title: Comparison of expected health impacts for major cancers: integration of incidence rate and loss of quality-adjusted life expectancy.
abstract: OBJECTIVE
  The study aims to quantify the expected impacts of different cancers through multiplying the incidence rate by loss-of-QALE (quality-adjusted life expectancy), with QALY (quality-adjusted life year) as the common unit, to aid prevention policy decisions.
  
  
  METHODS
  464,722 patients with pathologically verified cancer registered in the Taiwan Cancer Registry during 1998-2009 were used to estimate lifetime survival through Kaplan-Meier estimation combined with a semi-parametric method. A convenience sample for measuring the utility value with EQ-5D was conducted with 11,453 cancer patients, with the results then multiplied by the survival functions to estimate QALE. The loss-of-QALE was calculated by subtracting the QALE of each cancer cohort from the life expectancy of the corresponding age- and gender-matched reference population. The cumulative incidence rates from age 20 to 79 (CIR₂₀₋₇₉) were calculated to estimate the lifetime risk of cancer for each organ-system.
  
  
  RESULTS
  Liver and lung cancer were found the highest expected lifetime health impacts in males and females, or expected lifetime losses of 0.97 and 0.41 QALYs that could be averted, respectively. While the priority changes for prevention based on expected health impacts were slightly different for females based on standardized mortality rates, those of males involve a broader spectrum, including oral, colorectal, esophageal and stomach cancer.
  
  
  CONCLUSIONS
  The integration of incidence rate with loss-of-QALE could be used to represent the expected losses that could be averted by prevention, which may be useful in prioritizing strategies for cancer control.
authors.affiliation: Department of Public Health, National Cheng Kung University College of Medicine, Tainan 704, Taiwan.
authors.forename: Mei-Chuan
authors.initials: MC
authors.lastname: Hung
authors.affiliation: Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
authors.forename: Wu-Wei
authors.initials: WW
authors.lastname: Lai
authors.affiliation: Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
authors.forename: Helen H W
authors.initials: HH
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
authors.forename: Wu-Chou
authors.initials: WC
authors.lastname: Su
authors.affiliation: Department of Public Health, National Cheng Kung University College of Medicine, Tainan 704, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan. Electronic address: jdwang121@gmail.com.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000473:pathology; D019057:Quality-Adjusted Life Years; D012042:Registries; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Cancer prevention; Health impacts; Incidence rate; Loss-of-QALE (quality-adjusted life expectancy)