You are here

Article Text

Article menu

Download PDFPDF

XML
Research methods
Research
Estimating the change in life expectancy after a diagnosis of cancer among the Australian population
  1. Peter D Baade1,2,3,
  2. Danny R Youlden1,
  3. Therese M-L Andersson4,
  4. Philippa H Youl1,2,3,
  5. Michael G Kimlin1,2,5,
  6. Joanne F Aitken1,2,
  7. Robert J Biggar2,5
  1. 1Cancer Council Queensland, Brisbane, Queensland, Australia
  2. 2School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
  3. 3Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
  4. 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  5. 5AusSun Research Laboratory, Institute of Health and Biotechnical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
  1. Correspondence to Professor Peter D Baade; peterbaade{at}cancerqld.org.au

Abstract

Objectives Communication of relevant prognostic information is critical in helping patients understand the implications of their cancer diagnosis. We describe measures of prognosis to help communicate relevant prognostic information to improve patients’ understanding of the implications of their cancer diagnosis.

Setting Australia-wide population-based cancer registry cohort.

Participants 870 878 patients aged 15–89 years diagnosed with invasive cancer between 1990 and 2007, with mortality follow-up information to December 2010.

Primary and secondary outcome measures Flexible parametric models were used to estimate loss of life expectancy (LOLE), remaining life expectancy (RLE) and 10-year cumulative probability of cancer-specific death (1-relative survival).

Results On average, Australians diagnosed with cancer at age 40 years faced losing an average of 11.2 years of life (95% CI 11.1 to 11.4) due to their cancer, while those diagnosed at 80 years faced losing less, an average of 3.9 years (3.9 to 4.0) because of higher competing mortality risks. In contrast, younger people had lower estimated cumulative probabilities of cancer-specific death within 10 years (40 years: 21.5%, 21.4% to 22.1%) compared with older people (80 years: 55.4%, 55.0% to 55.9%). The patterns for individual cancers varied widely, both by cancer type and by age within cancer type.

Conclusions The LOLE and RLE measures provide complementary messages to standard relative survival estimates (expressed here in terms of cumulative probability of cancer-specific death). Importantly, relative survival per se underplays the greater absolute impact that a cancer diagnosis has at a younger age on LOLE. When presented in isolation for all cancers, it may provide a misleading impression of future mortality burden of cancer overall, and furthermore, it will obscure patterns of mortality by type and by age data within type. Alternative measures of LOLE, therefore, provide important communication about mortality risk to patients with cancer worldwide and should be incorporated into standard reporting and dissemination strategies.

  • Survival
  • Life expectancy
  • Cancer
  • Risk communication

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2014-006740

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text