Background. Therapy for head and neck cancers has evolved over the past decade, but few detailed analyses of recent developments in survival on the population level have been published.Methods. We use period analysis and modeled period analysis to disclose recent trends in survival in patients with head and neck cancer. Data are derived from the Surveillance, Epidemiology, and End Results limiteduse database.Results. A major, statistically significant improvement in survival was observed, with the overall 5-year relative survival rate going from 54.7% in 1992-1996 to 65.9% in 2002-2006. Subgroup analysis showed improvement in cancers of the oral cavity, tongue, tonsils,

IntroductionIn the past, most patients with multiple myeloma (MM) died within 5 to 10 years after diagnosis. Several new therapeutic interventions have been introduced for MM during the past decade. These include autologous stem-cell transplantation (SCT) and novel agents, including thalidomide, an antiangiogenic and immunomodulatory small molecule, lenalidomide, a derivative of thalidomide, and bortezomib, a protosome inhibitor. All 3 novel agents have been shown to be active in MM, and regimens containing one of these compounds are gradually replacing chemotherapy-only regimens as standard of care in MM for patients who are not candidates for SCT. 1,2 The effect of such therapeutic innovation and its dissemination on long-term prognosis should be monitored in an as timely as possible manner, but it is only disclosed with substantial delay by conventional methods of survival analysis. We aimed to disclose trends from 1990-1992 to 2002-2004 and to derive up-to-date estimates of long-term survival of patients with MM by novel techniques of period survival analysis. 3,4 Because of the differential application, efficacy and tolerance of novel therapies according to age, we were specifically interested in age-specific trends of prognosis. Detroit, Seattle-Puget Sound, and San Francisco-Oakland that together cover a population of approximately 30 million people. Geographic areas were selected for inclusion in the SEER Program based on their ability to operate and maintain a high-quality population-based cancer reporting system and for their epidemiologically significant population subgroups. The SEER population is comparable to the general US population for measures of poverty and education, although it tends to be more urban and has a higher proportion of foreign-born persons than the latter. MethodsFor this analysis, we selected 27 038 patients aged 15 years or older with a first diagnosis of MM (and no previous cancer diagnosis) between 1980 and 2004, who have been followed for vital status until the end of 2004. After exclusion of 58 patients (0.21%) who were reported by autopsy only and 457 patients (1.69%) who were reported by death certificate only, there remained 26 523 patients (98.10%) for the survival analysis.Five-and 10-year survival was calculated for the calendar periods 1990-1992, 1993-1995, 1996-1998, 1999-200, and 2002-2004 with the period analysis method. 3 Furthermore, we tested for statistical significance of trends in 5-and 10-year survival between 1990-1992 and 2002-2004 by a recently described modeling approach. 4 All analyses were performed separately for the following 5 major age groups: younger than 50 years, 50 to 59 years, 60 to 69 years, 70 to 79 years, and 80 years and older.With period analysis, first proposed by Brenner and Gefeller in 1996, 6 only survival experience during the period of interest is included in the analysis. This is achieved by left truncation of observations at the beginning of the period in addition to right censoring at its end. A graphical illustration of the ...

Although chronic lymphocytic leukemia (CLL) has remained incurable with standard treatments, newer therapeutic approaches, such as chemoimmunotherapy or stem cell transplantation, bear the potential for prolonged survival. We estimated trends in age-specific 5- and 10-year absolute and relative survival of CLL patients in the United States between 1980-1984 and 2000-2004 from the 1973 to 2004 database of the Surveillance, Epidemiology, and End Results Program. Period analysis was used to disclose recent developments with minimum delay. Overall, 5- and 10-year absolute survival from diagnosis increased from 54.2% to 60.2% (+6 percentage points; P < .0001) and from 27.8% to 34.8% (+7 percentage points; P < .0001), respectively. Despite a strong age gradient in prognosis, increases in 5-year absolute and relative survival over time were rather homogeneous across age groups. In contrast, increases in 10-year absolute and relative survival close to or well above 10% units were observed for all patients younger than 80 years of age at diagnosis compared with no increase at all for older patients. Long-term survival expectations of patients with CLL have substantially improved over the past 2 decades except for patients 80 years of age or older at the time of diagnosis. Future studies are needed to confirm and expand our findings.

Acute lymphoblastic leukemia (ALL) is an uncommon but highly fatal disease in adults. We used period analysis to data from the Surveillance, Epidemiology, and End Results (SEER) database to disclose changes in outcomes for patients diagnosed with ALL in the United States in the 2 decades between 1980-1984 and 2000-2004. Major improvement in survival was observed for patients less than 60 years of age. Improvement in survival was greater for women than for men, but was significant for both genders. IntroductionAcute lymphoblastic leukemia (ALL) is a common form of leukemia in childhood but is rare in adults. Nevertheless, in the United States, it is estimated that 5430 people will develop ALL in 2008, and 1460 people died of the disease. 1 ALL is frequently curable in children but is much more difficult to treat in adults. Nonetheless, substantial progress has been made in the late 20th century and early 21st century in the treatment of ALL. 2 The aim of this study is to monitor progress in long-term survival of adult patients diagnosed with ALL from the early 1980s to the early 21st century. The novel technique of period analysis is used to disclose most recent trends with minimum delay. Overall, 3483 patients aged 15 years or older with a first diagnosis of ALL (and no previous cancer diagnosis) between 1980-2004, who have been followed for vital status until the end of 2004, were included in the dataset. After exclusion of 32 patients who were reported by autopsy or by death certificate only, there remained 3451 patients (99.1%) for the survival analysis.Five-and 10-year survival were calculated for the calendar periods 1980-1984, 1985-1989, 1990-1994, 1995-1999, and 2000-2004 using the period analysis methodology. 3 Furthermore, we tested for statistical significance of trends in 5-and 10-year year survival between 1980-1984 and 2000-2004 by a recently described modeling approach. 6 Age is a major prognostic factor in ALL. 7 Therefore, all analyses were carried out separately for the following 5 age groups: 15-19, 20-29, 30-44, 45-59, and 60 and over, as well as for men and women.With period analysis, first proposed by Brenner and Gefeller in 1996, 3 only survival experience during the period of interest is included in the analysis. This is achieved by left truncation of observations at the beginning of the period in addition to right censoring at its end. It has been shown by extensive empirical evaluation that period analysis provides more up-todate long-term survival estimates than traditional cohort-based survival analysis and quite closely predicts long-term survival expectations of cancer patients diagnosed within the period of interest. 8,9 According to standard practice in population-based cancer survival analysis, relative survival was calculated in addition to absolute (observed) survival. Relative survival reflects survival of cancer patients compared with survival of the general population. It is calculated as the ratio of absolute survival of cancer patients divided by the expected survival o...

Background. Treatment of multiple myeloma has changed significantly over the past several years with clinical trials reporting superior survival results using newer agents. Previous work has shown that the survival rate has improved for younger, but not older, patients with myeloma. Here, we update survival estimates for patients with myeloma in the early 21st century to determine whether continued improvement can be seen on a population level and whether or not it now extends to older patients.Methods. Using period analysis to examine data from the Surveillance, Epidemiology, and End Results database, we estimate changes in the 5-and 10-year relative

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Treatment of adults with acute myeloblastic leukemia has changed substantially over the past two decades. Currently available estimates of survival do not reflect results from present state-of-the-art treatment due to a lag between the availability of new treatments and data concerning their effect on survival on the population level when traditional cohort analysis is used. We estimated trends in age-specific 5-and 10-year relative survival of acute myeloblastic leukemia patients aged over 15 years old for 5-year calendar periods from 1980-1984 through 2000-2004 using data from the Surveillance, Epidemiology, and End Results Program. Period analysis was employed to reveal recent developments in prognosis. Five and 10-year relative survival improved greathy between 1980-1984 and 2000-2004 for all patients except those aged over 75 years old. Improvements were greatest for patients aged 15-34, with increases in 5-and 10-year relative survival of greater than 30% points in this group. Five and 10-year relative survival reached 52.3% and 47.9%, respectively, in this group in 2000-2004. Less pronounced but still substantial improvements in relative survival were seen in the 35-54 and 55-64 age groups. Survival was unchanged, at less than 5%, for patients aged over 75 years old. Our period analysis reveals major improvement on the population level in long-term prognosis of younger patients with acute myeloblastic leukemia, most likely explained by multiple incremental improvements in care including better and more specific diagnosis, improvements in and extension of the use of stem cell transplantation and high dose therapy, and improved supportive care.

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