1. Can cancer registries show whether treatment is contributing to survival increases for melanoma of the skin at a population level?
- Author
-
Shahnam, Adel, Roder, David M., Tracey, Elizabeth A., Neuhaus, Susan J., Brown, Michael P., and Sorich, Michael J.
- Subjects
- *
AGE distribution , *CONFIDENCE intervals , *STATISTICAL correlation , *DEATH , *REPORTING of diseases , *MELANOMA , *HEALTH outcome assessment , *REGRESSION analysis , *RISK assessment , *SURVIVAL analysis (Biometry) , *SURVIVAL , *U-statistics , *TREATMENT effectiveness , *DATA analysis software , *DESCRIPTIVE statistics - Abstract
Rationale, aims and objectives It is uncertain whether survival increases from melanoma recorded by some population registries include a treatment effect. The US Surveillance, Epidemiology and End Results ( SEER) programme has good data quality control, large numbers of cases enabling high statistical precision and summary stage plus thickness, which we consider to be a best-case population registry scenario to investigate potential for a treatment effect. We have investigated SEER data to indicate whether survivals increases are fully attributable to earlier diagnosis and other non-treatment factors. Methods Through relative survival regression, the effects of diagnostic period on 5-year excess mortality were investigated, adjusting for socio-demographic factors, lesion sub-site, histology, thickness and stage at diagnosis in 1990-2009 (n = 99 690 cases). Results The reduction in excess mortality (95% confidence interval) between 1990-1999 and 2000-2009 was 31 (20-41)% for localised melanoma, 18 (12-22)% for regional melanoma and 3 (-5-10)% for melanomas with distant spread. Younger age was predictive of a greater percentage reduction. Treatment benefits are inferred from the higher survivals in 2000-2009 but uncertainty remains due to incomplete data to adjust for non-treatment factors and a lack of treatment data. Conclusions Registries should use new information systems to collect more complete data on stage, other prognostic indicators, co-morbidities and treatment, to provide more definitive and detailed information on population effects of cancer control. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF