Temporal trends in loss of life expectancy after a cancer diagnosis among the Australian population.

BACKGROUND: Loss of life expectancy (LOLE) provides valuable insights into the impact of cancer. We evaluated the temporal trends in LOLE for Australian cancer patients and the gain in life years for recently diagnosed patients due to survival improvements. METHODS: Analysis was conducted using an Australian population-based cohort (n = 1,865,154) aged 50-89 years, who were primarily diagnosed with one of 19 leading cancers between 1982-2015. Flexible parametric survival models were used to estimate LOLE and the proportion of life lost (POLL) by year, age group, sex, and, for New South Wales only, spread of disease. The total years of LOLE and gain in life years due to survival improvements were estimated for those diagnosed in 2014. RESULTS: For 19 cancers combined, LOLE and POLL were significantly lower for more recent diagnoses. Cancer-specific temporal trends were consistent by age, sex, and spread of disease (where relevant) although the magnitude varied. Prostate, kidney, or non-Hodgkin lymphoma experienced the largest decreases in POLL over time. For the 2014 diagnoses, an estimation of 403,094 life years lost will be caused by the 19 cancers. With the increase in cancer survival over time, the 2014 cohort will gain an extra 432,588 life years (52 %) compared to that experienced by the 1982 cohort. CONCLUSION: While reduced impact of a cancer diagnosis on LOLE over time is encouraging, the growing number of cancer survivors in Australia is likely to pose complex challenges for cancer patients, their care givers, and health-care systems.

Patterns of prostate-specific antigen testing by remoteness of residence and socio-economic status: An Australian population-based study.

OBJECTIVE: Describes the variation in prostate cancer testing by the remoteness of residence and socio-economic status groups in Australia. DESIGN: A national population-based descriptive study using Medicare data extracted by the Department of Health (formerly the Department of Health and Ageing). SETTING: Australia. PARTICIPANTS: All men, with a Medicare-reimbursed prostate-specific antigen test conducted in Australia between 2002 and 2017, were included. We focused on "screening and case finding" tests (Medicare Benefits Schedule item number 66655) from 1 April 2005 to 31 December 2009, to describe testing differences in subgroups. Groups were categorised into State and Territory, socio-economic status and region of residence. A negative binomial regression model was fitted to measure the incidence rate ratios of those who had a screening prostate-specific antigen test by group. MAIN OUTCOME MEASURES: Age-standardised testing rates and incidence rate ratios. RESULTS: Between 2002 and 2017, 11 588 775 screening prostate-specific antigen tests were reimbursed by the Department of Human Services. During 2005-2009, 52% of all Australian men, aged 40 years and over, had a screening test. The incidence rate ratios differed by State and Territory. Men aged 40 years and over, living in very remote areas, were 43% less likely to have had a screening test than residents of major cities. Prostate-specific antigen testing rates fell in all age groups between 2007 and 2009 and 2017. CONCLUSIONS: The prostate-specific antigen testing behaviour differs between community groups in Australia. Men were less likely to have had a screening prostate-specific antigen test the farther they lived from the major cities. This highlights the need for a more targeted approach to achieve an equitable and evidence-based prostate cancer care across all sectors of the community.

Projecting prevalence by stage of care for prostate cancer and estimating future health service needs: protocol for a modelling study.

Introduction Current strategies for the management of prostate cancer are inadequate in Australia. We will, in this study, estimate current service needs and project the future needs for prostate cancer patients in Australia. Methods and analysis First, we will project the future prevalence of prostate cancer for 2010-2018 using data for 1972-2008 from the New South Wales (NSW) Central Cancer Registry. These projections, based on modelled incidence and survival estimates, will be estimated using PIAMOD (Prevalence, Incidence, Analysis MODel) software. Then the total prevalence will be decomposed into five stages of care: initial care, continued monitoring, recurrence, last year of life and long-term survivor. Finally, data from the NSW Prostate Cancer Care and Outcomes Study, including data on patterns of treatment and associated quality of life, will be used to estimate the type and amount of services that will be needed by prostate cancer patients in each stage of care. In addition, Central Cancer Registry episode data will be used to estimate transition rates from localised or locally advanced prostate cancer to metastatic disease. Medicare and Pharmaceutical Benefits data, linked with Prostate Cancer Care and Outcomes Study data, will be used to complement the Cancer Registry episode data. The methods developed will be applied Australia-wide to obtain national estimates of the future prevalence of prostate cancer for different stages of clinical care. Ethics and dissemination This study was approved by the NSW Population and Health Services Research Ethics Committee. Results of the study will be disseminated widely to different interest groups and organisations through a report, conference presentations and peer-reviewed articles.

Changes in smoking prevalence among U.S. adults by state and region: Estimates from the Tobacco Use Supplement to the Current Population Survey, 1992-2007.

BACKGROUND: Tobacco control policies at the state level have been a critical impetus for reduction in smoking prevalence. We examine the association between recent changes in smoking prevalence and state-specific tobacco control policies and activities in the entire U.S. METHODS: We analyzed the 1992-93, 1998-99, and 2006-07 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) by state and two indices of state tobacco control policies or activities [initial outcome index (IOI) and the strength of tobacco control (SOTC) index] measured in 1998-1999. The IOI reflects cigarette excise taxes and indoor air legislation, whereas the SOTC reflects tobacco control program resources and capacity. Pearson Correlation coefficient between the proportionate change in smoking prevalence from 1992-93 to 2006-07 and indices of tobacco control activities or programs was the main outcome measure. RESULTS: Smoking prevalence decreased from 1992-93 to 2006-07 in both men and women in all states except Wyoming, where no reduction was observed among men, and only a 6.9% relative reduction among women. The percentage reductions in smoking in men and women respectively were the largest in the West (average decrease of 28.5% and 33.3%) and the smallest in the Midwest (18.6% and 20.3%), although there were notable exceptions to this pattern. The decline in smoking prevalence by state was correlated with the state's IOI in both women and men (r = -0.49, p < 0.001; r = -0.31, p = 0.03; respectively) and with state's SOTC index in women(r = -0.30, p = 0.03 0), but not men (r = -0.21, p = 0.14). CONCLUSION: State level policies on cigarette excise taxes and indoor air legislation correlate strongly with reductions in smoking prevalence since 1992. Strengthening and systematically implementing these policies could greatly accelerate further reductions in smoking.

Improved survival for non-Hodgkin lymphoma patients in New South Wales, Australia.

BACKGROUND: We evaluated if the survival benefit of adding rituximab to standard chemotherapy for non-Hodgkin lymphoma (NHL) observed in clinical trials has been experienced by an Australian NHL patient population. METHODS: NHL cases diagnosed in 1985-2004 in New South Wales (NSW) were followed-up to the end of 2004. Rituximab prescription data were obtained from Medicare Australia. Using a Poisson regression model adjusted for age group, sex, NHL subtype and time period (1990-1994, 1995-1999 and 2000-2004), we estimated excess risk of death after a diagnosis of NHL. To give context to the survival trend, trends in incidence and mortality were also estimated. RESULTS: Compared with 1990-1994, after adjusting for age, sex and NHL subtype the relative excess risk of death was significantly lower (p < 0.0001) in 1995-1999 (0.89) and 2000-2004 (0.74). A sharp fall in mortality was observed from 2000 to 2004 (annual percentage change (APC) = -4.7, p = 0.009), while a small but significant rise in incidence was seen from 1990 to 2004 (APC = 0.5, p = 0.01). The number of times rituximab was dispensed in NSW increased rapidly from 1274 in 1999 to 9250 in 2004. CONCLUSION: It is likely that some benefit of adding rituximab to the standard chemotherapy for NHL has been experienced at the population level.

Misclassification of colorectal cancer stage and area variation in survival.

We previously investigated the impact of health area of residence on colon and rectal cancer survival by estimating area-specific relative excess risk of death (RER), stratified by stage at diagnosis. The aims of this study were to quantify errors in colorectal cancer stage obtained from an Australian population-based cancer registry and assess the potential impact of errors in stage on these estimates. For a subset of cases, we compared the cancer registry stage with that from a survey of treating surgeons. We then randomly reallocated all cases to a simulated "corrected" stage according to the estimated misclassification probabilities and repeated the analysis of area variation stratified by simulated stage 1,000 times. We found 70% agreement between the Registry and Survey stage. This reallocation of the Registry cases by stage resulted in substantial variation in area-specific RERs across the simulated samples. Area variation in survival for localized colon and localized rectal cancer, which were previously statistically significant when classified using Registry stage, appeared no longer to be so. Misclassification of cancer registry stage can have an important impact on estimates of spatial variation in stage-specific colon and rectal cancer survival. If population-based cancer registry data are to be effectively used in evaluating and improving cancer care, the quality of the stage data may need to be improved.

Trends in survival and excess risk of death after diagnosis of cancer in 1980-1996 in New South Wales, Australia.

Survival from almost all cancers has improved during the last 30 years. There is debate over the reasons for the improvement. We examined trends in survival for 28 cancers from 1980 to 1996 in New South Wales (NSW), Australia, with adjustment for disease spread at diagnosis. NSW Central Cancer Registry data were used to estimate 5-year relative survival and relative excess risk of death for patients diagnosed in 1980-84, 1985-88, 1989-92 and 1993-96. Statistical significance of variation in excess deaths between periods of diagnosis was assessed using Poisson regression, with adjustment for age, sex, duration of follow-up, histology and spread of disease at diagnosis. There were statistically significant falls in excess deaths for 20 of the cancers with a 25% fall for all cancers combined. Cancers of the prostate, liver, thyroid, breast, gallbladder, body of uterus, rectum, cervix and ovary had falls of >30%. The falls varied by spread of disease; the largest being in localised and regionally spread tumours. Overall survival, when unadjusted for spread of cancer, generally fell in parallel with that in the specific categories of spread, which implies that stage migration did not contribute importantly to survival trends. While acknowledging the limitations of incomplete data on stage of cancer at diagnosis, we conclude that falls in excess deaths in NSW from 1980 to 1996 are unlikely, for many cancers, to be attributed to earlier diagnosis or stage migration; thus advances in cancer treatment have almost certainly contributed to them.

A population-based study from New South Wales, Australia 1996-2001: area variation in survival from colorectal cancer.

In this study, we have investigated the impact of area of residence on survival from colon and rectal cancer. Relative survival and relative excess risk of death from cancer were calculated for each of 17 health areas in New South Wales, Australia. There were statistically significant differences in survival across areas for both cancers after adjusting for demographic factors. The variation remained for colon cancer but was reduced for rectal cancer after adjustment for spread of disease at diagnosis. This persistent variation in colon cancer survival suggests that variation in treatment contributes to it, and there is separate evidence for such variation. Of the 7186 patients whose deaths within five years were attributable to colorectal cancer, 784 could have had their survival increased to more than five years if the excess risk of death in all areas was reduced to the 20th centile of its distribution. Estimates such as this can assist in prioritizing improvements in cancer services.

Estimating regional variation in cancer survival: a tool for improving cancer care.

OBJECTIVE: To improve estimation of regional variation in cancer survival and identify cancers to which priority might be given to increase survival. METHODS: Survival measures were calculated for 25 major cancer types diagnosed in each of 17 health service regions in New South Wales, Australia, from 1991 to 1998. Region-specific risks of excess death due to cancer were estimated adjusting for age, sex, and extent of disease at, and years since, diagnosis. Empirical Bayes (EB) methods were used to shrink the estimates. The additional numbers of patients who would survive beyond five years were estimated by shifting the State average risk to the 20th centile. RESULTS: Statistically significant regional variation in the shrunken estimates of risk of excess death was found for nine of the 25 cancer types. The lives of 2903 people (6.4%) out of the 45,047 whose deaths within 5 years were attributable to cancer could be extended with the highest number being for lung cancer (791). CONCLUSIONS: The EB approach gives more precise estimates of region-specific risk of excess death and is preferable to standard methods for identifying cancer sites where gains in survival might be made. The estimated number of lives that could be extended can assist health authorities in prioritising investigation of and attention to causes of regional variation in survival.

Remoteness of residence and survival from cancer in New South Wales.

OBJECTIVE: To analyse cancer survival in New South Wales by geographic remoteness. DESIGN, SETTING AND PARTICIPANTS: A survival analysis of all patients with cancers diagnosed in NSW between 1 January 1992 and 31 December 1996. Survival was determined to 31 December 1999. MAIN OUTCOME MEASURES: The relative excess risk (RER) of death over 5 years was estimated for each geographic remoteness category relative to the highly accessible category for 20 cancer types adjusted for age, sex, years since diagnosis and, subsequently, stage of cancer at diagnosis. RESULTS: There were statistically significant differences in the RER of death across remoteness categories (P < 0.001) for cancers of the cervix and prostate and for all cancers. The RERs for the most remote categories (compared with the highly accessible category) before and after adjustment for stage were cervix, 3.22 (95% CI, 1.54-6.75) and 2.25 (95% CI, 1.06-4.77); prostate, 3.38 (95% CI, 2.21-5.16) and 2.53 (95% CI, 1.60-4.01); all cancers, 1.35 (95% CI, 1.20-1.51) and 1.25 (95% CI, 1.11-1.41). In addition, there were significant variations in RER of death by remoteness for head and neck, lung and colon cancers and cutaneous melanoma. CONCLUSION: Cancer survival varies by remoteness of residence in NSW for all cancers together and some cancers individually. Access to screening or early diagnosis probably contributes to this variation, but persistence after adjustment for stage suggests that treatment variation is also important.