Finnish Cancer Registry Institute for Statistical and Epidemiological Cancer Research. Survival ratios of cancer patients by area in Finland

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1 Survival ratios of cancer patients by area in Finland Pages 3 16 present the age-standardised relative survival ratios for patients diagnosed in and followed-up in (see Methods p. 17) on different university hospital catchment areas. Patients diagnosed in the hospital district of Vaasa before 2013 were included in the university hospital area of, and thereafter, in the university hospital area of. The cancer types (ICD-10 code) with the highest incidence have been included: colon (C18) lung, trachea (C33 34) melanoma of the skin (C43) skin, non-melanoma (C44) breast (C50) corpus uteri (C54) prostate (C61) bladder and urinary tract (C65 68) brain, central nervous system (C70 72, D32 33, D42 43) non-hodgkin lymphoma (C82 86, C96, D76) In breast cancer, the results are also presented by age group, because the screening has extended from years old to years old female population during the period of diagnosis and the inclusion of the new age groups has varied between municipalities. For melanoma of the skin and prostate cancer, survival ratios are additionally presented for patients diagnosed with metastatic cancer. For brain and central nervous system tumors, survival ratios have also been calculated for patients with malignant tumors. A large number of areal differences can be explained by random statistical variation (see Methods p. 17). In addition to random variation, the extent of a cancer s spread at the time of diagnosis has a significant effect on survival ratios. The time of diagnosis has in turn an effect on the spread of cancer. The diagnosis of cancer depends on the following: the patient s ability to seek medical care, the availability of health care services and any potential delays, cancer screenings and other methods of early cancer detection. For example, the prostate specific antigen (PSA) test identifies many local, low-risk prostate cancer cases, which do not necessarily cause any symptoms or lead to increased mortality. If in some area a large number of local and slowly progressive cancer cases are diagnosed, which would remain undiagnosed 1

2 in other areas during the lifetime of the person in question, the survival ratios for the particular area will increase in relation to other areas. Cancer treatment also has an effect on the survival ratio. However, the patient s own will, general condition, other diseases and the spread of cancer play an important role when deciding, which treatment will be given to the patient. 2

3 Colon (80, 85) 67 (62, 72) (77, 85) 58 (53, 65) 1.29 (4, 1.60) (80, 86) 66 (61, 71) 5 (5, 1.29) (72, 81) 58 (53, 65) 1.28 (2, 1.60) (75, 85) 66 (59, 74) 0.98 (0.75, 1.29) (77, 83) 67 (62, 71) (82, 89) 70 (64, 76) 3 (6, 5) (78, 84) 61 (56, 66) 1.12 (0.92, 1.35) (75, 84) 62 (56, 68) 1.11 (9, 1.38) (75, 84) 66 (59, 73) 0 (0.79, 1.27) 3

4 Lung, trachea (32, 37) 11 (9, 13) (33, 40) (7, 6) (33, 40) 11 (9, 14) 0.98 (9, 7) (33, 40) - 1 (0.92, 1.12) (33, 41) 12 (9, 15) 0.99 (9, 9) (41, 47) 15 (13, 17) (37, 47) 14 (11, 18) 6 (0.93, 1.21) (39, 48) 15 (12, 19) 0.99 (7, 1.12) (43, 55) 18 (14, 24) 0.91 (0.78, 6) (33, 44) 14 (11, 19) 9 (0.94, 1.25) 4

5 Melanoma of the skin (94, 98) 88 (84, 93) (92, 98) 83 (76, 91) 1.53 (0.97, 2.43) (92, 97) 86 (82, 92) 1.12 (0.72, 1.75) (87, 95) 78 (71, 85) 1.88 (1.20, 2.93) (87, 96) 79 (71, 88) 2.28 (1.45, 3.58) (97, 100) 92 (88, 96) (96, 100) 90 (84, 96) 1.21 (6, 2.24) (96, 100) 92 (88, 96) 0.98 (0.54, 1.76) (95, 101) 89 (83, 95) 1.36 (0.73, 2.52) (94, 100) 86 (78, 95) 1.49 (0.74, 3.03) 5

6 Melanoma of the skin, metastatic cancer (67, 82) 41 (32, 54) (70, 88) 47 (35, 62) 0.99 (6, 1.49) (62, 82) 45 (35, 58) 4 (0.56, 1.26) (53, 80) 36 (22, 58) 1.18 (0.75, 1.86) (42, 72) 29 (20, 42) 1.51 (0.97, 2.36) (81, 97) 59 (47, 73) (74, 93) 55 (39, 78) 1.21 (8, 2.17) (76, 93) 58 (50, 68) 1.15 (8, 1.93) (71, 100) (5, 2.30) (69, 98) (0, 2.85) 6

7 Skin, non-melanoma (95, 100) 94 (87, 101) (90, 97) 87 (79, 96) 1.90 (0.90, 3.98) (96, 101) 90 (83, 97) 1.16 (0.53, 2.53) (91, 98) 88 (79, 98) 1.62 (0.74, 3.55) (96, 103) 87 (77, 97) 1.60 (0.70, 3.67) (96, 101) 91 (85, 99) (95, 101) 89 (80, 99) 2.33 (1, 6.74) (96, 100) 92 (85, 100) 1.77 (3, 5.01) (92, 99) 89 (80, 99) 1.90 (1, 5.91) (94, 102) 87 (76, 99) 1.78 (0.51, 6.25) 7

8 Breast Please note that the vertical axis in the Figure has been set between and (97, 98) 91 (89, 92) (97, 99) 91 (89, 93) 4 (3, 1.30) (97, 99) 92 (90, 93) 0.98 (0, 1.19) (96, 98) 87 (85, 89) 1.35 (1.10, 1.66) (97, 99) 91 (89, 93) 9 (6, 1.39) 8

9 Breast, by age group 0 59 years old women (99, 100) 94 (92, 95) (99, 100) 93 (91, 95) 1.12 (0, 1.58) (98, 99) 93 (91, 94) 1.13 (4, 1.51) (97, 99) 92 (90, 94) 1.29 (0.93, 1.79) (98, 100) 92 (89, 94) 1.32 (0.94, 1.85) years old women (98, 99) 94 (93, 96) (99, 100) 96 (94, 98) 0.78 (5, 1.38) (99, 100) 94 (92, 96) 2 (7, 1.55) (97, 99) 89 (86, 92) 1.84 (1.23, 2.75) (97, 100) 95 (92, 98) 0.90 (0.50, 1.61) 70 years old and older women (94, 97) 83 (80, 87) (91, 96) 84 (79, 89) 9 (0.76, 1.54) (93, 97) 88 (84, 92) 0 (0.56, 1.14) (93, 98) 79 (74, 85) 1.16 (2, 1.65) (92, 98) 86 (81, 93) 0.94 (1, 1.45) 9

10 Corpus uteri (91, 95) 83 (79, 86) (87, 94) 80 (75, 86) 1.31 (0.93, 1.84) (89, 94) 83 (80, 87) 1.14 (4, 1.55) (91, 96) 86 (82, 91) 6 (0.58, 1.26) (88, 95) 85 (79, 91) 0 (6, 1.52) 10

11 Prostate Please note that the vertical axis in the Figure has been set between and (98, 99) 95 (93, 96) (98, 100) 94 (91, 96) 0.98 (3, 1.53) (98, 100) 95 (94, 97) 5 (0.56, 1.28) (98, 100) 92 (89, 95) 1.57 (7, 2.30) (97, 100) 91 (89, 94) 1.63 (1.11, 2.39) 11

12 Prostate, metastatic cancer (82, 90) 65 (60, 70) (86, 95) 73 (65, 80) 0.76 (0.56, 3) (86, 94) 75 (70, 81) 0.70 (0.53, 0.92) (84, 93) 67 (61, 73) 0.98 (0.75, 1.29) (82, 92) 64 (57, 71) 6 (0, 1.40) 12

13 Bladder and urinary tract (86, 92) 77 (73, 82) (85, 92) 74 (68, 81) 7 (0.78, 1.45) (86, 92) 79 (74, 85) 0.92 (8, 1.24) (86, 93) 80 (74, 87) 0.95 (8, 1.32) (84, 92) 79 (72, 86) 0.97 (8, 1.38) (77, 87) 73 (65, 81) (9, 1.76) (71, 83) 73 (65, 83) 1.13 (0.75, 1.69) (76, 90) 75 (64, 87) 0.91 (0.56, 1.48) (71, 89) (4, 2.51) 13

14 Brain, central nervous system (71, 79) 57 (52, 63) (63, 74) 54 (46, 63) 1.33 (2, 1.75) (70, 79) 53 (48, 60) 1.19 (0.94, 1.50) (67, 80) 47 (39, 57) 1.18 (9, 1.55) (67, 82) (3, 1.54) (85, 90) 80 (77, 84) (74, 84) 70 (64, 76) 1.66 (1.22, 2.26) (79, 87) 75 (70, 81) 1.30 (0.96, 1.76) (79, 88) 72 (65, 78) 1.35 (0.97, 1.88) (75, 86) 76 (70, 83) 1.40 (0.97, 2.00) 14

15 Brain, central nervous system, malignant tumor (48, 60) 22 (17, 27) (44, 60) (5, 1.48) (52, 65) (0.77, 1.25) (43, 62) 18 (13, 26) 0.99 (0.75, 1.31) (44, 62) 21 (15, 28) 1.14 (3, 1.57) (54, 67) (36, 53) (5, 2.01) (50, 65) - 9 (1, 1.47) (47, 65) 25 (17, 37) 1.20 (4, 1.71) (40, 61) 25 (17, 37) 1.34 (0.92, 1.96) 15

16 Non-Hodgkin lymphoma (80, 86) 69 (64, 74) (71, 81) 60 (54, 67) 1.37 (6, 1.76) (75, 83) 66 (61, 72) 1.16 (0.90, 1.49) (72, 82) 64 (58, 71) 1.23 (0.95, 1.60) (77, 87) 65 (59, 73) 4 (0.77, 1.40) (74, 80) 65 (61, 70) (72, 82) 64 (58, 71) 7 (2, 1.40) (75, 83) 64 (59, 70) 0.98 (0.77, 1.24) (75, 84) 66 (60, 73) 0.94 (0.73, 1.23) (68, 80) 59 (52, 67) 1.18 (8, 1.59) 16

17 Methods is used as an indirect tool to assess recovery from cancer. It indicates the proportion of patients who stay alive for a certain interval (for example one year or five years) after cancer diagnosis compared to the proportion of people of the same age in the same area, who stay alive during the same interval. can be interpreted as an estimation of expected survival probability in a situation, in which the cancer the patient has had is the only possible cause of death. The calculation of the survival ratios was carried out by means of a period analysis 1 by using the Ederer II method 2 and the survival ratios were age-standardised to reflect the age distribution of all patients diagnosed in Finland during In the period analysis survival ratios are calculated based on a follow-up of patients restricted to the time period For instance, one-year survival ratio is based on patients diagnosed during and followed-up during Age-standardised survival ratios cannot necessarily be provided for areas because of small number of patients under follow-up. The benefit of this method is providing up-to-date estimates of survival ratios. The drawback of the method is that the survival ratios cannot be associated with a follow-up of a certain patient group to satisfactorily ensure total coverage. The interpretation of results derived from period analysis is of hypothetical nature: the survival of patients complies with the results of the period analysis, if survival in different time periods is similar to that perceived during the most recent time period, namely in For an areal comparison, the excess mortality risk of patients diagnosed in the specific catchment area of each university hospital was calculated in relation to the University Hospital catchment area by using a statistical model for relative survival 3. The University Hospital catchment area was selected as a reference point, because it has the largest population base. By measuring excess mortality risk one measures the risk of death caused to the patient by the cancer. For example, an excess mortality risk ratio 1.12 suggests that patients diagnosed in the area in question have an excess risk of death which is 12% higher than for patients diagnosed in the University Hospital catchment area. The risk ratio has been adjusted for age at the time of diagnosis. Thus, areal differences in patient age structure do not have an effect on the comparison. To be able to improve comparability, 95% confidence intervals were calculated for the survival ratios and excess mortality risk ratio. The confidence intervals reflect random statistical variation. In addition, a p-value assessing the equality of the areal excess risks was calculated. The p-value measures the probability of randomly receiving areal differences, which are at least as high as those perceived, if the actual excess risk would be equally high in all areas. If the p-value is less than 5, we can conclude that there are areal differences in the relative survival of patients. 1 Seppä, K., Dyba, T. and Hakulinen T.: Cancer Survival, Reference Module in Biomedical Sciences. Elsevier. 17-Oct-2014 doi: /b Seppä, K., Hakulinen, T., Läärä, E. and Pitkäniemi, J.: Comparing net survival estimators of cancer patients. Statist. Med. 2016; 35: Dickman, P. W., Sloggett, A., Hills, M. and Hakulinen, T.: Regression models for relative survival. Statist. Med. 2004; 23: