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Background: Cancer is becoming more of a chronic disease due to improvements in treatment and early detection for multiple cancer sites. To gain insight on increased life expectancy due to these improvements, we quantified trends in the loss in expectation of life (LEL) due to a cancer diagnosis for six cancer sites from 1975 through 2018. Methods: We focused on patients diagnosed with female breast cancer, chronic myeloid leukemia (CML), colon and rectum cancer, diffuse large B-cell lymphoma (DLBCL), lung cancer, or melanoma between 1975 and 2018 from nine Surveillance, Epidemiology, and End Results cancer registries. Life expectancies for patients with cancer ages 50+ were modeled using flexible parametric survival models. LEL was calculated as the difference between general population life expectancy and life expectancy for patients with cancer. Results: Over 2 million patients were diagnosed with one of the six cancers between 1975 and 2018. Large increases in life expectancy were observed between 1990 and 2010 for female breast, DLBCL, and CML. Patients with colon and rectum cancer and melanoma had more gradual improvements in life expectancy. Lung cancer LEL only began decreasing after 2005. Increases in life expectancy corresponded with decreases in LEL for patients with cancer. Conclusions: The reported gains in life expectancy largely correspond to progress in the screening, management, and treatment of these six cancers since 1975. [ABSTRACT FROM AUTHOR]

Background: To estimate risk of recurrence for women diagnosed with nonmetastatic breast cancer considering the risks of other causes mortality. Methods: We extend a method based on the diagnosis-metastasis-death pathway to include risks of other causes mortality. We estimate three probabilities as cumulative incidence of: (i) being alive and recurrence-free, (ii) death for other causes before a recurrence, and (iii) recurrence. We apply the method to female breast cancer relative survival from the Surveillance, Epidemiology, and End Results Program registries (2000-2018) data. Results: The cumulative incidence of recurrence shows a higher increase with more advanced cancer stage and is less influenced by age at diagnosis. At 5 years from diagnosis, the cumulative incidence of recurrence is less than 3% for those diagnosed with stage I, 10% to 13% for those diagnosed with stage II, and 37% to 47% for those diagnosed with stage III breast cancer. The estimates of recurrence considering versus ignoring the risks of dying from other causes were generally consistent, except for older women with more advanced stage, and longer time since diagnosis. In these groups, the net probability of recurrence, excluding the risks of dying from other causes, were overestimated. Conclusions: For patients with cancer who are older or long-term survivors, it is important to include the risks of other cause mortality as the crude cumulative incidence of recurrence is a more appropriate measure. Impact: These estimates are important in clinical decision making, as higher competing mortality may preclude the benefits of aggressive treatments. [ABSTRACT FROM AUTHOR]

Background: Stage is the most important prognostic factor for understanding cancer survival trends. Summary stage (SS) classifies cancer based on the extent of spread: In situ, Localized, Regional, or Distant. Continual updating of staging systems poses challenges to stage comparisons over time. We use a consistent summary stage classification and present survival trends for 25 cancer sites using the joinpoint survival (JPSurv) model. Methods: We developed a modified summary stage variable, Long-Term Site-Specific Summary Stage, based on as consistent a definition as possible and applied it to a maximum number of diagnosis years, 1975-2019. We estimated trends by stage by applying JPSurv to relative survival data for 25 cancer sites in SEER-8, 1975-2018, followed through December 31, 2019. To help interpret survival trends, we report incidence and mortality trends using the joinpoint model. Results: Five-year relative survival improved for nearly all sites and stages. Large improvements were observed for localized pancreatic cancer [4.25 percentage points annually, 2007-2012 (95% confidence interval, 3.40-5.10)], distant skin melanoma [2.15 percentage points annually, 2008-2018 (1.73-2.57)], and localized esophagus cancer [1.18 percentage points annually, 1975-2018 (1.11-1.26)]. Conclusions: This is the first analysis of survival trends by summary stage for multiple cancer sites. The largest survival increases were seen for cancers with a traditionally poor prognosis and no organized screening, which likely reflects clinical management advances. Impact: Our study will be particularly useful for understanding the population-level impact of new treatments and identifying emerging trends in health disparities research. [ABSTRACT FROM AUTHOR]

Introduction: Molecularly targeted therapies such as tyrosine kinase inhibitors (TKI) are effective treatments for B-cell receptor (BCR)-ABL-bearing leukemias. We evaluated the impact of TKIs on historical chronic myeloid leukemia (CML) mortality trends compared with acute lymphoblastic leukemia (ALL) and chronic lymphoblastic leukemia (CLL). Methods: Because mortality trends reflect combined effects of leukemia incidence and survival, we also evaluated the contribution of incidence and survival trends to mortality trends by subtypes. We used data from 13 U.S. (SEER) registries (1992-2017) among U.S. adults. We utilized histology codes to identify cases of CML, ALL, and CLL and death certificate data to calculate mortality. We used Joinpoint to characterize incidence (1992-2017) and mortality (1992-2018) trends by subtype and diagnosis year. Results: For CML, mortality rates started declining in 1998 at an average rate of 12% annually. Imatinib was approved by the FDA for treating CML and ALL in 2001, leading to clear benefits for patients with CML. Five-year CML survival increased dramatically over time, especially between 1996 to 2011, 2.3% per year on average. ALL incidence increased 1.5% annually from 1992 to 2017. ALL mortality decreased 0.6% annually during 1992 to 2012 and then stopped declining. CLL incidence fluctuated during 1992 to 2017 while mortality decreased 1.1% annually during 1992 to 2011 and at a faster rate of 3.6% per year from 2011. Five-year survival increased 0.7% per year on average during 1992 to 2016. Conclusions: Survival benefit from TKIs and other novel therapies for treating leukemia subtypes has been demonstrated in clinical trials. Impact: Our study highlights the impact of molecularly targeted therapies at the population level. [ABSTRACT FROM AUTHOR]

Background: Metastatic prostate cancer (MPC) includes metastases detected at diagnosis (de novo) and those occurring after diagnosis with early-stage disease (recurrent). Cancer registries collect data only on de novo MPC, providing a partial picture of the burden of MPC. We use cancer registry data to estimate the number of men living with MPC in the United States including both de novo and recurrent cases. Methods: We apply a back-calculation method to estimate MPC incidence and prevalence from U.S. prostate cancer mortality and de novo MPC relative survival for cases diagnosed between 2000 and 2017 in 18 Surveillance, Epidemiology, and End Results registries. We hold overall prostate cancer mortality and MPC survival constant for future prevalence projections. Results: On January 1, 2018, we estimated 120,400 U.S. men living with MPC (45% de novo, 55% recurrent). The age-adjusted prevalence in 2018 for Black men was over double that of White men (137.1 vs. 62.2 per 100,000 men). By 2030, 192,500 men are expected to be living with MPC, with the increase being driven by population growth projections. Conclusions: The number of men living with MPC in the United States exceeds 100,000 and represents a small fraction of the >3 million men living with a prior diagnosis of prostate cancer. [ABSTRACT FROM AUTHOR]

Background: Improvements in cancer survival are usually assessed by comparing survival in grouped years of diagnosis. To enhance analyses of survival trends, we present the joinpoint survival model webtool (JPSurv) that analyzes survival data by single year of diagnosis and estimates changes in survival trends and year-over-year trend measures. Methods: We apply JPSurv to relative survival data for individuals diagnosed with female breast cancer, melanoma cancer, non-Hodgkin lymphoma (NHL), and chronic myeloid leukemia (CML) between 1975 and 2015 in the Surveillance, Epidemiology, and End Results Program. We estimate the number and location of joinpoints and the trend measures and provide interpretation. Results: In general, relative survival has substantially improved at least since the mid-1990s for all cancer sites. The largest improvements in 5-year relative survival were observed for distant-stage melanoma after 2009, which increased by almost 3 survival percentage points for each subsequent year of diagnosis, followed by CML in 1995-2010, and NHL in 1995-2003. The modeling also showed that for patients diagnosed with CML after 1995 (compared with before), there was a greater decrease in the probability of dying of the disease in the 4th and 5th years after diagnosis compared with the initial years since diagnosis. Conclusions: The greatest increases in trends for distant melanoma, NHL, and CML coincided with the introduction of novel treatments, demonstrating the value of JPSurv for estimating and interpreting cancer survival trends. Impact: The JPSurv webtool provides a suite of estimates for analyzing trends in cancer survival that complement traditional descriptive survival analyses. [ABSTRACT FROM AUTHOR]

Background: The prevalence of cancer survivorship is increasing. In this study, we provide contemporary population-based estimates and projections of the overall and site-specific cancer-attributable medical care costs in the United States. Methods: We identified survivors aged =65 years diagnosed with cancer between 2000 and 2012 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and used 2007 to 2013 claims to estimate costs by cancer site, phases of care, and stage at diagnosis. Annualized average cancer-attributable costs for medical care (Medicare Parts A and B) and oral prescription drugs (Medicare Part D) were estimated by subtracting costs between patients with cancer and matched controls. Costs are reported in 2019 U.S. dollars. We combined phase-specific attributable costs with prevalence projections to estimate national costs from 2015 through 2030. Results: Overall annualized average costs were highest in the end-of-life-cancer death phase, followed by the initial and continuing phases (medical care: $105,500, $41,800, and $5,300 and oral prescription drugs: $4,200, $1,800, $1,100, respectively). There was considerable variation in costs by cancer site and stage. Overall national costs in 2015 were $183 billion and projected to increase 34% to $246 billion by 2030, based only on population growth. Conclusions: Phase of care cancer-attributable cost estimates by cancer site and stage are key inputs for simulation models and cost-effectiveness analyses. [ABSTRACT FROM AUTHOR]

Background: We investigated differences in net cancer survival (survival observed if the only possible cause of death was the cancer under study) estimated using new approaches for relative survival (RS) and cause-specific survival (CSS). Methods: We used SEER data for patients diagnosed in 2000 to 2013, followed-up through December 31, 2014. For RS, we used new life tables accounting for geography and socio-economic status. For CSS, we used the SEER cause of death algorithm for attributing cancer-specific death. Estimates were compared by site, age, stage, race, and time since diagnosis. Results: Differences between 5-year RS and CSS were generally small. RS was always higher in screen-detectable cancers, for example, female breast (89.2% vs. 87.8%) and prostate (98.5% vs. 93.7%) cancers; differences increased with age or time since diagnosis. CSS was usually higher in the remaining cancer sites, particularly those related to specific risk factors, for example, cervix (70.9% vs. 68.3%) and liver (20.7% vs. 17.1%) cancers. For most cancer sites, the gap between estimates was smaller with more advanced stage. Conclusion: RS is the preferred approach to report cancer survival from registry data because cause of death may be inaccurate, particularly for older patients and long-term survivors as comorbidities increase challenges in determining cause of death. However, CSS proved to be more reliable in patients diagnosed with localized disease or cancers related to specific risk factors as general population life tables may not capture other causes of mortality. [ABSTRACT FROM AUTHOR]

Background: Population-representative risks of metastatic recurrence are not generally available because cancer registries do not collect data on recurrence. This article presents a novel method that estimates the risk of recurrence using cancer registry disease-specific survival. Methods: The method is based on an illness-death process coupled with a mixture cure model for net cancer survival. The risk of recurrence is inferred from the estimated survival among the noncured fraction and published data on survival after recurrence. We apply the method to disease-specific survival curves from female breast cancer cases without a prior cancer diagnosis and with complete stage and hormone receptor (HR) status in Surveillance, Epidemiology and End Results registries (1992-2013). Results: The risk of recurrence is higher for women diagnosed with breast cancer at older age, earlier period, more advanced stage, and HR-negative tumors. For women diagnosed at ages 60-74 in 2000-2013, the projected percent recurring within 5 years is 2.5%, 9.6%, and 34.5% for stages I, II, and III HR-positive, and 6.5%, 20.2%, and 48.5% for stages I, II, and III HR-negative tumors. Although HR-positive cases have lower risk of recurrence soon after diagnosis, their risk persists longer than for HR-negative cases. Results show a high degree of robustness to model assumptions. Conclusions: The results show that it is possible to extract information about the risk of recurrence using disease-specific survival, and the methods can in principle be extended to other cancer sites. [ABSTRACT FROM AUTHOR]

Background: Distant metastatic breast cancer (MBC), including metastases found at diagnosis (de novo) and those occurring later (recurrence), represents the most severe form of the disease, when resource utilization is most intensive. Yet, the number of women living with MBC in the United States is unknown. The objective of this article is to use population-based data to estimate the prevalence of MBC. Methods: We used a back-calculation method to estimate MBC prevalence from U.S. breast cancer mortality and survival from the Surveillance, Epidemiology and End Results (SEER) registries. On the basis of the illness-death process, this method assumes that each observed breast cancer death is the result of MBC, either de novo or a recurrence with metastatic disease. Results: We estimate that by January 1, 2017, there will be 154,794 women living with MBC in the United States, three in four initially diagnosed with stage I-III breast cancer who later progressed to MBC. Median survival and 5-year relative survival for de novo MBC increased over the years, especially in younger women. We estimate a two-fold increase in 5-year relative survival rate from 18% to 36%, for women diagnosed with de novo MBC at age 15-49 between 1992-1994 and 2005-2012, respectively. Conclusions: This study demonstrates an increasing number of women in the United States living with MBC, likely the result of improvements in treatment and aging of the U.S. population. Impact: The increasing burden of MBC highlights the importance of documenting recurrence to foster more research into the specific needs of this understudied population. [ABSTRACT FROM AUTHOR]

Background: The human immunodeficiency virus (HIV) epidemic has strongly influenced non-Hodgkin lymphoma (NHL) incidence in the U.S. general population, but its effects on NHL mortality trends are unknown. Methods: Using SEER cancer registry data, we assessed NHL mortality rates in the United States (2005-2012) and mapped NHL deaths to prior incident cases. Data included HIV status at NHL diagnosis. We describe the proportion of NHL deaths linked to an HIV-infected case, for 3 AIDS-defining subtypes [diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma, and central nervous system (CNS) lymphoma] and within demographic categories. We also present incidence-based mortality (IBM) rates showing the impact of HIV on mortality trends and describe survival after NHL diagnosis by calendar year. Results: Of 11,071 NHL deaths, 517 (4.6%) were in HIV-infected persons. This proportion was higher in deaths mapped to DLBCL (7.3% with HIV), Burkitt lymphoma (33.3%), and CNS lymphoma (17.6%), and among deaths from these subtypes, for people aged 20-49 years (46.6%), males (15.2%), and blacks (39.3%). IBM rates declined steeply during 2005-2012 for HIV-infected NHL cases (-7.6% per year, P = 0.001). This trend reflects a steep decline in incident NHL among HIV-infected people after 1996, when highly active antiretroviral therapy was introduced. Five-year cancer-specific survival improved more markedly among HIV-infected cases (9%-54%) than HIV-uninfected cases (62%-76%) during 1990-2008. Conclusions: The HIV epidemic has strongly contributed to NHL deaths, especially for AIDS-defining NHL subtypes and groups with high HIV prevalence. Impact: Declining NHL mortality rates for HIV-infected cases reflect both declining incidence and improving survival. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors are a growing population, due in large part to the aging of the baby boomer generation and the related "silver tsunami" facing the U.S. health care system. Understanding the impact of a graying nation on cancer prevalence and comorbidity burden is critical in informing efforts to design and implement quality cancer care for this population. Methods: Incidence and survival data from 1975 to 2011 were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program to estimate current cancer prevalence. SEER-Medicare claims data were used to estimate comorbidity burden. Prevalence projections were made using U.S. Census Bureau data and the Prevalence Incidence Approach Model, assuming constant future incidence and survival trends but dynamic projections of the U.S. population. Results: In 2016, there were an estimated 15.5 million cancer survivors living in the United States, 62% of whom were 65 years or older. The prevalent population is projected to grow to 26.1 million by 2040, and include 73% of survivors who are 65 years and older. Comorbidity burden was highest in the oldest survivors (those ≥ 85 years) and worst among lung cancer survivors. Conclusions: Older adults, who often present with complex health needs, now constitute the majority of cancer survivors and will continue to dominate the survivor population over the next 24 years. Impact: The oldest adults (i.e., those >75 years) should be priority populations in a pressing cancer control and prevention research agenda that includes expanding criteria for clinical trials to recruit more elderly participants and developing relevant supportive care interventions. [ABSTRACT FROM AUTHOR]

The article discusses a study related to prevalence of childhood cancer and burden of morbidity in individuals diagnosed with cancer in the U.S. It mentions several chronic conditions for burden of morbidity in this population which include neurocognitive dysfunction, functional impairment, and compromised health-related quality of life.

The article discusses the social and economic impacts of the prevalent population of cancer survivors in terms of overall numbers and prevalence by cancer site and time since diagnosis. Topics covered include the use of the Prevalance Incidence Approach Model (PIAMOD) in modeling cancer prevalence, details relating to the reported increase in the number of living people diagnosed with cancer and the improved health technologies for improving the long-term health of cancer survivors.

The article discusses a research study on U.S. measures on the economic burden of cancer for identifying future research areas, evaluating targeted therapies and assessing financial burdens for patients. It presents estimates on cancer costs including incidence cost, prevalence and direct medical costs and studies on genetic mutations for the corresponding treatment response. Conclusions indicated the need to focus on future efforts for improvement of estimates and research enhancement.

The article discusses research on cancer survivorship and the aging population to serve a guide for cancer control research. The study data were collected from the Surveillance, Epidemiology and End Results (SEER) Program using the Complete Prevalence (COMPREV) and Prevalence, Incidence Approach Model (PIAMOD) for cancer prevalence projection from 2008 to 2020 in the dynamic U.S. population. The results of the study showed that 60% of cancer survivors in 2008 were 65 years old and above.

The article attempts to estimate the number of individuals in the U.S. diagnosed with cancer as children as of 2005, with focus on those less than 30 years survivors. It uses data from the Surveillance Epidemiology and End Results program from 1975 to 2004, to estimate the national prevalence of survivors of childhood cancers. It is expected that the number of survivors of childhood cancers will increase in the future.

The article offers information on a study which investigated the prevalence and pattern of disease among cancer survivors in the U.S. The study used data from the Surveillance, Epidemiology and End Results program to examine the number of survivors with multiple malignant cancers. It identified the prevalence of multiple cancers in the country. The article also discusses the implications of the study findings.

Background: We investigated differences in net cancer survival (survival observed if the only possible cause of death was the cancer under study) estimated using new approaches for relative survival (RS) and cause-specific survival (CSS)., Methods: We used SEER data for patients diagnosed in 2000 to 2013, followed-up through December 31, 2014. For RS, we used new life tables accounting for geography and socio-economic status. For CSS, we used the SEER cause of death algorithm for attributing cancer-specific death. Estimates were compared by site, age, stage, race, and time since diagnosis., Results: Differences between 5-year RS and CSS were generally small. RS was always higher in screen-detectable cancers, for example, female breast (89.2% vs. 87.8%) and prostate (98.5% vs. 93.7%) cancers; differences increased with age or time since diagnosis. CSS was usually higher in the remaining cancer sites, particularly those related to specific risk factors, for example, cervix (70.9% vs. 68.3%) and liver (20.7% vs. 17.1%) cancers. For most cancer sites, the gap between estimates was smaller with more advanced stage. Conclusion: RS is the preferred approach to report cancer survival from registry data because cause of death may be inaccurate, particularly for older patients and long-term survivors as comorbidities increase challenges in determining cause of death. However, CSS proved to be more reliable in patients diagnosed with localized disease or cancers related to specific risk factors as general population life tables may not capture other causes of mortality., Impact: Different approaches for net survival estimation should be considered depending on cancer under study., (©2019 American Association for Cancer Research.)