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How can we make cancer survival statistics more useful for patients and clinicians: An illustration using localized prostate cancer in Sweden

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Abstract

Purpose

Studies of cancer patient survival typically report relative survival or cause-specific survival using data from patients diagnosed many years in the past. From a risk-communication perspective, such measures are suboptimal for several reasons; their interpretation is not transparent for non-specialists, competing causes of death are ignored and the estimates are unsuitable to predict the outcome of newly diagnosed patients. In this paper, we discuss the relative merits of recently developed alternatives to traditionally reported measures of cancer patient survival.

Methods

In a relative survival framework, using a period approach, we estimated probabilities of death in the presence of competing risks. To illustrate the methods, we present estimates of survival among 23,353 initially untreated, or hormonally treated men with intermediate- or high-risk localized prostate cancer using Swedish population-based data.

Results

Among all groups of newly diagnosed patients, the probability of dying from prostate cancer, accounting for competing risks, was lower compared to the corresponding estimates where competing risks were ignored. Accounting for competing deaths was particularly important for patients aged more than 70 years at diagnosis in order to avoid overestimating the risk of dying from prostate cancer.

Conclusions

We argue that period estimates of survival, accounting for competing risks, provide the tools to communicate the actual risk that cancer patients, diagnosed today, face to die from their disease. Such measures should offer a more useful basis for risk communication between patients and clinicians and we advocate their use as means to answer prognostic questions.

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Acknowledgments

This project was made possible by the continuous work of the National Prostate Cancer Register of Sweden steering group: Pär Stattin chair, Anders Widmark, Stefan Carlsson, Magnus Törnblom, Jan Adolfsson, Anna Bill-Axelson, Ove Andrén, David Robinson, Bill Pettersson, Jonas Hugosson, Jan-Erik Damber, Ola Bratt, Göran Ahlgren, Lars Egevad, and Mats Lambe. This work was supported by the Swedish Cancer Society (grant number CAN 2010/676).

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Authors and Affiliations

  1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77, Stockholm, Sweden

    Sandra Eloranta, Paul C. Lambert, Therese M-L. Andersson & Paul W. Dickman

  2. CLINTEC, Karolinska Institutet, 171 77, Stockholm, Sweden

    Jan Adolfsson

  3. Department of Health Sciences, Center for Biostatistics and Epidemiology, University of Leicester, 2nd Floor, Adrian Building, University Road, Leicester, LE1 7RH, UK

    Paul C. Lambert

  4. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, 901 85, Umeå, Sweden

    Pär Stattin

  5. Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Pär Stattin

  6. Clinical Epidemiology Unit, Karolinska University Hospital, Solna, M9:01, 171 76, Stockholm, Sweden

    Olof Akre

Authors
  1. Sandra Eloranta
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  2. Jan Adolfsson
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  3. Paul C. Lambert
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  4. Pär Stattin
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  6. Therese M-L. Andersson
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  7. Paul W. Dickman
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Correspondence to Sandra Eloranta.

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Eloranta, S., Adolfsson, J., Lambert, P.C. et al. How can we make cancer survival statistics more useful for patients and clinicians: An illustration using localized prostate cancer in Sweden. Cancer Causes Control 24, 505–515 (2013). https://doi.org/10.1007/s10552-012-0141-5

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  • DOI: https://doi.org/10.1007/s10552-012-0141-5

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