Cancer Causes & Control

, Volume 24, Issue 3, pp 505–515 | Cite as

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

  • Sandra ElorantaEmail author
  • Jan Adolfsson
  • Paul C. Lambert
  • Pär Stattin
  • Olof Akre
  • Therese M-L. Andersson
  • Paul W. Dickman
Original paper



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.


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.


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.


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.


Relative survival Prostate cancer Competing risks Period analysis Population based 



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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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Sandra Eloranta
    • 1
    Email author
  • Jan Adolfsson
    • 2
  • Paul C. Lambert
    • 1
    • 3
  • Pär Stattin
    • 4
    • 5
  • Olof Akre
    • 6
  • Therese M-L. Andersson
    • 1
  • Paul W. Dickman
    • 1
  1. 1.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  2. 2.CLINTECKarolinska InstitutetStockholmSweden
  3. 3.Department of Health Sciences, Center for Biostatistics and EpidemiologyUniversity of LeicesterLeicesterUK
  4. 4.Department of Surgical and Perioperative Sciences, Urology and AndrologyUmeå University HospitalUmeåSweden
  5. 5.Department of SurgeryUrology Service, Memorial Sloan-Kettering Cancer CenterNew YorkUSA
  6. 6.Clinical Epidemiology UnitKarolinska University HospitalStockholmSweden

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