title: Explanations for worsening cancer survival.
abstract: If cancer survival is reported to be worsening over time or inferior compared to other countries, politicians and health-care workers may get blamed because suboptimal care is presumed to be the cause. Yet, a variety of reasons exist for cancer survival statistics to change for the worse, of which deterioration of care is only one. Another explanation is that the improved diagnosis of premalignant lesions causes survival statistics to reflect only the most aggressive cancers-those with the poorest prognosis. In addition, deleterious changes in the distribution of prognostic factors and in the distribution of sociodemographic characteristics may negatively affect survival proportions. In this article, we identify the pitfalls that might be encountered in comparisons of published, population-based survival data from different time periods or populations.
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands. e.devries@erasmusmc.nl
authors.forename: Esther
authors.initials: E
authors.lastname: de Vries
authors.forename: Henrike E
authors.initials: HE
authors.lastname: Karim-Kos
authors.forename: Maryska L G
authors.initials: ML
authors.lastname: Janssen-Heijnen
authors.forename: Isabelle
authors.initials: I
authors.lastname: Soerjomataram
authors.forename: Lambertus A
authors.initials: LA
authors.lastname: Kiemeney
authors.forename: Jan Willem W
authors.initials: JW
authors.lastname: Coebergh
mesh_terms: D002423:Cause of Death; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003710:Demography; D042241:Early Diagnosis; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008403:Mass Screening; D009026:Mortality / Q000639:trends; D009369:Neoplasms / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy; D009426:Netherlands / Q000453:epidemiology; D011157:Population Dynamics; D011230:Precancerous Conditions / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D012922:Social Change; D012959:Socioeconomic Factors; D016019:Survival Analysis; D017211:Treatment Failure