Improved survival of Danish cancer patients compared to patients from earlier periods

Transkript

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2 Improved survival of Danish cancer patients compared to patients from earlier periods Hans Henrik Storm, Anne Mette Tranberg Kejs & Gerda Engholm Danish Cancer Society Prevention and Documentation Dan Med Bul 2011;58(12):A4346 Ugeskr Læger 2012;174(8):479

3 Florence Nightingale 1875 The ultimate goal is to manage quality. But you cannot manage it until you have a way to measure it, and you cannot measure it until you can monitor it.

4 DATAKILDE

5 Baggrund: 5-year relative cancer survival in the Nordic countries all sites excl. prostate and breast Men Women Storm et al., Acta Oncol 2010; 49:

6 Case-mix adjusted excess mortality of cancer patients in the Nordic countries followed through Storm et al., Acta Oncol 2010; 49:

7 1 års relativ overlevelse vs. 5 års LOESS curves 15 frequent sites, excl. prostate and breast

8 In search of perfect data... The scientific purist who waits for medical statistics until they are nosologically exact is no more than Horace s purist, waiting for the river to flow away. Major Greenwood, Biometrika 1942

9 Materiale & analyse Alle cancere : 47,239 mænd og 46,919 kvinder Ekskluderet: 608 kun kendt fra dødsattest eller autopsi. Alle cancere : 51,775 mænd og 51,718 kvinder Ekskluderet: 142 kun kendt fra dødsattest eller autopsi Follow-up: Til og med 2010 gennem CPR register Analyse: Kohorte metode 1 års relativ overlevelse Aldersstandardisering (Corazziari et al.) 3 og 5 års rel. overlev. hybrid metode (kohorte and periode).

10 Trend i 1-års relativ overlevelse (RS) og 95% konfidens interval (CI) for danske kræftpatienter Alle excl. nonmelanom hud Mænd Alle excl. nonmelanoma hud & prostata kræft Alle excl. nonmelanoma hud Kvinder Alle excl. nonmelanoma hud & brystkræft Periode RS 95% CI RS 95% CI RS 95% CI RS 95% CI (59-60) 55 (54-56) 68 (67-68) 59 (59-60) (62-63) 57 (57-58) 69 (68-69) 60 (60-61) (64-65) 59 (58-59) 70 (70-71) 62 (61-62) (68-69) 61 (60-61) 72 (72-72) 65 (64-65) (72-73) 65 (64-65) 75 (74-75) 67 (66-67)

11 Trend i 1-års relativ overlevelse (RS) og 95% konfidens interval (CI) for danske kræftpatienter Cancer Mænd Kvinder RS 95% CI RS 95% CI RS 95% CI RS 95% CI Mund 68 (62-74) 75 (70-81) 70 (63-76) 81 (76-86) Svælg 62 (57-67) 69 (65-74) 68 (61-75) 69 (62-76) Spiserør 28 (25-31) 37 (34-41) 28 (23-34) 37 (32-43) Statistisk signifikant forbedring

12 Trend i 1-års relativ overlevelse (RS) og 95% konfidens interval (CI) for danske kræftpatienter Cancer Mænd Kvinder RS 95% CI RS 95% CI RS 95% CI RS 95% CI Mave 41 (38-45) 46 (43-49) 41 (37-45) 43 (39-47) Colon 73 (71-75) 76 (74-77) 75 (74-77) 77 (75-78) Rectum 79 (77-81) 83 (81-84) 82 (80-83) 83 (82-85) Pancreas 17 (15-20) 23 (21-26) 18 (16-21) 22 (20-25) Larynx 82 (78-85) 85 (82-89) 84 (77-91) 80 (73-87) Lunge 31 (30-33) 34 (33-35) 35 (34-37) 40 (38-41) Bryst 97 (91-103) 95 (88-101) 95 (94-95) 96 (95-96) Nyre 65 (62-68) 70 (68-73) 63 (59-67) 73 (70-76) Statistisk signifikant forbedring

13 Trend i 1-års relativ overlevelse (RS) og 95% konfidens interval (CI) for danske kræftpatienter Cancer Mænd Kvinder RS 95% CI RS 95% CI RS 95% CI RS 95% CI Non-Hodgkin 75 (73-77) 82 (80-84) 78 (76-81) 80 (78-82) Hodgkin 90 (86-94) 89 (85-93) 93 (89-97) 89 (86-93) M-Myeloma 77 (73-81) 76 (72-80) 79 (76-84) 76 (72-80) Leukæmi 74 (71-77) 71 (69-74) 76 (73-79) 74 (71-77)

14 Højeste internationale standard? % år relativ overlevelse (%) excl hud, mænd Denmark Finland Iceland Norway Sweden

15 % 60 5 år relativ overlevelse (%) excl. hud & prostatakræft Denmark Finland Iceland Norway Sweden 0

16 % 80 1 år relativ overlevelse (%), excl. Hud & prostata, mænd % Denmark Finland Iceland Norway Sweden 0

17 % år relativ overlevelse (%), excl. hud & brystkræft, kvinder % Denmark Finland Iceland Norway Sweden 0

18 1 års overlevelse % og komorbiditet Cancer Charlson score Reference 0 1-2* 3** Bryst ( ) 95% 87% 71% Cronin-Fenton et al Prostata ( ) 94% 83% 69% Lund et al Ovarie ( ) 73% 58% 44% Tetsche et al Blære ( ) 73% 59% 44% Lund et al Rectum ( ) 83% 71% 50% Iversen et al Colon ( ) 75% 69% 58% * 16-33% af alle patienter ** <10% af alle patienter

19 1 års overlevelse %, stadie og komorbiditet, ovarie cancer FIGO stadie Charlson score Reference 0 1-2* 3** I Lokaliseret 95% 88% 81% Tetsche et al II-III Regional 77% 63% 47% IV Fjernmetast. 50% 38% 34% Uoplyst 62% 40% 33% * 21% af patienterne ** 7 % af patienterne

20 All cancer 1 yr rsr (%) for high Social Position (SP) and % point diff. vs low SP, ages 30+ in Denmark High SP 1 yr RSR Men Low SP % diff. High SP 1 yr RSR Women Low SP % diff. Education (high/basic) Income (high/low) Working (vs early retired) House owner (vs rental) House size (>150/ 0-49) Married (vs divorsed) City inhab. (vs rural) Dalton et al CANULI EJC 2008

21 Ranking Swedish men Danish men Swedish women Danish women Life expectancy for men and women in 20 OECD countries, Denmark and Swedens relative ranking by calender time since 1950 Juel K, UFL 170/

22 Udviklingen i andel dagligrygere i Norden Mænd Kvinder

23 Udviklingen i alkoholforbrug i Norden Mænd og kvinder Liter per person per år

24 Bradford Hill caution (1965): All scientific work is incomplete Liable to be upset or modified by advancing knowledge This does not confer upon us a freedom to ignore the knowledge we already have or to postpone the action it appears to demand. Robert Browning: Who knows, the world may end to night? Yet based on available evidence we all prepare for tomorrows workday! Hill AB, The environment or disease: Association or causation Proc Soc Med 58:295, 1965