title: Should relative survival be used with lung cancer data?
abstract: BACKGROUND
  Under certain assumptions, relative survival is a measure of net survival based on estimating the excess mortality in a study population when compared with the general population. Background mortality estimates are usually taken from national life tables that are broken down by age, sex and calendar year. A fundamental assumption of relative survival methods is that if a patient did not have the disease of interest then their probability of survival would be comparable to that of the general population. It is argued, as most lung cancer patients are smokers and therefore carry a higher risk of smoking-related mortalities, that they are not comparable to a population where the majority are likely to be non-smokers.
  
  
  METHODS
  We use data from the Finnish Cancer Registry to assess the impact that the non-comparability assumption has on the estimates of relative survival through the use of a sensitivity analysis.
  
  
  RESULTS
  Under realistic estimates of increased all-cause mortality for smokers compared with non-smokers, the bias in the estimates of relative survival caused by the non-comparability assumption is negligible.
  
  
  CONCLUSIONS
  Although the assumption of comparability underlying the relative survival method may not be reasonable, it does not have a concerning impact on the estimates of relative survival, as most lung cancer patients die within the first 2 years following diagnosis. This should serve to reassure critics of the use of relative survival when applied to lung cancer data.
authors.affiliation: Department of Health Sciences, Centre for Biostatistics and Genetic Epidemiology, 2nd Floor Adrian Building, University Road, University of Leicester, Leicester LE1 7RH, UK. srh20@leicester.ac.uk
authors.forename: S R
authors.initials: SR
authors.lastname: Hinchliffe
authors.forename: M J
authors.initials: MJ
authors.lastname: Rutherford
authors.forename: M J
authors.initials: MJ
authors.lastname: Crowther
authors.forename: C P
authors.initials: CP
authors.lastname: Nelson
authors.forename: P C
authors.initials: PC
authors.lastname: Lambert
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D005260:Female; D005387:Finland; D006801:Humans; D015993:Life Tables; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D016019:Survival Analysis; D055815:Young Adult