Clinical Relevance of Conditional Survival of Cancer Patients in Europe: Age-Specific Analyses of 13 Cancers

Janssen‐Heijnen, M.L.G.; Gondos, Ádám; Bray, Freddie; Hakulinen, Timo; Brewster, David H.; Brenner, Hermann; Coebergh, Jan Willem

doi:10.1200/jco.2009.25.9697

Cited by 166 publications

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“…A remaining excess mortality among NHL patients aged 45 years or older also appeared in some studies from Europe, as well as Canada and Australia. [10][11][12] Late recurrences of lymphoma are likely as well as late effects of chemotherapy and radiotherapy (mainly cardiovascular disease and secondary tumors). 27,28 Furthermore, a large proportion of NHL patients reported a high level of fatigue up until 10 years after diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Most previous studies on conditional survival for patients with NHL did not subdivide between the distinct entities of NHL, [10][11][12] except one study on diffuse large B-cell lymphoma that displayed conditional survival up to 5 years after diagnosis. 13 It is, however, obvious that better information would be provided by subdividing these entities, each with a different prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Actual prognosis during follow-up of survivors of B-cell non-Hodgkin lymphoma in the Netherlands

et al. 2013

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© F e r r a t a S t o r t i F o u n d a t i o nstage, 16 were obtained routinely from the medical records about 9 months after diagnosis.In addition to passive follow-up via the hospitals, date of death was also retrieved from the Municipal Personal Records Database. Follow-up of vital status was complete until January, 1 st , 2010. For the present study, all patients with mature B-cell NHL newly diagnosed in the period [1989][1990][1991][1992][1993][1994][1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006][2007][2008] in the Netherlands were included (n=54,015). Patients with plasma cell neoplasms were excluded. NHL entities were defined according to the World Health Organization classification, 4 th edition. 18 The exact codes used for each entity are described in a previous publication.2 Sufficient patients were available to report the entity-specific conditional relative survival for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL), marginal zone lymphoma (MZL), lymphoplasmacytic lymphoma (LPL), follicular lymphoma (FL), mantle cell lymphoma (MCL), and diffuse large B-cell lymphoma (DLBCL).We also used two major diagnostic subgroups, based on a combination of entities of more or less similar clinical behavior and comparable response to therapies: indolent and aggressive B-cell neoplasms. The entities included in each subgroup are shown in Table 1. Unspecified cases were excluded from these analyses.Patients younger than 15 years and older than 89 years were excluded from the analysis, as were cases diagnosed at autopsy. Patients were divided into four age groups (15-44, 45-59, 60-74, and 75-89 years old). Patients aged 15-29 and 30-44 years were merged, because of the small numbers. Statistical analysesRelative survival is an approximation of disease-specific survival. It is calculated as the absolute survival among cancer patients divided by the expected survival of a comparable group from the general population (same period, age, and gender). Expected survival was calculated from population life tables from the Netherlands, according to the Ederer II method. 19 Period analysis 20,21 was used to provide up-to-date survival estimates; all observations included in the analysis are left-truncated at the beginning of the period of interest, in addition to being right-censored at its end. Furthermore, to enable the estimation of even more up-to-date survival, hybrid analysis was used. 22Five-year relative survival rates were computed for every additional year of survival up to 15 years after diagnosis, conditional on being alive at the beginning of that year (conditional 5-year relative survival, CRS), unadjusted for other variables. Conditional survival was computed according to disease entity, grade, gender, 15-year age group, and stage of disease. For the analysis according to period of diagnosis (1995-2000 versus 2003-2008) conditional 3-year relative survival rates were computed, since follow-up time for patients diagnosed in 2003-2008 was limited. When the CRS pe...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Actual prognosis during follow-up of survivors of B-cell non-Hodgkin lymphoma in the Netherlands

et al. 2013

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“…However, prognosis is a dynamic process that improves after the initial critical years of recurrence-free survival. Conditional relative survival shows clinically relevant variations according to time since diagnosis, type of cancer, and age [3]. Conditional survival rates can better analyze and reflect actual life expectancy.…”

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confidence: 99%

On the need for comprehensive assessment of impact of comorbidity in elderly patients with head and neck cancer

Teymoortash

Halmos

Silver

et al. 2014

Eur Arch Otorhinolaryngol

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Although a generally accepted definition of ''elderly'' still does not exist, in a medical context, persons over the age of 65 are often considered to be elderly. As life expectancy rates have increased within the last decades and continuously increase every year by approximately 3 months [1], this segment of the population has increased, particularly in Western countries. Because cancer is a disease of aging, the risk of developing malignant disease including head and neck cancer is highest in this patient population. It also follows that malignancy-related mortality is highest among the elderly.Younger patients with head and neck cancers have a much better overall prognosis. A comparative survival analysis revealed that patients with head and neck cancer who are aged 40 years or younger at the time of diagnosis show significantly improved 5-year survival when compared to older patients [2]. For all age groups the 5-year survival rate of patients with a newly diagnosed head and neck cancer is approximately 60 % at diagnosis. However, prognosis is a dynamic process that improves after the initial critical years of recurrence-free survival. Conditional relative survival shows clinically relevant variations according to time since diagnosis, type of cancer, and age [3]. Conditional survival rates can better analyze and reflect actual life expectancy. After 3 years of survival, the conditional survival rate improves from 60 % up to 80 %. However, long-term survival rates stagnate at 80 %. Patients cured of and neck cancer face an excess mortality of about 20 % in long-term follow-up [4]. The critical reason for this is attributed to the comorbid burden of head and neck cancer patients, connected with unhealthy habits and general lifestyle choices.Comorbidities in cancer patients are defined as one or more unrelated diseases present at the time of cancer diagnosis. Particularly in elderly patients, these predominantly consist of reduced organ and cognitive functions, malnutrition, polypharmacy, and socio-economic factors. Most studies show that approximately 60 % of head and neck cancer patients have concurrent illnesses [5]. For better evaluation of comorbidities, weighted assessment systems like Adult Comorbidity Evaluation-27 (ACE-27), and Charlson Comorbidity Index (CCI) include the occurrence of comorbidities as well as their degrees. Comorbidities exist in 46 % of head and neck cancer

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“…Conditional relative survival-the probability of a patient surviving an additional 5 or 10 years after already surviving a given number of years-is a clinically relevant measure of long-term excess mortality in a cohort of cancer patients 6 . Favourable long-term survival has been reached in colorectal 4,6,7 and invasive cervical cancer 4,7,8 , with large studies consistently showing that, in comparison with a general population, lack of excess mortality is reached in approximately 8 years.…”

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confidence: 99%

“…Favourable long-term survival has been reached in colorectal 4,6,7 and invasive cervical cancer 4,7,8 , with large studies consistently showing that, in comparison with a general population, lack of excess mortality is reached in approximately 8 years. For patients with breast cancer, a small but significant excess mortality remains for up to 15 years after diagnosis 7,9 , but approximately half of all breast cancer patients will not die from their cancer 10,11 , reaching a negligible excess risk of death at approximately 20 years after diagnosis.…”

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confidence: 99%

Use of the Word “Cured” for Cancer Patients—Implications for Patients and Physicians: The Siracusa Charter

et al. 2015

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Long-term survival for adult patients with solid tumours continues to increase. For some cancers, the possibility of recurrence after a number of years is extremely low, and the risk of death becomes similar to that of the general population of the same sex and age. During the Fifth European Conference on Survivors and Chronic Cancer Patients held in Siracusa, Italy, June 2014, oncologists, general practitioners, epidemiologists, cancer patients and survivors, and patient advocates joined to discuss the possible use of the term “cured” in reference to some adult patients with solid tumours. The specific focus was the appropriateness of using the term in communicating with cancer patients, survivors, and their families. Initial results of the discussion, in concert with a review of the published literature on the subject, were later further discussed by all participants through electronic communication. The resulting final statement aims to suggest appropriate ways to use the word “cured” in the clinical and communicative setting, to highlight the potential impact of the word on patients, and to open a critical discussion concerning this timely and delicate matter.

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Clinical Relevance of Conditional Survival of Cancer Patients in Europe: Age-Specific Analyses of 13 Cancers

Abstract: Conditional relative survival shows clinically relevant variations according to time since diagnosis, type of cancer, and age, and can help serve as a guide for cancer survivors in planning for their future and for doctors in planning schedules for surveillance.

Cited by 166 publications

References 50 publications

Actual prognosis during follow-up of survivors of B-cell non-Hodgkin lymphoma in the Netherlands

Actual prognosis during follow-up of survivors of B-cell non-Hodgkin lymphoma in the Netherlands

On the need for comprehensive assessment of impact of comorbidity in elderly patients with head and neck cancer

Use of the Word “Cured” for Cancer Patients—Implications for Patients and Physicians: The Siracusa Charter

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