuable insights into cancer prevention and control.

Premature Mortality Due to Chronic Obstructive Pulmonary Disease (COPD) in Poland

Background and objectives: Chronic obstructive pulmonary disease (COPD) is responsible for 5.3% of deaths worldwide and constitutes the third most common cause of death. The deaths from this cause occur over 10times more often in smokers than in non-smokers. Fortunately, for nearly 30 years, the proportion of people smoking tobacco in Poland has been decreasing. This study aims to analyse the change in premature mortality rates of men and women due to COPD in Poland during 2008-2017. Materials and Methods: The time trends of deaths occurring under 65 were analysed. Standardised premature mortality rates were used, as well as the mortality rates for the five-year age ranges, with a breakdown by gender. The Joinpoint model was used to determine time trends. Results: Over the period analysed, premature mortality in the female population decreased by 2.6% from year to year, albeit without statistical significance, and in the male population there was a decrease by statistically significant 5.2% per year. The biggest drop in mortality, almost 10% per year, was observed in the group of females aged between 50 and 54. Among males, the most significant reduction in mortality was observed in groups between the ages of 40 and 54, and it amounted to approximately 8% annually. With increasing age, the dynamics of mortality reduction decreased. Conclusions: The study showed a steady downward trend in premature mortality due to chronic obstructive pulmonary disease in Poland in both genders. The reduction in mortality was at a high level, despite the lower mortality due to this cause than in other European countries.

The utility of joinpoint regression for estimating population parameters given changes in population structure

The method of joinpoint regression has been used in numerous domains to assess changes in time series data, including such things as cancer mortality rates, motor vehicle collision mortalities, and disease risk. To help improve estimation of population parameters for use in ecological risk assessment and management, we present a simulation and analysis to describe the utility of this method for the ecological domain. We demonstrate how joinpoint regression can accurately identify if the population structure changes based on time series of abundance, as well as identify when this change occurs. In addition, we compare and contrast population parameter estimates derived through joinpoint and surplus production methods to those derived from standard surplus production methods alone. When considering a change point at 32 years (out of a 64 year simulation), the joinpoint regression model was able, on average, to estimate a joinpoint time of 32.31 years with a variance of 6.82 and 95% confidence interval for the mean relative bias of (0.0085, 0.0112). The model was able to consistently estimate population parameters, with variance of these estimations decreasing as the change in these population parameters increased. We conclude that joinpoint regression be added to the list of methods employed by those who assess ecological risk to allow for a more accurate and complete understanding of population dynamics.

Time-varying Readmission Diagnoses During 30 Days After Hospitalization for COPD Exacerbation

OBJECTIVE

To investigate the longitudinal changes in principal readmission diagnoses within 30 days after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

STUDY SETTING

Medicare claims data, 2010-2012.

STUDY DESIGN

Retrospective cohort study.

DATA COLLECTION METHODS

We identified AECOPD hospitalizations aged 65 years and above, and examined the principal 30-day readmission diagnoses (respiratory related, cardiac related, and other conditions). We also constructed Joinpoint regression models to test whether patients with each of the 3 major readmission conditions had a unique temporal pattern of readmission during the 30-day period.

PRINCIPAL FINDINGS

Among 76,697 index hospitalizations with AECOPD, 14,090 (18.4%) were readmitted within 30 days. Respiratory-related conditions accounted for 55% of readmissions. The proportion of respiratory-related conditions as the readmission diagnosis decreased from postdischarge day 1 to day 8 (4.0% decrease), and then increased thereafter (13.2% increase; P=0.06). Cardiac-related conditions had a similar nonlinear trend with an inflection point at day 6 (P=0.02), with a subsequent downward trend from day 22 (P=0.01). By contrast, the other conditions increased from day 1 to day 6 (15.0% increase), and then significantly decreased (28.8% decrease; P=0.04).

CONCLUSIONS

The proportions of principal discharge diagnosis of readmission changed significantly at around postdischarge day 7. Our findings advance research into identification of the underlying mechanisms and development of targeted interventions to prevent readmissions.

Hepatitis C virus-related complications are increasing in women veterans: A national cohort study

There are gender-specific variations in the epidemiology and clinical course of hepatitis C virus (HCV) infection. However, few long-term longitudinal studies have examined trends in the incidence and prevalence of serious liver complications among women compared with men with HCV infection. We used the Veterans Administration Corporate Data Warehouse to identify all veterans with positive HCV viraemia from January 2000 to December 2013. We calculated gender-specific annual incidence and prevalence rates of cirrhosis, decompensated cirrhosis and hepatocellular cancer (HCC) adjusting for age, diabetes, HIV and alcohol use. We also calculated the average annual per cent change (AAPC) for each outcome by gender using piecewise linear regression in the Joinpoint software. We identified 264 409 HCV-infected veterans during 2000-2013, of whom 7162 (2.7%) were women. There were statistically significant increases over time in the incidence rates of cirrhosis, decompensated cirrhosis and HCC for both men and women. The annual-adjusted incidence rates of cirrhosis, decompensated cirrhosis and HCC were higher in men than women for all study years. However, these complications increased at a similar rate in both groups. Specifically, the AAPC for cirrhosis was 13.1 and 15.2, while it was 15.6 and 16.9 for decompensated cirrhosis and 21.0 and 25.3 for HCC in men and women, respectively (all test of parallelism not significant). The results were similar in the prevalence analyses, although AAPCs were slightly smaller for each outcome. In conclusion, we found an ongoing upward trend in the incidence and prevalence of HCV complications in this cohort of HCV-infected women. This increase in cirrhosis complications in women with active HCV infection is similar to those in men. With cure from HCV now becoming a reality, most of the projected burden of HCV is potentially preventable. However, benefits of HCV treatment will need to extend to all patients in order to stem the rising tide of HCV complications.

MicroRNA-15a inhibits the growth and invasiveness of malignant melanoma and directly targets on CDCA4 gene

MicroRNAs can affect behaviors of tumor cells by modulating the expression of the target genes that involve tumor growth, invasiveness, and death. The goal of this research is to examine the effects of miR-15a on the proliferation and invasiveness of malignant melanoma cells in vitro, as well as the therapeutic effect of miR-15a in a mouse melanoma model. miR-15a displayed inhibitory effects on proliferation and invasiveness of several malignant melanoma cell lines. miR-15a also caused cell cycle arrest at G1/G0 phase. miRNA 15a downregulated the expressions of CDCA4 and AKT-3 in melanoma cell lines. In vivo, experiment showed that miRNA 15a significantly retarded the growth of melanoma tumors in the mouse model. The luciferase reporter assay demonstrated that miR15a can suppress gene expression through the binding site in the 3 'UTR of CACD4, which is a bona fide target of miRNA 15a. In conclusion, miRNA 15a suppressed the growth and invasiveness of melanoma cells, suggesting that miRNA 15a may represent a viable microRNA-based therapy against melanoma.

Contributions of HIV to Non-Hodgkin Lymphoma Mortality Trends in the United States

BACKGROUND

The human immunodeficiency virus (HIV) epidemic has strongly influenced non-Hodgkin lymphoma (NHL) incidence in the U.S. general population, but its effects on NHL mortality trends are unknown.

METHODS

Using SEER cancer registry data, we assessed NHL mortality rates in the United States (2005-2012) and mapped NHL deaths to prior incident cases. Data included HIV status at NHL diagnosis. We describe the proportion of NHL deaths linked to an HIV-infected case, for 3 AIDS-defining subtypes [diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma, and central nervous system (CNS) lymphoma] and within demographic categories. We also present incidence-based mortality (IBM) rates showing the impact of HIV on mortality trends and describe survival after NHL diagnosis by calendar year.

RESULTS

Of 11,071 NHL deaths, 517 (4.6%) were in HIV-infected persons. This proportion was higher in deaths mapped to DLBCL (7.3% with HIV), Burkitt lymphoma (33.3%), and CNS lymphoma (17.6%), and among deaths from these subtypes, for people aged 20-49 years (46.6%), males (15.2%), and blacks (39.3%). IBM rates declined steeply during 2005-2012 for HIV-infected NHL cases (-7.6% per year, P = 0.001). This trend reflects a steep decline in incident NHL among HIV-infected people after 1996, when highly active antiretroviral therapy was introduced. Five-year cancer-specific survival improved more markedly among HIV-infected cases (9%-54%) than HIV-uninfected cases (62%-76%) during 1990-2008.

CONCLUSIONS

The HIV epidemic has strongly contributed to NHL deaths, especially for AIDS-defining NHL subtypes and groups with high HIV prevalence.

IMPACT

Declining NHL mortality rates for HIV-infected cases reflect both declining incidence and improving survival. Cancer Epidemiol Biomarkers Prev; 25(9); 1289-96. ©2016 AACR.

When do changes in cancer survival mean progress? The insight from population incidence and mortality

BACKGROUND

It is often assumed that increases in cancer survival reflect true progress against cancer. This is true when these increases are accompanied by decreased burden of disease: Fewer people being diagnosed or dying from cancer (ie, decreased incidence and mortality). But increased survival can also occur even when incidence is increasing and mortality is unchanged.

OBJECTIVE

To use trends in cancer burden-incidence and mortality-to illustrate when changes in survival reflect true progress.

METHODS

Using data from 1975 to 2010 collected by the Surveillance, Epidemiology, and End Results Program (incidence, survival) and the National Center for Health Statistics (mortality), we analyzed US trends in five-year relative survival, age-adjusted incidence, and mortality for selected cancers to identify patterns that do and do not reflect progress.

RESULTS

Among the nine common cancers examined, survival increased in seven, and changed little or not at all for two. In some cases, increased survival was accompanied by decreased burden of disease, reflecting true progress. For example, from 1975 to 2010, five-year survival for colon cancer patients improved (from 48% to 68%) while cancer burden fell: Fewer cases (incidence decreased from 60 to 41 per 100,000) and fewer deaths (mortality decreased from 28 to 16 per 100,000), a pattern explained by both increased early detection (with removal of cancer precursors) and more effective treatment. In other cases, however, increased survival did not reflect true progress. In melanoma, kidney, and thyroid cancer, five-year survival increased but incidence increased with no change in mortality. This pattern suggests overdiagnosis from increased early detection, an increase in cancer burden.

CONCLUSIONS

Changes in survival must be interpreted in the context of incidence and mortality. Increased survival only represents progress when accompanied by a reduction in incidence, mortality, or ideally both.

Cancer survival: an overview of measures, uses, and interpretation

Survival statistics are of great interest to patients, clinicians, researchers, and policy makers. Although seemingly simple, survival can be confusing: there are many different survival measures with a plethora of names and statistical methods developed to answer different questions. This paper aims to describe and disseminate different survival measures and their interpretation in less technical language. In addition, we introduce templates to summarize cancer survival statistic organized by their specific purpose: research and policy versus prognosis and clinical decision making.

Predicting county-level cancer incidence rates and counts in the USA

Many countries, including the USA, publish predicted numbers of cancer incidence and death in current and future years for the whole country. These predictions provide important information on the cancer burden for cancer control planners, policymakers and the general public. Based on evidence from several empirical studies, the joinpoint (segmented-line linear regression) model (JPM) has been adopted by the American Cancer Society to estimate the number of new cancer cases in the USA and in individual states since 2007. Recently, cancer incidence in smaller geographic regions such as counties, and local policy makers are increasingly interested with Federal Information Processing Standard code regions. The natural extension is to directly apply the JPM to county-level cancer incidence data. The direct application has several drawbacks and its performance has not been evaluated. To address the concerns, we developed a spatial random-effects JPM for county-level cancer incidence data. The proposed model was used to predict both cancer incidence rates and counts at the county level. The standard JPM and the proposed method were compared through a validation study. The proposed method outperformed the standard JPM for almost all cancer sites, especially for moderate or rare cancer sites and for counties with small population sizes. As an application, we predicted county-level prostate cancer incidence rates and counts for the year 2011 in Connecticut.

Histological and Demographic Characteristics of the Distribution of Brain and Central Nervous System Tumors' Sizes: Results from SEER Registries Using Statistical Methods

The examination of brain tumor growth and its variability among cancer patients is an important aspect of epidemiologic and medical data. Several studies for tumors of brain interpreted descriptive data, in this study we perform inference in the extent possible, suggesting possible explanations for the differentiation in the survival rates apparent in the epidemiologic data. Population based information from nine registries in the USA are classified with respect to age, gender, race and tumor histology to study tumor size variation. The Weibull and Dagum distributions are fitted to the highly skewed tumor sizes distributions, the parametric analysis of the tumor sizes showed significant differentiation between sexes, increased skewness for both the male and female populations, as well as decreased kurtosis for the black female population. The effect of population characteristics on the distribution of tumor sizes is estimated by quantile regression model and then compared with the ordinary least squares results. The higher quantiles of the distribution of tumor sizes for whites are significantly higher than those of other races. Our model predicted that the effect of age in the lower quantiles of the tumor sizes distribution is negative given the variables race and sex. We apply probability and regression models to explore the effects of demographic and histology types and observe significant racial and gender differences in the form of the distributions. Efforts are made to link tumor size data with available survival rates in relation to other prognostic variables.