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REFERENCE ADJUSTED AND STANDARDIZED ALL-CAUSE AND CRUDE PROBABILITIES AS AN ALTERNATIVE TO NET SURVIVAL IN POPULATION-BASED CANCER STUDIES

Version 2 2020-06-02, 10:18
Version 1 2020-06-02, 10:10
journal contribution
posted on 2020-06-02, 10:18 authored by Paul Lambert, Therese M-L Andersson, Mark Rutherford, Tor Åge Myklebust, Bjørn Møller

Background

In population-based cancer survival studies the most common measure to compare population groups is age standardized marginal relative survival, which under assumptions can be interpreted as marginal net survival; the probability of surviving if it was not possible to die of causes other than the cancer under study (if the age distribution was that of a common reference population). The hypothetical nature of this definition has led to confusion and incorrect interpretation. For any measure to be fair in terms of comparing cancer survival, then differences between population groups should depend only on differences in excess mortality rates due to the cancer and not differences in other cause mortality rates or differences in the age distribution.

Methods

We propose using crude probabilities of death and all-cause survival that incorporate reference expected mortality rates. This makes it possible to obtain marginal crude probabilities and all-cause probability of death that only differ between population groups due to excess mortality rate differences. Choices have to be made regarding what reference mortality rates to use and what age distribution to standardize to.

Results

We illustrate the method and some potential choices using data from England for men diagnosed with Melanoma. Various marginal measures are presented and compared.

Conclusions

The new measures help enhance understanding of cancer survival and are a complement to the more commonly used measures.

Funding

This work was supported by Cancer Research UK (Grant number C1483/A18262), the Swedish Cancer Society (Cancerfonden) (Grant number 2018/744) and the Swedish Research Council (Vetenskapsrådet) (Grant number 2017-01591).

History

Citation

International Journal of Epidemiology, 2020, In Press

Version

  • AM (Accepted Manuscript)

Published in

International Journal of Epidemiology

Publisher

Oxford University Press (OUP) for International Epidemiological Association

issn

0300-5771

Acceptance date

2020-05-26

Copyright date

2020

Language

en

Publisher version

TBA

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