Prognosis of breast cancer molecular subtypes in routine clinical care: A large prospective cohort study.

BACKGROUND: In Germany, most breast cancer patients are treated in specialized breast cancer units (BCU), which are certified, and routinely monitored. Herein, we evaluate up-to-date oncological outcome of breast cancer (BC) molecular subtypes in routine clinical care of a specialized BCU. METHODS: The study was a prospectively single-center cohort study of 4102 female cases with primary, unilateral, non-metastatic breast cancer treated between 01 January 2003 and 31 December 2012. The five routinely used molecular subtypes (Luminal A-like, Luminal B/HER2 negative-like, Luminal B/HER2 positive-like, HER2-type, Triple negative) were analyzed. The median follow-up time of the whole cohort was 55 months. We calculated estimates for local control rate (LCR), disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS), and relative overall survival (ROS). RESULTS: Luminal A-like tumors were the most frequent (44.7 %) and showed the best outcome with LCR of 99.1 % (95 % CI 98.5; 99.7), OS of 95.1 % (95 % CI 93.7; 96.5), and ROS of 100.0 % (95 % CI 98.5; 101.5). Triple negative tumors (12.3 %) presented the poorest outcome with LCR of 89.6 % (95 % CI 85.8; 93.4), OS of 78.5 % (95 % CI 73.8; 83.3), and ROS of 80.1 % (95 % CI 73.8; 83.2). CONCLUSIONS: Patients with a favorable subtype can expect an OS above 95 % and an LCR of almost 100 % over 5 years. On the other hand the outcome of patients with HER2 and Triple negative subtypes remains poor, thus necessitating more intensified research and care.

Time trends in axilla management among early breast cancer patients: Persisting major variation in clinical practice across European centers.

Background We examined time trends in axilla management among patients with early breast cancer in European clinical settings. Material and methods EUROCANPlatform partners, including population-based and cancer center-specific registries, provided routinely available clinical cancer registry data for a comparative study of axillary management trends among patients with first non-metastatic breast cancer who were not selected for neoadjuvant therapy during the last decade. We used an additional short questionnaire to compare clinical care patterns in 2014. Results Patients treated in cancer centers were younger than population-based registry populations. Tumor size and lymph node status distributions varied little between settings or over time. In 2003, sentinel lymph node biopsy (SLNB) use varied between 26% and 81% for pT1 tumors, and between 2% and 68% for pT2 tumors. By 2010, SLNB use increased to 79-96% and 49-92% for pT1 and pT2 tumors, respectively. Axillary lymph node dissection (ALND) use for pT1 tumors decreased from between 75% and 27% in 2003 to 47% and 12% in 2010, and from between 90% and 55% to 79% and 19% for pT2 tumors, respectively. In 2014, important differences in axillary management existed for patients with micrometastases only, and for patients fulfilling the ACOSOG Z0011 criteria for omitting ALND. Conclusion This study demonstrates persisting differences in important aspects of axillary management throughout the recent decade. The results highlight the need for international comparative patterns of care studies in oncology, which may help to identify areas where further studies and consensus building may be necessary.

Recent cancer survival in Germany: an analysis of common and less common cancers.

The monitoring of cancer survival by population-based cancer registries is a prerequisite to evaluate the current quality of cancer care. Our study provides 1-, 5- and 10-year relative survival as well as 5-year relative survival conditional on 1-year survival estimates and recent survival trends for Germany using data from 11 population-based cancer registries, covering around one-third of the German population. Period analysis was used to estimate relative survival for 24 common and 11 less common cancer sites for the period 2007-2010. The German and the United States survival estimates were compared using the Surveillance, Epidemiology and End Results 13 database. Trends in cancer survival in Germany between 2002-2004 and 2008-2010 were described. Five-year relative survival increased in Germany from 2002-2004 to 2008-2010 for most cancer sites. Among the 24 most common cancers, largest improvements were seen for multiple myeloma (8.0% units), non-Hodgkin lymphoma (6.2% units), prostate cancer (5.2% units) and colorectal cancer (4.6% units). In 2007-2010, the survival disadvantage in Germany compared to the United States was largest for cancers of the mouth/pharynx (-11.0% units), thyroid (-6.8% units) and prostate (-7.5% units). Although survival estimates were much lower for elderly patients in both countries, differences in age patterns were observed for some cancer sites. The reported improvements in cancer survival might reflect advances in the quality of cancer care on the population level as well as increased use of screening in Germany. The survival differences across countries and the survival disadvantage in the elderly require further investigation.

Socioeconomic deprivation and cancer survival in Germany: an ecological analysis in 200 districts in Germany.

Although socioeconomic inequalities in cancer survival have been demonstrated both within and between countries, evidence on the variation of the inequalities over time past diagnosis is sparse. Furthermore, no comprehensive analysis of socioeconomic differences in cancer survival in Germany has been conducted. Therefore, we analyzed variations in cancer survival for patients diagnosed with one of the 25 most common cancer sites in 1997-2006 in ten population-based cancer registries in Germany (covering 32 million inhabitants). Patients were assigned a socioeconomic status according to the district of residence at diagnosis. Period analysis was used to derive 3-month, 5-year and conditional 1-year and 5-year age-standardized relative survival for 2002-2006 for each deprivation quintile in Germany. Relative survival of patients living in the most deprived district was compared to survival of patients living in all other districts by model-based period analysis. For 21 of 25 cancer sites, 5-year relative survival was lower in the most deprived districts than in all other districts combined. The median relative excess risk of death over the 25 cancer sites decreased from 1.24 in the first 3 months to 1.16 in the following 9 months to 1.08 in the following 4 years. Inequalities persisted after adjustment for stage. These major regional socioeconomic inequalities indicate a potential for improving cancer care and survival in Germany. Studies on individual-level patient data with access to treatment information should be conducted to examine the reasons for these socioeconomic inequalities in cancer survival in more detail.

Improved population level survival in younger Hodgkin lymphoma patients in Germany in the early 21st century.

Treatment for Hodgkin lymphoma (HL) is more aggressive in Germany than in the United States (US) and differences in treatment may lead to differences in population level survival. Patients diagnosed with HL in 11 German states in 1997-2006 were included in the analyses and were compared to similar analyses from patients in the Surveillance, Epidemiology, and End Results database in the US. Period analysis was used to calculate 5-year relative survival for the time period of 2002-2006 overall and by gender, age and histology. Overall 5-year relative survival for patients with HL in Germany was 84·3%, compared to 80·6% for the US. Survival was highest in patients aged 15-29 years at 97·9% and decreased with age to 57·5% at age 60 + Survival for men and women, respectively, was 84·7% and 84·1% in Germany and 78·2% and 83·6% in the US. 5-year relative survival for patients diagnosed with HL in Germany was close to 100% for younger patients. Survival of HL patients in the US was lower than in Germany overall, but was comparable in older patients and in women. Population-based studies with longer follow-up are still needed to examine effects of late toxicity on long term survival.

Cancer survival in Lithuania after the restoration of independence: rapid improvements, but persisting major gaps.

BACKGROUND: Following restoration of political independence in 1990, Lithuania underwent rapid societal and economic changes. We aimed to assess trends in cancer survival in the first two decades following these changes. MATERIAL AND METHODS: We used population-based data from the Lithuanian Cancer Registry and period analysis techniques to examine trends in one-, 2-5- and five-year relative survival between 1995-1999 and 2005-2009 for 24 common cancers in Lithuania. RESULTS: Between 1995-1999 and 2005-2009, five-year relative survival increased significantly for 20 of 24 cancers, and for 10 cancers the increase exceeded 10% units. Five-year relative survival estimates reached 46%, 69% and 91% for colorectal, breast and prostate cancer in 2005-2009, respectively, while patients with testicular cancer, Hodgkin's or non-Hodgkin's lymphoma had a five-year relative survival of 77%, 75% and 50%, respectively. CONCLUSION: We found a rapid increase in survival for most forms of common cancers in Lithuania between 1995 and 2009. Nevertheless, several cancers with effective therapies exhibit considerable gaps compared with Northern and Western European countries. Despite ongoing rises in survival, mortality declines are not yet manifesting for important common cancers such as breast and colorectal cancer. Rapid incidence rises suggest that increases in survival for prostate and thyroid cancers are massively influenced by early detection-related effects. Improving the availability of effective therapies, and carefully planned early detection programs may help to increase cancer survival in Lithuania in the future.

Cost-effectiveness of large-panel next-generation sequencing in guiding first-line treatment decisions for patients with nonsquamous advanced non-small cell lung cancer.

BACKGROUND: Clinical practice guidelines recommend broad-panel genomic profiling to identify actionable genomic alterations for patients with advanced non-small cell lung cancer (aNSCLC). OBJECTIVE: To assess the cost-effectiveness of large-panel next-generation sequencing (LP-NGS) compared with current empirical single-gene test (SGT) patterns to inform first-line treatment decisions for patients with aNSCLC from a US commercial payer perspective, accounting for the effect of testing turnaround time and time to treatment initiation. METHODS: We developed a discrete-event simulation model to estimate the impact of LP-NGS vs SGT for patients with nonsquamous aNSCLC. Discrete events and timing included testing patterns, receipt of the initial test result, treatment initiation (targeted vs nontargeted therapies), switching, retesting, rebiopsies, clinical trial participation, progression on therapy, and death. LP-NGS and SGT cohorts each comprised 100,000 adults with aNSCLC simulated over a 5-year postdiagnosis period, assumed to have the same distribution of genomic alterations. The model predicted the proportion of patients receiving appropriate first-line therapy according to clinical practice guidelines. Economic outcomes included expected life-years gained, quality-adjusted life-years, and the total costs of care over 5 years. Sensitivity and scenario analyses explored the robustness of the base-case model results. RESULTS: In the base-case model, LP-NGS was likely to identify more alterations than SGT. Total 5-year costs per patient were $539,658 for LP-NGS and $544,550 for SGT (net difference, $4,892 lower costs per patient for LP-NGS), which is likely to be cost-effective 95.1% of the time. The most influential model parameters on the 5-year total costs of care were preprogression nondrug medical costs on nontargeted therapy, NGS turnaround time, and clinical trial participation. CONCLUSIONS: This study suggests that LP-NGS to guide first-line treatment decisions is clinically more appropriate (more likely to identify alterations and subsequently allocate patients to clinically appropriate therapy) and provides a dominant cost-effectiveness treatment strategy over 5 years for patients with newly diagnosed aNSCLC in the United States.

Survival among adolescents and young adults with cancer in Germany and the United States: an international comparison.

Serious concern arose in the scientific literature about the state of and progress in cancer survival among adolescent and young adult (AYA) patients in the recent years. We provide an up-to-date international comparison of survival among AYA patients. Using population-based cancer data from 11 German cancer registries and the SEER Program of the United States (covering populations of 39 and 33 million people, respectively), standardized tumor group classifications, period analysis and modeling, we compared the 5-year relative survival of AYA patients in the age groups 15-29 and 30-39 to survival seen among adults aged 40-49 for the 2002-2006 period. Additionally, we also provide an age-specific survival comparison between the two countries. In 2002-2006, for the overwhelming majority of the more than 30 types of cancer examined, AYA patients aged both 15-29 and 30-39 years had higher or similar survival than patients in the age group 40-49 in both countries. A numerically large and statistically significant survival deficit among AYA patients was only found for breast carcinomas in both populations, and colorectal and stomach carcinoma in the United States for the age group 15-29. Overall, results of the country-specific comparisons did not indicate systematic differences. With very few exceptions, no survival deficit between AYA patients and adults aged 40-49 years was found in either of the examined countries in the first decade of the 21st century.

Survival of endometrial cancer patients in Germany in the early 21st century: a period analysis by age, histology, and stage.

BACKGROUND: Population-based studies on endometrial cancer providing survival estimates by age, histology, and stage have been sparse. We aimed to derive most up-to-date and detailed survival estimates for endometrial cancer patients in Germany. METHODS: We used a pooled German national dataset including data from 11 cancer registries covering a population of 33 million people. 30,906 patients diagnosed with endometrial cancer in 1997-2006 were included. Period analysis was performed to calculate 5-year relative survival (RS) in 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age-adjustment was performed using five age groups (15-44, 45-54, 55-64, 65-74, and 75+ years). RESULTS: Overall, age-adjusted 5-year relative survival in 2002-2006 was 81%. A moderate age gradient was observed, with 5-year RS decreasing from 90% in the age group 15-49 years to 75% in the age group 70+ years. Furthermore prognosis varied strongly by histologic subtypes and stage, with age-adjusted 5-year RS ranging from 43% (for sarcoma) to 94% (for squamous metaplasia), and reaching 91% for localized, 51% for regional, and 20% for distant stage. Except for age group 65-74 years, no significant improvement in survival was seen during the recent 5-year period under investigation. CONCLUSION: In this comprehensive population-based survival analysis of patients with endometrial cancer from Germany, prognosis of endometrial cancer moderately varied by age, and strongly varied by histology and stage. While prognosis is rather good overall, further improvement in 5-year relative survival of endometrial cancer patients has been stagnating in the early 21(st) century.

Survival of cervical cancer patients in Germany in the early 21st century: a period analysis by age, histology, and stage.

PURPOSE: Population-based studies on cervical cancer providing survival estimates by age, histology, and stage have been sparse. We aimed to derive most up-to-date and detailed survival estimates for cervical cancer patients in Germany. METHODS: We used a pooled German national dataset including data from 11 cancer registries covering a population of 33 million people. Included were 15 685 patients diagnosed with cervical cancer from 1997 to 2006. Period analysis was performed to calculate the five-year relative survival (RS) 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age-adjustment was done using five age groups (15-44, 45-54, 55-64, 65-74, and 75 + years). RESULTS: Overall, age-adjusted five-year relative survival in 2002-2006 was 64.7%. A strong age gradient was observed, with five-year RS decreasing from 81.7% in age group 15-49 years to 46.3% in age group 70 + years. Prognosis furthermore strongly varied by stage, with age-adjusted five-year RS reaching 84.6% for localized, 48.2% for regional, and 17.9% for distant stage. From 2002 to 2006, a significant improvement (4.7 percent units) in overall age-adjusted five-year RS was seen. The improvement was most pronounced for age groups 55-64 years (from 54.2 to 65.6%) and 65-74 years (from 50.0 to 58.1%). CONCLUSION: In this first comprehensive population-based study from Germany, prognosis of cervical cancer strongly varied by age and stage. Prognosis continued to improve, in particular in age range 55-74 years, in the five-year period assessed.

Survival of stomach and esophagus cancer patients in Germany in the early 21st century.

BACKGROUND: Esophagus and stomach cancers are associated with poor prognosis. But most published population-based cancer survival estimates for stomach and esophagus cancer refer to survival experience of patients diagnosed in the 1990s or earlier years. The aim of this study was to provide up-to-date survival estimates and trends for patients with stomach and esophagus cancer in Germany. MATERIAL AND METHODS: Our analysis is based on data from 11 population-based cancer registries, covering 33 million inhabitants. Patients diagnosed with stomach and esophagus cancer in 1997-2006 were included. Period analysis was used to derive five-year relative survival estimates and trends by age, sex, cancer subsite, and stage for the time period of 2002-2006. German and US survival estimates were compared utilizing the SEER 13 database. RESULTS: Overall age-standardized five-year relative survival was 31.8% and 18.3% for stomach and esophagus cancer, respectively, compared to 27.2% and 17.4% in the US. Survival was somewhat higher among female than among male patients for both cancer sites (33.6% vs. 30.6% and 21.5% vs. 17.5%, respectively) and much higher for non-cardia stomach cancer (40.4%) than for cardia cancer (23.4%). From 2002 to 2006, a moderate increase in five-year relative survival by 2.7 percent units was observed for non-cardia stomach cancer patients in Germany (p < 0.001). CONCLUSION: Five-year relative cancer survival has reached levels around 40% for patients with non-cardia stomach cancer in Germany in the early 21st century, whereas it remained at lower levels around 20% for patients with esophagus and cardia cancer.

Cancer survival in Eastern and Western Germany after the fall of the iron curtain.

Prior to the German reunification, cancer survival was much lower in East than in West Germany. We compare cancer survival between Eastern and Western Germany in the early twenty-first century, i.e. the second decade after the German reunification. Using data from 11 population-based cancer registries covering a population of 33 million people, 5-year age-standardized relative survival for the time period 2002-2006 was estimated for the 25 most common cancers using model-based period analysis. In 2002-2006, 5-year relative survival was very similar for most cancers, with differences below 3% units for 20 of 25 cancer sites. Larger, statistically significant survival advantages were seen for oral cavity, oesophagus, and gallbladder cancer and skin melanoma in the West and for leukemia in the East. Our study shows that within two decades after the assimilation of political and health care systems, the former major survival gap of cancer patients in Eastern Germany has been essentially overcome. This result is encouraging as it suggests that, even though economic conditions have remained difficult in Eastern Germany, comparable health care provision may nevertheless enable comparable levels of cancer survival within a relatively short period of time.

Genomic testing among patients with newly diagnosed advanced non-small cell lung cancer in the United States: A contemporary clinical practice patterns study.

OBJECTIVES: According to 2018 United States and international lung cancer and pathology guidelines, testing of EGFR, ALK, ROS1 and BRAF genes is a minimum requirement to identify targeted therapy options in patients with advanced non-small cell lung cancer (aNSCLC). We describe real-world use and clinical features of next-generation sequencing (NGS) and other non-NGS testing technologies in these patients. MATERIALS AND METHODS: Patients were from the Flatiron Health electronic health record-derived de-identified database and were newly diagnosed with non-squamous aNSCLC between 1 January 2018 and 30 June 2019. We describe occurrence and patterns of NGS- (including comprehensive genomic profiling [CGP]) and non-NGS-based genomic testing before the start of first-line therapy, unsuccessful genotyping (<4 genes tested) and incidence of potentially missed targeted therapy options (<4 genes tested with no positive results). RESULTS: Among 3050 patients, 2356 received any type of genomic testing (NGS: 1406 [59.7%]). Unsuccessful genotyping occurred in 13.2% and 52.2% of NGS- and non-NGS-tested patients, respectively. Among NGS-tested patients, 10.0% had a potentially missed targeted therapy option (CGP: 2.9%), compared with 40.2% in the non-NGS tested group. While all four guideline-recommended genes were tested in ≥ 92% of patients who had NGS testing, when only non-NGS testing was used, although EGFR and ALK had similarly high testing proportions, BRAF and ROS1 (56.1% and 83.7%, respectively) were examined less often. CONCLUSIONS: Our findings suggest that in aNSCLC clinical practice, NGS testing may help to avoid potentially missed targeted therapy options and improve testing uptake for recently approved biomarkers. Results therefore support the use of guideline-recommended broad-panel NGS testing in clinical practice.

Cancer-of-Unknown-Primary-Origin: A SEER-Medicare Study of Patterns of Care and Outcomes among Elderly Patients in Clinical Practice.

Knowledge of contemporary patterns of cancer-of-unknown-primary-origin (CUP) diagnostic work-up, treatment, and outcomes in routine healthcare is limited. Thus, we examined data from elderly patients diagnosed with CUP in real-world US clinical practice. From the Surveillance, Epidemiology, and End Results-Medicare-linked database, we included patients ≥ 66 years old with CUP diagnosed between 1 January 2013 and 31 December 2015. We analyzed baseline demographics, clinical characteristics, methods of diagnostic work-up (biopsy, immunohistochemistry, imaging), treatment-related factors, and survival. CUP diagnosis was histologically confirmed in 2813/4562 patients (61.7%). Overall, 621/4562 (13.6%) patients received anticancer pharmacotherapy; among these, 97.3% had a histologically confirmed tumor and 83.1% received all three procedures. Among those with a histologically confirmed tumor, increasing age, increasing comorbidity score, not receiving all three diagnostic measures, and having a not-further specified histologic finding of only 'malignant neoplasm' were all negatively associated with receipt of anticancer pharmacotherapy. Median overall survival was 1.2 months for all patients. Median time between CUP diagnosis and treatment initiation was 41 days. Limited diagnostic work-up was common and most patients did not receive anticancer pharmacotherapy. The poor outcomes highlight a substantial unmet need for further research into improving diagnostic work-up and treatment effectiveness in CUP.

Improvement in survival of older adults with multiple myeloma: results of an updated period analysis of SEER data.

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 survival rates (RSRs) from 1998-2002 to 2003-2007. RESULTS: The 5- and 10-year RSRs have improved for patients with myeloma overall, from 32.8% and 15% in 1998-2002 to 40.3% and 20.8%, respectively, in 2003-2007. The greatest improvements were observed for patients aged 15-44 years, with 5- and 10-year RSRs reaching >70% and ~50%, respectively, but improvements were also seen for patients aged >70 years. CONCLUSION: Overall, survival continues to improve for patients with myeloma, including older patients, suggesting that newer treatment options continue to make a population-wide impact.

Survival of patients with chronic myelocytic leukemia: comparisons of estimates from clinical trial settings and population-based cancer registries.

INTRODUCTION: The survival of patients with chronic myelocytic leukemia (CML) has improved during the past decades. However, there have been discrepancies between results reported from clinical trials and population-based studies. We aimed to elucidate the extent of these discrepancies. METHODS: We examined the 5-year survival rate of patients in clinical trials of CML treatment and compared these results with the survival of patients in the general population using the Surveillance, Epidemiology, and End Results (SEER) database, correcting for differences in the age structure of the patient populations. RESULTS: Twenty-nine trials were identified for data extraction. The survival rate calculated from SEER data was lower than the survival rate in clinical trials in the corresponding period, with differences of 2.1%-50.7%. Age-adapted survival was similar for four trials, but differences up to 35.8% were seen in most. Limitations of the study include the lack of information on chemotherapy in the SEER database and possible heterogeneity of cases. DISCUSSION: The survival rate in clinical trials of CML treatment is higher than the survival rate of all patients with CML. We speculate that the difference may be a result of access to better medications, selection of healthier patients for trials, and the time necessary for adoption of new treatments. This finding underscores the need for population-based studies to give a more realistic idea of survival for patients with a given malignancy in the general population.

Improvement in survival in younger patients with acute lymphoblastic leukemia from the 1980s to the early 21st century.

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. The greatest improvement was seen in patients aged 15 to 19, in whom 5-year relative survival improved from 41.0% to 61.1%, and 10-year survival improved from 33.0% to 60.4%. Lesser but significant improvements were seen for age groups 20-29, 30-44, and 45-59. Survival for patients aged 60 and over remained essentially unchanged at levels around or below 10%, respectively. Survival has improved for patients with ALL over the time period studied, but treatment of older patients remains a difficult issue.

Testicular cancer survival in Estonia: improving but still relatively low.

BACKGROUND: international comparisons have pointed to very low survival of patients diagnosed with testicular cancer (TC) in Estonia. METHODS: using population based data from the Estonian Cancer Registry and period analysis, we examined trends in TC survival between 1985 and 2004. Additional results from a review of clinical records to ascertain patterns of disease management (1990-2003) were used to explain the changes and identify the areas for potential improvement. RESULTS: age-adjusted 5-year period relative survival increased from 47.9% in 1985-1989 to 74.5% in 2000-2004 (p for trend <0.01). A marked improvement was seen for the patients younger than 30, with the 5-year survival reaching 93.3%, while the improvement remained modest among patients aged 30 and above. Although substantial advances occurred in staging and treatment techniques since 1990, deficiencies remained evident in disease management, including not referring patients to an oncologist after their orchiectomy and less careful diagnostic workup for patients above 30 years of age. Low use of radiotherapy suggests poor access to contemporary equipment. Delays in seeking medical consultation, but also in starting adjuvant therapy, could have contributed to poorer outcomes. CONCLUSIONS: survival in TC increased markedly in Estonia by the 21(st) century, but is still notably lower than in the more developed countries. Multidisciplinary efforts may help to achieve further improvement. The provision of TC care should be coordinated by specialised cancer centres.

Cancer survival differences between European countries and an urban population from the Philippines.

BACKGROUND: The EUROCARE study has disclosed large variations of survival across Europe, with the magnitude varying, depending on cancer site. Comparisons of these rates with those from the developing countries are rare, but important in evaluating international cancer care discrepancies. This study aimed to provide up-to-date estimates of cancer survival in a Philippine urban population, and to compare these with those observed in the European countries. METHODS: Using the results from the EUROCARE-4 study, the survival estimates of the European patients who were diagnosed in 1995-99 and followed till December 2003 were abstracted. From randomly selected samples drawn from the Manila and Rizal Cancer Registries, 5-year survival was estimated for nine common cancers. Age-adjusted survival estimates were then compared between the Philippine population and Europeans. RESULTS: In comparison to the European mean, survival estimates for the Philippine residents were lower for most cancers, with differences ranging from 2 to 40% units. Differences with European country-specific estimates were large for cancers of the breast and cervix, where early detection is possible, and for leukaemia, where treatment regimens are costly, highlighting the importance of health care. Smaller discrepancies were observed for stomach, liver and lung cancers, with the 5-year relative survival being similar to the Philippines and to many European countries. A survival advantage was seen though for the Philippine residents for ovarian cancer. CONCLUSION: Apart from efforts to prevent cancers, improvements in cancer control and making early diagnosis and treatment more accessible remain major challenges, both in the Philippines and in the European nations.

From cancer to transplantation: an evaluation of period analysis for calculating up-to-date long-term survival estimates.

The timeliness of survival monitoring is particularly important in a field such as transplantation medicine, where progress occurs rapidly. Period analysis, a method successfully applied for improving the timeliness of survival monitoring in population-based cancer survival analysis, could potentially be useful in the field of transplantation as well. Using data from the Collaborative Transplant Study, the authors compared the ability of traditional, cohort-based analysis methods and the period analysis method to provide timely 5-year graft and patient survival estimates for kidney, heart, and liver transplants in 6 age groups (0-17, 18-29, 30-39, 40-49, 50-59, >or=60 years) on 378 occasions between 1990-1992 and 2000-2002. Overall, period estimates provided superior predictions for the survival of most recent transplants on 344 of 378 occasions (91%); in the organ-specific analysis, this proportion ranged between 83% for heart and 100% for kidney graft survival. This evaluation provides evidence that the period analysis method can improve the timeliness of survival monitoring in solid organ transplantation. The method appears useful for providing more up-to-date long-term survival estimates than traditional methods, and its use in pertinent studies is encouraged.