Summary
Because routinely collected survival data for cancer patients in England and Wales do not typically specify cause of death, conventional estimates of survival in cancer patients based on such data are a measure of their mortality from all causes rather than their mortality due to cancer. As a result, trends in survival over time are difficult to interpret because changes in overall survival may well reflect changes in the risk of death from other causes, rather than from the cancer of interest. One way of overcoming this problem is to use some form of ‘relative survival’ defined as a measure of survival corrected for the effect of other independent causes of death. Since this concept was first introduced, various methods for calculating relative survival have been proposed and this had led to some confusion as to the most appropriate choice of estimate. This paper aims to provide an introduction to the concept of relative survival and reviews some of the suggested methods of estimation. In addition, a particularly simple, but robust approach, is highlighted based on expected and observed mortality. This method is illustrated using preliminary data from the Office for National Statistics on cancer survival in patients born after 1939 and diagnosed with cancer during 1972–84. The examples presented, although limited to analyses on a small number of selected sites, highlight some encouraging trends in survival in people aged under 35 diagnosed with leukaemia, Hodgkin’s disease and testicular cancer during this period.
Similar content being viewed by others
Article PDF
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Adami, H. O., Glimelius, B., Sparen, P., Holmberg, L., Krusemo, U. B. & Ponten, J. (1992). Trends in childhood and adolescent cancer survival in Sweden 1960 through 1984. Acta Oncol 31: 1–10.
Berkson, J. & Gage, R. P. (1950). Calculation of survival rates for cancer. Proc Staff Meetings Mayo Clin 25: 270–286.
Brinkley, D. & Haybittle, J. L. (1975). The curability of breast cancer. Lancet 2: 95–97.
Coleman, M., Douglas, A., Hermon, C. & Peto, J. (1986). Cohort study analysis with a FORTRAN computer program. Int J Epidemiol 15: 134–137.
Duncan, W. & Kerr, G. R. (1976). The curability of breast cancer. Br Med J 2: 781–783.
Ederer, F. & Heise, H. (1959). Instructions to IBM 650 Programmers in Processing Survival Computations. Methodological note no. 10. Bathseda, MD: End Results Evaluation Section, National Cancer Institute
Ederer, F., Axtell, L. M. & Cutler, S. J. (1961). The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr 6: 101–121.
Edmiston, K. L. & Stewart, F. M. (1993). Germ cell testicular cancer: advances in treatment. Forum Trends Exp Clin Med 6: 574–583.
Esteve, J., Benhamou, E., Croasdale, M. & Raymond, L. (1990). Relative survival and the estimation of net survival: elements for further discussion. Stat Med 9: 529–538.
Hakulinen, T. (1977). On long-term relative survival rates. J Chronic Dis 30: 431–443.
Hakulinen, T. (1982). Cancer survival corrected for heterogeneity in patient withdrawal. Biometrics 38: 933–942.
Hakulinen, T. (1985). A computer program package for relative survival analysis. Comput Programs Biomed 19: 197–207.
Langlands, A. O. (1995). Prognostic factors and the curability of breast cancer. Aust NZ J Surg 65: 630–633.
Pocock, S. J., Gore, S. M. & Kerr, G. R. (1982). Long term survival analysis: the curability of breast cancer. Stat Med 1: 93–104.
Stiller, C. A. & Bunch, K. J. (1990). Trends in survival for childhood cancer in Britain diagnosed 1971–85. Br J Cancer 62: 806–815.
Thomsen, B. L., Keiding, N. & Altman, D. G. (1991). A note on the calculation of expected survival illustrated by the survival of liver transplant patients. Stat Med 10: 733–738.
Author information
Authors and Affiliations
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Reeves, G., Beral, V., Bull, D. et al. Estimating relative survival among people registered with cancer in England and Wales. Br J Cancer 79, 18–22 (1999). https://doi.org/10.1038/sj.bjc.6690005
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bjc.6690005