Introduction: There have been significant improvements in both treatment and screening efforts for many types of cancer over the past decade. However, the effect of these advancements on the survival of cancer patients is unknown, and many question the value of both new treatments and screening efforts.
Methods: This study uses a retrospective analysis of SEER Registry data to quantify reductions in mortality rates for cancer patients diagnosed between 1997 and 2007. Using variation in trends in mortality rates by stage of diagnosis across cancer types, we use logistic regression to decompose separate survival gains into those attributable to advances in treatment versus advances in detection. We estimate the gains in survival due to gains in both treatment and detection overall and separately for 15 of the most common cancer types.
Results: We estimate that 3-year cancer-related mortality of cancer patients fell 16.7% from 1997 to 2007. Overall, advances in treatment reduced mortality rates by approximately 12.2% while advances in early detection reduced mortality rates by 4.5%. The relative importance of treatment and detection varied across cancer types. Improvements in detection were most important for thyroid, prostate and kidney cancer. Improvements in treatment were most important for non-Hodgkins lymphoma, lung cancer and myeloma.
Conclusion: Both improved treatment options and better early detection have led to significant survival gains for cancer patients diagnosed from 1997 to 2007, generating considerable social value over this time period.
Conflict of interest: Support was provided by Celgene Corporation under contract with Precision Health Economics, a health care consultancy. Authors hold the following positions at Precision Health Economics: partner (DPG, TJP, DNL); consultant (SAS); and chief scientific officer (AC). CNG was previously an employee of Precision Health Economics.
Research funding: Support was provided by Celgene Corporation.
Author statement: SAS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Support was provided by Celgene Corporation under contract with Precision Health Economics, a health care consultancy. Authors hold the following positions at Precision Health Economics: partner (DPG, TJP, DNL); consultant (SAS); and chief scientific officer (AC). CNG was previously an employee of Precision Health Economics. Precision Health Economics maintained all rights to publication subject to a time-limited period for review and comment by Celgene. In addition, ZMK of Celgene Corporation was fully involved with all aspects of this research, including the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
American Cancer Society (2013) Cancer Facts & Figures 2013. Atlanta: American Cancer Society.Search in Google Scholar
Bleyer, A. and H. G. Welch (2012) “Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence,” New England Journal of Medicine, 367(21):1998–2005.10.1056/NEJMoa1206809Search in Google Scholar
Chu, K. C., C. R. Smart and R. E. Tarone (1988) “Analysis of Breast Cancer Mortality and Stage Distribution by Age for the Health Insurance Plan Clinical Trial,” Journal of the National Cancer Institute, 80(14):1125–1132.10.1093/jnci/80.14.1125Search in Google Scholar
Citarda, F., G. Tomaselli, R. Capocaccia, S. Barcherini, M. Crespi and I. M. S. Group (2001) “Efficacy in Standard Clinical Practice of Colonoscopic Polypectomy in Reducing Colorectal Cancer Incidence,” Gut, 48(6):812–815.10.1136/gut.48.6.812Search in Google Scholar
German, R. R., A. K. Fink, M. Heron, S. L. Stewart, C. J. Johnson, J. L. Finch and D. Yin (2011) “The Accuracy of Cancer Mortality Statistics Based on Death Certificates in the United States,” Cancer Epidemiology, 35(2):126–131.10.1016/j.canep.2010.09.005Search in Google Scholar
Goldman, D. P., C. Gupta, E. Vasudeva, K. Trakas, R. Riley, D. Lakdawalla, D. Agus, N. Sood, A. B. Jena and T. J. Philipson (2013) “The Value of Diagnostic Testing in Personalized Medicine,” Forum for Health Economics and Policy, 16:S87–S99.10.1515/fhep-2013-0023Search in Google Scholar
Lakdawalla, D. N., E. C. Sun, A. B. Jena, C. M. Reyes, D. P. Goldman and T. J. Philipson (2010) “An Economic Evaluation of the War on Cancer,” Journal of Health Economics, 29(3):333–346.10.1016/j.jhealeco.2010.02.006Search in Google Scholar
Leaf, C. (2004) “Why We’re Losing The War on Cancer (and How to Win It),” Fortune (European Edition), 149(5):42–55.Search in Google Scholar
Lightwood, J. M. and S. A. Glantz (1997) “Short-term Economic and Health Benefits of Smoking Cessation Myocardial Infarction and Stroke,” Circulation, 96(4):1089–1096.10.1161/01.CIR.96.4.1089Search in Google Scholar
Pharmaceutical Research and Manufacturers of America (2013) 2013 Biopharmaceutical Research Industry Profile. Washington, DC: PhRMA.Search in Google Scholar
Philipson, T., M. Eber, D. N. Lakdawalla, M. Corral, R. Conti and D. P. Goldman (2012) “An Analysis of Whether Higher Health Care Spending in the United States versus Europe is ‘worth it’ in the Case of Cancer,” Health Affairs (Millwood), 31(4):667–675.10.1377/hlthaff.2011.1298Search in Google Scholar
Seabury, S. A., D. P. Goldman, J. R. Maclean, J. R. Penrod and D. N. Lakdawalla (2012) “Patients Value Metastatic Cancer Therapy More Highly Than Is Typically Shown Through Traditional Estimates,” Health Affairs, 31(4):691–699.10.1377/hlthaff.2012.0174Search in Google Scholar
Shapiro, S., J. D. Goldberg and G. B. Hutchison (1974). “Lead Time in Breast Cancer Detection and Implications for Periodicity of Screening,” American Journal of Epidemiology, 100(5):357–366.10.1093/oxfordjournals.aje.a112046Search in Google Scholar
Sharma, P., K. Wagner, J. D. Wolchok and J. P. Allison (2011) “Novel Cancer Immunotherapy Agents with Survival Benefit: Recent Successes and Next Steps,” Nature Reviews Cancer, 11(11):805–812.10.1038/nrc3153Search in Google Scholar
Soneji, S. and J. Yang (2015) “New Analysis Reexamines The Value Of Cancer Care In The United States Compared To Western Europe,” Health Affairs 34(3):390–397.10.1377/hlthaff.2014.0174Search in Google Scholar
Sun, E., A. B. Jena, D. Lakdawalla, C. Reyes, T. J. Philipson and D. P. Goldman (2010) “The Contributions of Improved Therapy and Early Detection to Cancer Survival Gains, 1988-2000,” Forum for Health Economics and Policy, 13(2): DOI: 10.2202/1558-9544.1195.10.2202/1558-9544Search in Google Scholar
Taylor Jr., D. H., V. Hasselblad, S. J. Henley, M. J. Thun and F. A. Sloan (2002). “Benefits of Smoking Cessation for Longevity,” American Journal of Public Health, 92(6):990–996.10.2105/AJPH.92.6.990Search in Google Scholar
US Department of Health and Human Services. (2013) Percentage of Adults Who Receive Colorectal Cancer Screening as Appropriate. Retrieved April 22, 2014, from https://healthmeasures.aspe.hhs.gov/measure/25.Search in Google Scholar
Winawer, S. J., A. G. Zauber, M. N. Ho, M. J. O’Brien, L. S. Gottlieb, S. S. Sternberg, J. D. Waye, M. Schapiro, J. H. Bond and J. F. Panish (1993) “Prevention of Colorectal Cancer by Colonoscopic Polypectomy,” New England Journal of Medicine, 329(27):1977–1981.10.1056/NEJM199312303292701Search in Google Scholar
The online version of this article (DOI: 10.1515/fhep-2015-0028) offers supplementary material, available to authorized users.
©2016 by De Gruyter