Does minimum follow-up time post-diagnosis matter? An assessment of changing loss of life expectancy for people with cancer in Western Australia from 1982 to 2016

Abstract

Background: Cancer survival has improved in Western Australia (WA) over recent decades. Loss of life expectancy (LOLE) is a useful measure for assessing cancer survival at a population-level. Some previous studies estimating LOLE have required a minimum follow-up beyond diagnosis to reduce the impact of modelled extrapolation, while others have not. The first aim of this study was to assess the impact of minimum length of follow-up on LOLE estimates for people diagnosed in 2006 with female breast, colorectal, prostate, lung, cervical, combined oesophageal and stomach cancers, and melanoma. Based on these results, the second aim was to assess temporal changes in LOLE for these cancer types for diagnoses between 1982 and 2016.

Methods: Person-level linked cancer registry and mortality data were used for invasive primary cancer diagnoses for WA residents aged 15-89 years. The analysis for aim one included cases diagnosed from 1982 to the end of 2006, followed to the end of 2006 (i.e. no minimum follow-up), 2011 (i.e. five years minimum follow-up, assuming survival) or 2016 (i.e. 10 years minimum follow-up). To achieve the second study aim, the diagnostic period was extended to the end of 2016. Life expectancy estimates were obtained after fitting flexible parametric relative survival models. Single-year age and sex-specific death rates were used as a reference to estimate LOLE and proportionate loss of life expectancy.

Results: Temporal changes were not reported for prostate, cervical, oesophageal and stomach cancers or melanoma, due to differences in LOLE estimates by minimum follow-up time, or estimate imprecision. Marked reductions in LOLE were observed for female breast and colorectal cancer. There was minimal absolute reduction for lung cancer, where LOLE remained high.

Conclusion: This study considered the appropriateness of including recent cancer diagnoses when assessing temporal changes in LOLE, finding variation in estimates with differing minimum follow-up or high parameter uncertainty for most included cancer types. Temporal changes in LOLE in-turn reflected changes in the life expectancy of the general population, cancer detection and management. These factors must be considered when estimating and interpreting LOLE estimates.

Keywords: Australia; Cancer; Life expectancy; Neoplasms; Prognosis.