Conditional Survival Among Cancer Patients in the United States

Purpose.

To report 5-year relative cancer survival probabilities conditional on having already survived ≥1 years after the initial diagnosis for 11 cancer sites, diagnosed during 1990–2001 and followed through 2006.

Methods.

Analyses are based on 1,151,496 cancer cases in population-based cancer registries in the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.

Results.

The 5-year relative conditional survival probability tended to improve with each year already survived. Improvement was greatest for more lethal cancers (e.g., lung or pancreas) and for cases with a more advanced stage at diagnosis. The 5-year relative survival probability conditional on already having survived 5 years exceeded 90% for locally staged prostate cancer, melanoma (whites only), breast cancer (females only), corpus uteri cancer, urinary bladder cancer, Hodgkin’s lymphoma, rectal cancer, colon cancer, ovary cancer, and pancreatic cancer. Only lung cancer did not reach 90%. For these cancer sites combined, 5-year relative survival probability conditional on already having survived 5 years averaged about 85% for regionally staged disease, 68% for distant staged disease, and 87% for unknown staged disease. The 5-year relative conditional survival probability tended to be significantly lower among patients diagnosed at older ages, among males, among nonwhites, and among those diagnosed during 1990–1995 compared with later years.

Conclusion.

Conditional survival probability estimation provides further useful prognostic information to cancer patients, tailored to the time already survived since diagnosis.     

Conditional probability of long‐term survival in glioblastoma

BACKGROUND:

Advances in glioblastoma care have resulted in a larger proportion of patients surviving beyond 2 years after diagnosis. It is not clear how long‐term survivors should be counseled with respect to future prognosis, or what factors influence that prognosis. The conditional probability of survival was evaluated from multiple time points in patients with glioblastoma, using Surveillance, Epidemiology, and End Results (SEER) data.

METHODS:

Patients diagnosed with glioblastoma from 1998 to 2008 who were treated with radiation‐containing regimens were identified within SEER data. Conditional survival probabilities from multiple survival points were calculated. Cox proportional hazards models were constructed to identify predictors of survival from diagnosis and from 1 and 2 years after diagnosis.

RESULTS:

A total of 10,022 patients with glioblastoma met study inclusion criteria; median survival was 12.61 months. Conditional probability of surviving an additional 2 years ranged from 19.8% at diagnosis to 65.9% at 5 years after diagnosis. The proportion of patients surviving 12 months from time of diagnosis as well as from 6, 12, and 18 months after diagnosis was significantly higher in patients diagnosed in 2005 through 2008 than those diagnosed in 1998 through 2004. Of demographic and treatment‐related factors evaluated, only age was associated with hazard of death at diagnosis and 1 and 3 years after diagnosis (P < .0001 at each time point).

CONCLUSIONS:

Patients surviving past 2 years from diagnosis have a relatively favorable conditional probability of survival into the future compared to newly diagnosed patients. This effect becomes more pronounced with increasing time since diagnosis. These data will assist in the counseling of glioblastoma survivors. Cancer 2012. © 2012 American Cancer Society.     

Prognostic role of pregnancy occurring before or after treatment of early breast cancer patients aged <35 years

BACKGROUND:

Usual practices recommend waiting at least 2 years between diagnosis of early breast cancer (EBC) and pregnancy. Few data highlighted a harmful effect of an early pregnancy for low‐risk patients. The authors analyzed retrospectively data from women younger than 35 years who became pregnant before or after treatment of EBC.

METHODS:

Between 1990 and 1999, 908 consecutive EBC patients were analyzed. The primary endpoint was to compare overall survival (OS) between pregnant and nonpregnant patients. The secondary endpoint was to establish a score index laying down the risk of distant recurrence.

RESULTS:

Within the year before the diagnosis, 105 (11.6%) patients became pregnant and 118 (13%) were pregnant after treatment. In a multivariate model, a pregnancy before the diagnosis was not predictive of death but of local relapse. A pregnancy subsequent to breast cancer therapy resulted in a 77% decrease of death (P < .001). In good‐prognosis score index patients, the annual risk of relapse remained low. In patients having the higher score, recurrences occurred mainly during the first years after the treatment. Beyond 80 months, the annual risk of relapse seemed to be similar to those of lower‐risk subgroups.

CONCLUSIONS:

In women aged younger than 35 years, a pregnancy occurring before or after the diagnosis of breast cancer was not an independent prognostic factor of death. In the subset of patients having a high risk of relapse, it may be preferable to postpone a pregnancy beyond 5 years after the breast cancer therapy. Cancer 2009. © 2009 American Cancer Society.     

Conditional survival predictions after surgery for patients with penile carcinoma

BACKGROUND:

Conditional survival (CS) implies that, on average, long‐term cancer survivors have a better prognosis than newly diagnosed individuals. The objective of the current study was to devise an accurate predictive tool that accounts for CS in men diagnosed with penile cancer.

METHODS:

Overall, 1245 patients treated with primary tumor excision (PTE) for pT_1‐3M0 squamous cell carcinoma of the penis (SCCP) between 1998 and 2006 were identified. Cox regression models were fitted for prediction of cancer‐specific mortality (CSM). Nomogram development for prediction of CSM using CS methodology at 2 and 5 years was performed on 670 patients. External validation and calibration of the conditional nomogram was performed in 575 patients.

RESULTS:

The 5‐year CSM‐free survival of patients at surgery was 84.3% and increased to 95.0% and 97.8% after 2 and 5 years of disease‐free survival (DFS), respectively. The predicted probabilities varied by as much as 49% (57% vs 85%) when, for example, predictions of CSM‐free survival at 5 years were made after PTE versus after 2 years of DFS. Within the external validation cohort, the accuracy of the conditional nomogram was 75.3% and 78.1% at 2 and 5 years after PTE.

CONCLUSIONS:

The authors developed and externally validated the first conditional nomogram for predicting SCCP CSM‐free survival that allows consideration of the length of survivorship. Cancer 2011;. © 2011 American Cancer Society.     

Estimating breast cancer‐specific and other‐cause mortality in clinical trial and population‐based cancer registry cohorts

BACKGROUND:

To compute net cancer‐specific survival rates using population data sources (eg, the National Cancer Institute's Surveillance, Epidemiology, and End Results [SEER] Program), 2 approaches primarily are used: relative survival (observed survival adjusted for life expectancy) and cause‐specific survival based on death certificates. The authors of this report evaluated the performance of these estimates relative to a third approach based on detailed clinical follow‐up history.

METHODS:

By using data from Cancer Cooperative Group clinical trials in breast cancer, the authors estimated 1) relative survival, 2) breast cancer‐specific survival (BCSS) determined from death certificates, and 3) BCSS obtained by attributing cause according to clinical events after diagnosis, which, for this analysis was considered the benchmark “true” estimate. Noncancer life expectancy also was compared between trial participants, SEER registry patients, and the general population.

RESULTS:

Among trial patients, relative survival overestimated true BCSS in patients with lymph node‐negative breast cancer; whereas, in patients with lymph node‐positive breast cancer, the 2 estimates were similar. For higher risk patients (younger age, larger tumors), relative survival accurately estimated true BCSS. In lower risk patients, death certificate BCSS was more accurate than relative survival. Noncancer life expectancy was more favorable among trial participants than in the general population and among SEER patients. Tumor size at diagnosis, which is a potential surrogate for screening use, partially accounted for this difference.

CONCLUSIONS:

In the clinical trials, relative survival accurately estimated BCSS in patients who had higher risk disease despite more favorable other‐cause mortality than the population at large. In patients with lower risk disease, the estimate using death certificate information was more accurate. For SEER data and other data sources where detailed postdiagnosis clinical history was unavailable, death certificate‐based estimates of cause‐specific survival may be a superior choice. Cancer 2009. © 2009 American Cancer Society.     

Long-term crude probabilities of death among breast cancer patients by age and stage: a population-based survival study in Northeastern Spain (Girona–Tarragona 1985–2004)

Background

We provide population-based long-term survival indicators of breast cancer patients by quantifying the observed survival, and the probabilities of death due to breast cancer and to other causes by age and tumor stage at diagnosis.

Methods

We included a total of 10,195 female patients diagnosed before 85 years with invasive primary breast cancer in Girona and Tarragona during the periods 1985–1994 and 1995–2004 and followed-up until December 31st 2014. The survival indicators were estimated at 5, 10, 15 and 20 years of follow-up comparing diagnostic periods.

Results

Comparing diagnostic periods: I) the probability of death due to other causes did not change; II) the 20-year survival for women diagnosed ≤ 49 years increased 13% (1995–2004 = 68%; 1985–1994:55%), whereas their probability of death due to breast cancer decreased at the same pace (1995–2004 = 29%; 1985–1994 = 42%); III) at 10 years of follow-up, decreases in the probabilities of death due to breast cancer across age groups switched from 11 to 17% resulting in a risk of death reduction of 19% after adjusting by stage. During 1995–2004, the stage-specific 10-year probabilities of death due to breast cancer switched from: 3–6% in stage I, 18–20% in stage II, 34–46% in stage III and surpassed 70% in stage IV beyond 5 years after diagnosis.

Conclusions

In our study, women diagnosed with breast cancer had higher long-term probability to die from breast cancer than from other causes. The improvements in treatment and the lead-time bias in detecting cancer in an early stage resulted in a reduction of 19% in the risk of death between diagnostic periods.

     

Impact of race on survival in patients with clinically nonmetastatic prostate cancer who deferred primary treatment

BACKGROUND:

Prostate cancer (PCa) racial disparity studies typically focus on survival differences after curative treatment. The authors of this report hypothesized that comparing mortality rates between African American (AA) and Caucasian American (CA) patients who deferred primary treatment for clinically nonmetastatic PCa may provide a better assessment of the impact of race on the natural course of PCa.

METHODS:

The pathology database of the New York Veterans Administration Medical Center (VAMC), an equal access‐of‐care facility, was searched for patients with biopsy‐proven PCa. Inclusion criteria included 1) no evidence of metastatic disease or death within 3 years after diagnosis, 2) no primary treatment, and 3) a minimum of 5 years of follow‐up for survivors.

RESULTS:

In total, 518 patients met inclusion criteria between 1990 and 2005. AA patients were younger (P = .02) and had higher median prostate‐specific antigen (PSA) levels (P = .001) at the time of diagnosis compared with CA patients. In a multivariate model, higher Gleason score and PSA level were associated with increased mortality (P = .001 and P = .03, respectively), but race was not a predictor of death from PCa.

CONCLUSIONS:

The current data suggested that race did not have a major impact on survival in patients with PCa who deferred primary treatment for clinically nonmetastatic disease. Cancer 2012;118: 3145–52. © 2011 American Cancer Society.     

Conditional survival in patients with pancreatic ductal adenocarcinoma resected with curative intent

BACKGROUND:

Prognosis after surgery for pancreatic ductal adenocarcinoma (PDAC) is typically reported from the date of surgery. Survival estimates, however, are dynamic and may change based on the time already survived. The authors sought to assess conditional survival among a large cohort of patients who underwent resection of PDAC.

METHODS:

Between 1970 and 2008, 1822 patients who underwent resection for PDAC with curative intent were identified. Kaplan‐Meier and Cox regression analyses were performed to validate established predictors of survival, and results were compared with 2‐year conditional survival.

RESULTS:

Actuarial survival was 18% at 5 years, with a median survival of 18 months. Multivariate analysis revealed that tumor size, lymph node ratio, and positive margins were associated with worse survival (all P < .001). Differences in actuarial versus conditional survival estimates were greater the more years already survived by the patient. The 2‐year conditional survival at 3 years—the probability of surviving to postoperative year 5 given that the patient had already survived 3 years—was 66% versus a 5‐year actuarial survival calculated from the time of surgery of 18%. Stratification of 2‐year conditional survival by lymph node ratio and margin status revealed that patients with high lymph node ratio or positive margins saw the greatest increase in 2‐year conditional survival as more time elapsed (both P ≤ .01).

CONCLUSIONS:

Differences in actuarial versus conditional survival estimates were more pronounced based on the additional years already survived by the patient. Conditional survival may be a helpful tool in counseling patients with PDAC, as it is a more accurate assessment of future survival for those patients who have already survived a certain amount of time. Cancer 2011. © 2011 American Cancer Society.     

Disparities in the application of adjuvant radiotherapy after breast-conserving surgery for early stage breast cancer: impact on overall survival

BACKGROUND:

Definitive local therapy of early stage breast cancer includes adjuvant radiotherapy after breast‐conserving surgery (BCS). The authors analyzed factors that influence the receipt of radiotherapy therapy and their resultant impact on outcome.

METHODS:

Using data from the Kentucky Cancer Registry, the authors analyzed the rate of adjuvant radiotherapy for 11,914 women who underwent BCS as a primary surgical treatment for stage 0, I, or II breast cancer between 1998 and 2007. The authors assessed the probability of receiving radiotherapy by using multivariate logistic regression and measured impact on outcome by using Cox survival analysis.

RESULTS:

Overall, 66.2% of women received adjuvant radiotherapy for BCS over a 10‐year period (annual rate range, 60.9%‐70.1%). On multivariate analysis, the rate of receiving radiotherapy was drastically lower for women aged older than 70 years (vs younger) and rural Appalachian (vs non‐Appalachian) populations. The rate was modestly lower for African American (vs white) women, those with in situ (vs invasive) disease, and uninsured (vs insured) patients. Lack of radiotherapy was associated with an increased hazard ratio for death of 1.67 (95% CI, 1.508‐1.851) on Cox survival analysis when age, stage, tumor size, grade, hormone receptors, smoking, and insurance were factored into the analysis. The 10‐year overall survival for patients who received adjuvant radiotherapy versus BCS alone was 79.7% versus 67.6% (P < .0001).

CONCLUSIONS:

Despite widespread knowledge of the benefit of RT after BCS, the rate of undertreatment remains high, with significant disparities for elderly, rural, minority, and uninsured women. Multidisciplinary management strategies, including accelerated and hypofractionated radiation regimens, are needed to eliminate disparities and improve outcomes. Cancer 2011. © 2010 American Cancer Society.     

Acute ovarian failure underestimates age-specific reproductive impairment for young women undergoing chemotherapy for cancer

BACKGROUND:

The authors sought to describe the age‐specific impact of infertility and early menopause after chemotherapy among reproductive age women with cancer.

METHODS:

A total of 1041 women diagnosed with cancer between the ages of 18 and 40 years responded to a retrospective survey on reproductive health history. Five cancer types were included: leukemia, Hodgkin disease (HD), non‐Hodgkin lymphoma (NHL), breast cancer, and gastrointestinal(GI) cancer. Survey questions addressed acute ovarian failure (cessation of menses after treatment), early menopause (menopause before 45 years old), and infertility (failed conception). Logistic regression was used to determine the proportions of acute ovarian failure and infertility based on age at diagnosis. Censored data methods were used to determine the probability of early menopause.

RESULTS:

Six hundred twenty women received chemotherapy alone. The percentage reporting acute ovarian failure was 8%, 10%, 9%, and 5% for HD, NHL, breast cancer, and GI cancer, respectively. Acute ovarian failure increased significantly with age at diagnosis (P < .05). In subjects not reporting acute ovarian failure, the incidence of infertility was at least 40% at age 35 years and increased significantly with age at diagnosis in HD and breast cancer (P < .05). The estimated probability of early menopause was at least 25% at age 30 years and increased significantly with younger age at diagnosis in HD, NHL, and GI cancer (P < .05).

CONCLUSIONS:

For patients to receive appropriate counseling, it is important that they understand the potential increased risk of infertility and early menopause beyond that of acute ovarian failure. These findings can provide improved, age‐specific counseling regarding reproductive impairment for young women diagnosed with cancer. Cancer 2012;. © 2011 American Cancer Society.     

Survival disparities by Medicaid status: an analysis of 8 cancers

BACKGROUND:

A study was undertaken to compare survival and 5‐year mortality by Medicaid status in adults diagnosed with 8 select cancers.

METHODS:

Linking records from the Ohio Cancer Incidence Surveillance System (OCISS) with Ohio Medicaid enrollment data, the authors identified Medicaid and non‐Medicaid patients aged 15 to 54 years and diagnosed with the following incident cancers in the years 1996‐2002: cancer of the testis; Hodgkin and non‐Hodgkin lymphoma; early stage melanoma, colon, lung, and bladder cancer; and pediatric malignancies (n = 12,703). Medicaid beneficiaries were placed in the pre‐diagnosis group if they were enrolled in Medicaid at least 3 months before cancer diagnosis, and in the peri/post‐diagnosis group if they enrolled in Medicaid upon or after being diagnosed with cancer. The authors also linked the OCISS with death certificates and data from the US Census. By using Cox and logistic regression analysis, they examined the association between Medicaid status and survival and 5‐year mortality, respectively, after adjusting for patient covariates.

RESULTS:

Nearly 11% of the study population were Medicaid beneficiaries. Of those, 45% were classified in the peri/post‐diagnosis group. Consistent with higher mortality, findings from the Cox regression model indicated that compared with non‐Medicaid, patients in the Medicaid pre‐diagnosis and peri/post‐diagnosis groups experienced unfavorable survival outcomes (adjusted hazard ratio [AHR], 1.52; 95% confidence interval [CI], 1.27‐1.82 and AHR, 2.01; 95% CI, 1.70‐2.38, respectively).

CONCLUSIONS:

Medicaid status was associated with unfavorable survival, even after adjusting for confounders. The findings reflect the vulnerability of Medicaid beneficiaries and possible inadequacies in the process of care. Cancer 2012. © 2011 American Cancer Society.     

Conditional survival of extremity soft-tissue sarcoma: results beyond the staging system

BACKGROUND:

With increasing interest in adult cancer survivorship, currently available prognostic estimates for long‐term survivors of extremity soft‐tissue sarcoma (ESTS) are limited. We assessed determinants of survival in adults surgically treated for nonmetastatic ESTS, conditional on specific survival periods.

Methods:

We identified 6215 persons aged >18 in the Surveillance Epidemiology and End Results program who were surgically treated for nonmetastatic ESTS from 1991 to 2006. We used Cox proportional hazards regression to assess demographic, tumor, and treatment factors associated with 10‐year sarcoma‐specific survival (SSS) at diagnosis and conditional on surviving 3 and 5 years postdiagnosis.

RESULTS:

At the time of diagnosis, age, tumor, and treatment factors predicted SSS. Although older age significantly predicted worse SSS for all age groups at diagnosis (HR 3.78 for age >81 vs 18‐35; P < .05 for all), the effect of age became nonsignificant as survival time increased, except for the oldest group (>80 years). Tumor size, grade, and histologic subtypes continued to be important predictors of SSS for all periods of conditional survival. Persons who underwent limb amputation were at 3 times the risk of mortality for all conditional survival periods.

CONCLUSIONS:

In this large population‐based experience of ESTS survivors, age >80, tumor, and treatment factors continued to affect long‐term survival, whereas the effect of age dampened over time. These estimates provide important counseling information for changing risk factors as survival time increases, help to streamline future surveillance programs, and provide insights into the design of adult survivorship care. Cancer 2011. © 2010 American Cancer Society.     

Prognosis for primary retroperitoneal sarcoma survivors: a conditional survival analysis

BACKGROUND:

The AJCC staging system and post‐operative nomograms use patient and tumor characteristics to provide prognostic estimates after resection of retroperitoneal sarcoma (RPS). While these variables help to predict survival at the time of diagnosis and resection, the applicability of these prognostic factors to survivors of RPS remains unknown. We hypothesized that the variables evaluated in the current staging system and post‐operative nomograms would have limited ability to predict conditional survival in patients surgically treated for RPS.

METHODS:

A retrospective study was conducted using National Cancer Institute‐sponsored tumor registries. We identified 1,199 patients who underwent surgical resection for non‐metastatic RPS from 1988 to 2007. Conditional survival was defined as time‐specific estimates conditioned on living a certain number of years post‐diagnosis. Cox proportional hazards regression was used to assess the impact of various factors on sarcoma‐specific survival (SSS) at baseline and up to 5 years after diagnosis.

RESULTS:

Older age, male gender, histologic subtype, and high tumor grade predicted worse SSS at the time of diagnosis. After 1 year of survival, older age, male gender, and histologic subtype were no longer significant predictors of conditional survival. Only high grade tumors remained a significant predictor of worse prognosis after 5 years of survival (HR 1.95).

CONCLUSIONS:

This population‐based study demonstrates that the factors which are predictive of survival at baseline lose significance after one year of survival. Conditional survival estimates allow clinicians to provide survivors with more meaningful prognostic estimates that may impact surveillance schedules and streamline adjuvant therapy decisions and design of future clinical trials. Cancer 2012. © 2012 American Cancer Society.     

A wide difference in cancer survival between middle aged and elderly patients in Europe

Nowadays the burden of cancer in elderly people has reached an alarming extent. The purpose of this study is comparing cumulative and conditional relative survival in elderly patients between 65 and 84 years and younger adults aged from 55 to 64. Fifty-three cancer registries of 22 European countries, participating in the EUROCARE-3 programme, collected information on the cases diagnosed over the period 1990-1994. We computed cumulative and conditional relative survival for 16 cancer sites. Middle aged patients experienced a better prognosis than the elderly for all cancer sites, in both sexes and the differences were more marked at 1 than 5 years since diagnosis. The very large differences noted in the first period after cancer detection declined in the subsequent years and, when 5-years conditional survival was considered, for several cancers the elderly and younger adults had the same probabilities of surviving. The death relative excess risks (RERs) in the elderly with respect younger individuals were really very high and markedly larger at 1 than 5 years, and in women than men. Genitourinary and gynaecological cancers showed the highest RERs, around 2.0 and between 1.5 and 2.5 respectively. This very high early mortality could be due not only to clinical aspects: the barriers to health care access and a consequent late diagnosis might represent for elderly patients the main determinant of this very large prognostic disadvantage. In conclusion, clinical management of cancer in the elderly remains a major issue to be faced with complex social and health care policies.     

Treatment and survival outcomes in young men diagnosed with prostate cancer

BACKGROUND:

Outcomes of treatment for young men compared with older men with prostate cancer are poorly defined outside of limited institutional series. In this study, the authors examined the association between age at diagnosis and grade, stage, treatment, and survival outcomes in men who were diagnosed during the era of prostate‐specific antigen testing.

METHODS:

The National Cancer Institute's Surveillance, Epidemiology, and End Results database was used to identify men who were diagnosed with prostate cancer between 1988 and 2003. Men ages 35 years to 74 years were stratified by age at diagnosis to examine differences in tumor characteristics, treatment, and survival within each age group.

RESULTS:

In total, 318,774 men ages 35 years to 74 years were identified who had been diagnosed with adenocarcinoma of the prostate between 1988 and 2003. The proportion of men aged ≤55 years at diagnosis increased over the study period from 2.3% between the years 1988 and 1991 to 9% between the years 2000 and 2003, and the median age at diagnosis decreased from 72 years in 1988 to 68 years in 2003. Younger men were diagnosed less frequently with organ‐confined tumors (P < .001) but were less likely to be diagnosed with high‐grade cancer (P < .001). Older men were more likely to receive no local therapy or external beam radiation than young men (P < .001 for trend). Among men who had tumors with a Gleason score between 5 and 7, overall survival was worse with advancing age. However, among all age groups with high grade and stage, the youngest men (ages 35‐44 years) were at the highest risk of all‐cause and cancer‐specific death.

CONCLUSIONS:

Age at diagnosis among men with prostate cancer continued to decline. Younger men were more likely to undergo prostatectomy, have lower grade cancer, and, as a group, to have better overall and equivalent cancer‐specific survival at 10 years compared with older men. Among men with high grade and locally advanced prostate cancer, the youngest men had a particularly poor prognosis compared with older men. Cancer 2009. Published 2009 by the American Cancer Society.     

Explaining racial differences in prostate cancer mortality

BACKGROUND:

In the United States, black males have an annual death rate from prostate cancer that is 2.4 times that of white males. The reasons for this are poorly understood.

METHODS:

Using the Surveillance, Epidemiology, and End Results–Medicare database, 77,038 black and white males aged >65 years were identified with a first primary diagnosis of prostate cancer between 1995 and 2005, as well as 49,769 controls. The racial gap in mortality was decomposed to differential incidence and stage‐specific prostate cancer mortality. The importance of various clinical and socioeconomic factors to each of these components was then examined.

RESULTS:

The estimated mortality gap for prostate cancer–specific mortality was 1320 more cases per 100,000 males among black than white men. This gap was due to higher prostate cancer incidence among black males (76%) and higher stage‐specific mortality once diagnosed (24%). Differences in prostate‐specific antigen testing, comorbidities, and income explained 29% of the difference in metastatic cancer incidence but none of the racial gap for local/regional incidence. Conditional on diagnosis, tumor characteristics explained 50% of the racial gap, comorbidities an additional 4%, choice of treatment and physician 17%, and socioeconomic factors 15%. Overall, approximately 25% of the racial gap in mortality and 86% of the gap in mortality conditional on diagnosis could be explained.

CONCLUSIONS:

More frequent prostate‐specific antigen testing for black and low‐income males could potentially reduce the prostate cancer mortality gap through earlier diagnosis of tumors that otherwise may become metastatic. More aggressive treatment of prostate cancer, especially in poor communities, might also reduce the gap. Cancer 2012. © 2012 American Cancer Society.     

Human immunodeficiency virus-associated lung cancer in the era of highly active antiretroviral therapy

BACKGROUND:

Lung cancer is the leading cause of death among non‐acquired immunodeficiency syndrome (AIDS)‐defining malignancies. Because highly active antiretroviral therapy (HAART) has improved the survival of patients with human immunodeficiency virus (HIV), the authors evaluated lung cancer outcomes in the HAART era.

METHODS:

HIV‐positive patients who were diagnosed with lung cancer at the authors' institution during the HAART era (1995‐2008) were analyzed. Patient charts were reviewed for clinical and laboratory data. The CD4 count at diagnosis was treated as a continuous variable and subcategorized into distinct variables with 3 cutoff points (50 cells/mL, 200 cells/mL, and 500 cells/mL). Pearson correlation coefficients were estimated for each covariate studied. Survival was determined by using the Kaplan‐Meier method.

RESULTS:

Of 80 patients, 73 had nonsmall cell lung cancer. Baseline characteristics were as follows: median patient age, 52 years; male, 80%; African Americans, 84%; injection drug users, 25%; smokers, 100%; and previous exposure to antiretroviral agents, 55%. At the time of cancer diagnosis, the mean CD4 count was 304 cells/mL, and the mean viral load was 82,420 copies/mL. The latency between HIV diagnosis and lung cancer diagnosis was significantly shorter among women (4.1 years vs 7.7 years; P = .02), and 71% of patients received anticancer therapy. The 1‐year and 3‐year survival rates for stage IIIB/IV were 25% and 0%, respectively. Grade 3/4 toxicities occurred in 60% of patients who received chemoradiation versus 36% of patients who received chemotherapy. Cancer‐related survival was better for patients with CD4 counts >200 cells/mL (P = .0298) and >500 cells/mL (P = .0076).

CONCLUSIONS:

The latency from diagnosis of HIV to lung cancer was significantly shorter for women. Although outcomes for patients with lung cancer who have HIV remain poor, a high CD4 count was associated with improved lung cancer‐related survival. Cancer 2012;. © 2011 American Cancer Society.     

Conditional survival analysis for patients with intraductal papillary mucinous neoplasms (IPMNs) undergoing curative resection

Background

Conditional survival (CS) analysis represents a novel method that may provide more clinically relevant perspectives to cancer management compared to conventional survival analysis. The purpose of this study was to evaluate conditional survival for patients with intraductal papillary mucinous neoplasms (IPMNs) undergoing curative resection.

Delays in diagnosis and bladder cancer mortality

BACKGROUND:

Mortality from invasive bladder cancer is common, even with high‐quality care. Thus, the best opportunities to improve outcomes may precede the diagnosis. Although screening currently is not recommended, better medical care of patients who are at risk (ie, those with hematuria) has the potential to improve outcomes.

METHODS:

The authors used the Surveillance, Epidemiology, and End Results‐Medicare linked database for the years 1992 through 2002 to identify 29,740 patients who had hematuria in the year before a bladder cancer diagnosis and grouped them according to the interval between their first claim for hematuria and their bladder cancer diagnosis. Cox proportional hazards models were fitted to assess relations between these intervals and bladder cancer mortality, adjusting first for patient demographics and then for disease severity. Adjusted logistic models were used to estimate the patient's probability of receiving a major intervention.

RESULTS:

Patients (n = 2084) who had a delay of 9 months were more likely to die from bladder cancer compared with patients who were diagnosed within 3 months (adjusted hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.20‐1.50). This risk was not markedly attenuated after adjusting for disease stage and tumor grade (adjusted HR, 1.29; 95% CI, 1.14‐1.45). In fact, the effect was strongest among patients who had low‐grade tumors (adjusted HR, 2.11; 95% CI, 1.69‐2.64) and low‐stage disease (ie, a tumor [T] classification of Ta or tumor in situ; adjusted HR, 2.02; 95% CI, 1.54‐2.64).

CONCLUSIONS:

A delay in the diagnosis of bladder cancer increased the risk of death from disease independent of tumor grade and or disease stage. Understanding the mechanisms that underlie these delays may improve outcomes among patients with bladder cancer. Cancer 2010. © 2010 American Cancer Society.     

Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer

BACKGROUND:

Prophylactic cranial irradiation has been used in patients with small cell lung cancer to reduce the incidence of brain metastasis after primary therapy. The purpose of this study was to evaluate the effects of prophylactic cranial irradiation (PCI) on overall survival and cause‐specific survival.

METHODS:

A total of 7995 patients with limited stage small cell lung cancer diagnosed between 1988 and 1997 were retrospectively identified from centers participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Of them, 670 were identified as having received PCI as a component of their first course of therapy. Overall survival and cause‐specific survival were estimated by the Kaplan‐Meier method, comparing patients treated with or without prophylactic whole‐brain radiotherapy. The Cox proportional hazards model was used in the multivariate analysis to evaluate potential prognostic factors.

RESULTS:

The median follow‐up time was 13 months (range, 1 month to 180 months). Overall survival at 2 years, 5 years, and 10 years was 23%, 11%, and 6%, respectively, in patients who did not receive PCI. In patients who received PCI, the 2‐year, 5‐year, and 10‐year overall survival rates were 42%, 19%, and 9%, respectively (P = <.001). The cause‐specific survival rate at 2 years, 5 years, and 10 years was 28%, 15%, 11%, respectively, in patients who did not receive PCI and 45%, 24%, 17%, respectively, in patients who did receive PCI (P = <.001). On multivariate analysis of cause‐specific and overall survival, age at diagnosis, sex, grade, extent of primary disease, size of disease, extent of lymph node involvement, and PCI were found to be significant (P = <.001). The hazards ratios for disease‐specific and all cause mortality were 1.13 and 1.11, respectively, for those not receiving PCI.

CONCLUSIONS:

Significantly improved overall and cause‐specific survival was observed in patients treated with prophylactic cranial irradiation on unadjusted and adjusted analyses. This study concurs with the previously published European experience. Prophylactic cranial irradiation should be considered for patients with limited stage small cell lung cancer. Cancer 2009. © 2008 American Cancer Society.