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Estimating Regional Variation in Cancer Survival: A Tool for Improving Cancer Care

Cancer Causes & Control volume 15, pages 611–618 (2004)Cite this article

Abstract

Objective: To improve estimation of regional variation in cancer survival and identify cancers to which priority might be given to increase survival.

Methods: Survival measures were calculated for 25 major cancer types diagnosed in each of 17 health service regions in New South Wales, Australia, from 1991 to 1998. Region-specific risks of excess death due to cancer were estimated adjusting for age, sex, and extent of disease at, and years since, diagnosis. Empirical Bayes (EB) methods were used to shrink the estimates. The additional numbers of patients who would survive beyond five years were estimated by shifting the State average risk to the 20th centile.

Results: Statistically significant regional variation in the shrunken estimates of risk of excess death was found for nine of the 25 cancer types. The lives of 2903 people (6.4%) out of the 45,047 whose deaths within 5 years were attributable to cancer could be extended with the highest number being for lung cancer (791).

Conclusions: The EB approach gives more precise estimates of region-specific risk of excess death and is preferable to standard methods for identifying cancer sites where gains in survival might be made. The estimated number of lives that could be extended can assist health authorities in prioritising investigation of and attention to causes of regional variation in survival.

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Affiliations

  1. Cancer Epidemiology Research Unit, The Cancer Council, New South Wales, P. O. Box 572, Kings Cross, NSW, 1340, Australia

    Xue Q. Yu, Dianne L. O'Connell & David P. Smith

  2. Health Services Research Group, Faculty of Medicine and Health Sciences, University of Newcastle, Australia

    Robert W. Gibberd

  3. Department of Medical Epidemiology, Karolinskat Institutet, Sweden

    Paul W. Dickman

  4. School of Public Health, The University of Sydney, Australia

    Bruce K. Armstrong

Authors
  1. Xue Q. Yu
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  2. Dianne L. O'Connell
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  3. Robert W. Gibberd
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  4. David P. Smith
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  5. Paul W. Dickman
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  6. Bruce K. Armstrong
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Correspondence to Xue Q. Yu.

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Yu, X.Q., O'Connell, D.L., Gibberd, R.W. et al. Estimating Regional Variation in Cancer Survival: A Tool for Improving Cancer Care. Cancer Causes Control 15, 611–618 (2004). https://doi.org/10.1023/B:CACO.0000036165.13089.e8

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  • DOI: https://doi.org/10.1023/B:CACO.0000036165.13089.e8

  • cancer
  • empirical Bayes methods
  • regional variation
  • relative survival