Quantifying Gains in the War on Cancer Due to Improved Treatment and Earlier Detection

Seth A. Seabury 1 , Dana P. Goldman 2 , Charu N. Gupta 3 , Zeba M. Khan 4 , Amitabh Chandra 5 , Tomas J. Philipson 6 ,  and Darius N. Lakdawalla 2
  • 1 University of Southern California – Department of Emergency Medicine and Leonard D. Schaeffer Center for Health Policy and Economics, 635 Downey Way Verna & Peter Dauterive Hall (VPD), 2nd Floor Los Angeles CA 90089-3333, USA
  • 2 University of Southern California – Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
  • 3 The Wharton School of the University of Pennsylvania – Health Care Management Department, PA, USA
  • 4 Celgene Corporation, Summit, New Jersey, USA
  • 5 Harvard University – John F. Kennedy School of Government, Boston, MA, USA
  • 6 University of Chicago – Irving B. Harris Graduate School of Policy Studies, Chicago, IL, USA
Seth A. Seabury, Dana P. Goldman, Charu N. Gupta, Zeba M. Khan, Amitabh Chandra, Tomas J. Philipson and Darius N. Lakdawalla

Abstract

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.

    • Supplementary material
  • American Cancer Society (2013) Cancer Facts & Figures 2013. Atlanta: American Cancer Society.

  • Bailar 3rd, J. and E. M. Smith (1986) “Progress Against Cancer?” New England Journal of Medicine, 314(19):1226–1232.

    • Crossref
    • Export Citation
  • 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.

    • Crossref
    • Export Citation
  • 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.

    • Crossref
    • PubMed
    • Export Citation
  • 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.

    • Crossref
    • PubMed
    • Export Citation
  • Cohen, M. M. and J. M. Diamond (1986) “Medical Research: Are We Losing the War On Cancer?” Nature, 323(6088):488–489.

    • Crossref
    • PubMed
    • Export Citation
  • Connor, R. J., K. C. Chu and C. R. Smart (1989) “Stage-Shift Cancer Screening Model,” Journal of Clinical Epidemiology, 42(11):1083–1095.

    • Crossref
    • PubMed
    • Export Citation
  • Cutler, D. M. (2008) “Are We Finally Winning The War on Cancer?” The Journal of Economic Perspectives, 22(4):3–26.

    • Crossref
    • Export Citation
  • Epstein, S. S. (1990) “Losing the War Against Cancer: Who’s to Blame and What To Do About It,” International Journal of Health Services, 20(1):53–71.

    • Crossref
    • Export Citation
  • 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.

    • Crossref
    • PubMed
    • Export Citation
  • 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.

    • Crossref
    • Export Citation
  • Howard, D. H., P. B. Bach, E. R. Berndt and R. M. Conti (2015) “Pricing in the Market for Anticancer Drugs,” Journal of Economic Perspectives, 29(1):139–162.

    • Crossref
    • Export Citation
  • 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.

    • Crossref
    • PubMed
    • Export Citation
  • Leaf, C. (2004) “Why We’re Losing The War on Cancer (and How to Win It),” Fortune (European Edition), 149(5):42–55.

  • 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.

    • Crossref
    • PubMed
    • Export Citation
  • Mellman, I., G. Coukos and G. Dranoff (2011) “Cancer Immunotherapy Comes of Age,” Nature, 480(7378):480–489.

    • Crossref
    • PubMed
    • Export Citation
  • National Cancer Institute. Overview of the SEER Program. Retrieved May 2, 2014, from http://seer.cancer.gov/about/overview.html.

  • Pharmaceutical Research and Manufacturers of America (2013) 2013 Biopharmaceutical Research Industry Profile. Washington, DC: PhRMA.

  • 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.

    • Crossref
    • Export Citation
  • 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.

    • Crossref
    • Export Citation
  • 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.

    • Crossref
    • PubMed
    • Export Citation
  • 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.

    • Crossref
    • PubMed
    • Export Citation
  • 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.

    • Crossref
    • Export Citation
  • Sporn, M. B. (1996) “The War On Cancer,” The Lancet, 347(9012):1377–1381.

    • Crossref
    • Export Citation
  • 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.

  • 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.

    • Crossref
    • PubMed
    • Export Citation
  • 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.

  • Vanneman, M. and G. Dranoff (2012) “Combining Immunotherapy and Targeted Therapies in Cancer Treatment,” Nature Reviews Cancer, 12(4):237–251.

    • Crossref
    • PubMed
    • Export Citation
  • Wickens, M. R. (1972) “A Note On The Use of Proxy Variables,” Econometrica, 759–761.

  • 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.

    • Crossref
    • Export Citation
Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


or
Log in with your institution

Journal + Issues

Search