Changing cancer survival in China during 2003–15: a pooled analysis of 17 population-based cancer registries
From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to inv...
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| Published in: | The Lancet global health Vol. 6; no. 5; pp. e555 - e567 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
Elsevier Ltd
01.05.2018
Elsevier |
| Subjects: | |
| ISSN: | 2214-109X, 2214-109X |
| Online Access: | Get full text |
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| Abstract | From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015.
We used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0–99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003–05, 2006–08, 2009–11, and 2012–15).
There were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003–05 to 2012–15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6–31·2) to 40·5% (40·3–40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5–8·5]), thyroid (5·4% [3·2–7·6]), cervix (4·5% [2·9–6·2]), and bone (3·2% [2·1–4·4]). In 2012–15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5–47·0) than in rural areas (33·6%, 33·3–33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied.
There was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care.
National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences. |
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| AbstractList | From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015.
We used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0–99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003–05, 2006–08, 2009–11, and 2012–15).
There were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003–05 to 2012–15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6–31·2) to 40·5% (40·3–40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5–8·5]), thyroid (5·4% [3·2–7·6]), cervix (4·5% [2·9–6·2]), and bone (3·2% [2·1–4·4]). In 2012–15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5–47·0) than in rural areas (33·6%, 33·3–33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied.
There was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care.
National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences. From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015.BACKGROUNDFrom 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015.We used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0-99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003-05, 2006-08, 2009-11, and 2012-15).METHODSWe used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0-99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003-05, 2006-08, 2009-11, and 2012-15).There were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003-05 to 2012-15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6-31·2) to 40·5% (40·3-40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5-8·5]), thyroid (5·4% [3·2-7·6]), cervix (4·5% [2·9-6·2]), and bone (3·2% [2·1-4·4]). In 2012-15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5-47·0) than in rural areas (33·6%, 33·3-33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied.FINDINGSThere were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003-05 to 2012-15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6-31·2) to 40·5% (40·3-40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5-8·5]), thyroid (5·4% [3·2-7·6]), cervix (4·5% [2·9-6·2]), and bone (3·2% [2·1-4·4]). In 2012-15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5-47·0) than in rural areas (33·6%, 33·3-33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied.There was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care.INTERPRETATIONThere was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care.National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences.FUNDINGNational Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences. Background: From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015. Methods: We used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0–99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003–05, 2006–08, 2009–11, and 2012–15). Findings: There were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003–05 to 2012–15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6–31·2) to 40·5% (40·3–40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5–8·5]), thyroid (5·4% [3·2–7·6]), cervix (4·5% [2·9–6·2]), and bone (3·2% [2·1–4·4]). In 2012–15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5–47·0) than in rural areas (33·6%, 33·3–33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied. Interpretation: There was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care. Funding: National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences. |
| Author | Jemal, Ahmedin Chen, Jianshun Zhang, Siwei Wei, Kuangrong Song, Guohui Li, Qilong Yang, Zhixun Xia, Changfa Sun, Kexin Gu, Xiaoping Zou, Xiaonong Bray, Freddie Chen, Wanqing Han, Renqiang He, Jie Zhou, Yan Wang, Jian Li, He Yan, Chunhua Xu, Yanjun Fan, Dongmei Fu, Zhentao Wang, Ning He, Yutong Zheng, Rongshou Ji, John S Zhou, Xin Baade, Peter Yu, Xue Qin Zeng, Hongmei Jin, Feng Liu, Shuzheng Zhao, Deli Wu, Tonghao Fu, Fangxian Jiang, Chunxiao Yang, Yanlei Li, Huizhang Li, Yanhua Mu, Huijuan Hua, Zhaolai Jiang, Jie Chen, Jianguo Dong, Jianmei |
| Author_xml | – sequence: 1 givenname: Hongmei surname: Zeng fullname: Zeng, Hongmei organization: National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 2 givenname: Wanqing surname: Chen fullname: Chen, Wanqing email: chenwq@cicams.ac.cn organization: National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 3 givenname: Rongshou surname: Zheng fullname: Zheng, Rongshou organization: National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 4 givenname: Siwei surname: Zhang fullname: Zhang, Siwei organization: National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 5 givenname: John S surname: Ji fullname: Ji, John S organization: Environmental Research Center, Duke Kunshan University, Jiangsu, China – sequence: 6 givenname: Xiaonong surname: Zou fullname: Zou, Xiaonong organization: National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 7 givenname: Changfa surname: Xia fullname: Xia, Changfa organization: National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 8 givenname: Kexin surname: Sun fullname: Sun, Kexin organization: National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 9 givenname: Zhixun surname: Yang fullname: Yang, Zhixun organization: National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 10 givenname: He surname: Li fullname: Li, He organization: National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China – sequence: 11 givenname: Ning surname: Wang fullname: Wang, Ning organization: Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China – sequence: 12 givenname: Renqiang surname: Han fullname: Han, Renqiang organization: Jiangsu Center for Disease Control and Prevention, Jiangsu, China – sequence: 13 givenname: Shuzheng surname: Liu fullname: Liu, Shuzheng organization: Henan Cancer Hospital, Henan, China – sequence: 14 givenname: Huizhang surname: Li fullname: Li, Huizhang organization: Zhejiang Provincial Office for Cancer Prevention and Control, Zhejiang Cancer Center/Cancer Hospital, Zhejiang, China – sequence: 15 givenname: Huijuan surname: Mu fullname: Mu, Huijuan organization: Liaoning Center for Disease Control and Prevention, Shenyang, China – sequence: 16 givenname: Yutong surname: He fullname: He, Yutong organization: Fourth Hospital of Hebei Medical University, Hebei, China – sequence: 17 givenname: Yanjun surname: Xu fullname: Xu, Yanjun organization: Guangdong Center for Disease Control and Prevention, Guangdong, China – sequence: 18 givenname: Zhentao surname: Fu fullname: Fu, Zhentao organization: Shandong Center for Disease Control and Prevention, Shandong, China – sequence: 19 givenname: Yan surname: Zhou fullname: Zhou, Yan organization: Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fujian, China – sequence: 20 givenname: Jie surname: Jiang fullname: Jiang, Jie organization: Dalian Cancer Registry, Dalian Center for Disease Control and Prevention, Liaoning, China – sequence: 21 givenname: Yanlei surname: Yang fullname: Yang, Yanlei organization: Haimen Cancer Registry, Haimen Center for Disease Control and Prevention, Jiangsu, China – sequence: 22 givenname: Jianguo surname: Chen fullname: Chen, Jianguo organization: Qidong Cancer Registry, Qidong Liver Cancer Institute, Jiangsu, China – sequence: 23 givenname: Kuangrong surname: Wei fullname: Wei, Kuangrong organization: Zhongshan Cancer Registry, Zhongshan People's Hospital, Guangdong, China – sequence: 24 givenname: Dongmei surname: Fan fullname: Fan, Dongmei organization: Taixing Cancer Registry, Taixing Center for Disease Control and Prevention, Jiangsu, China – sequence: 25 givenname: Jian surname: Wang fullname: Wang, Jian organization: Jianhu Cancer Registry, Jianhu Center for Disease Control and Prevention, Jiangsu, China – sequence: 26 givenname: Fangxian surname: Fu fullname: Fu, Fangxian organization: Linzhou Cancer Registry, Linzhou Cancer Hospital, Henan, China – sequence: 27 givenname: Deli surname: Zhao fullname: Zhao, Deli organization: Feicheng Cancer Registry, Feicheng People's Hospital, Shandong, China – sequence: 28 givenname: Guohui surname: Song fullname: Song, Guohui organization: Cixian Cancer Registry, Cixian Institute for Cancer Prevention and Control, Hebei, China – sequence: 29 givenname: Jianshun surname: Chen fullname: Chen, Jianshun organization: Changle Cancer Registry, Changle Institute for Cancer Prevention and Control, Fujian, China – sequence: 30 givenname: Chunxiao surname: Jiang fullname: Jiang, Chunxiao organization: Haining Cancer Registry, Haining Institute for Cancer Prevention and Control, Zhejiang, China – sequence: 31 givenname: Xin surname: Zhou fullname: Zhou, Xin organization: Jintan Cancer Registry, Jintan Center for Disease Control and Prevention, Jiangsu, China – sequence: 32 givenname: Xiaoping surname: Gu fullname: Gu, Xiaoping organization: Dafeng Cancer Registry, Dafeng Center for Disease Control and Prevention, Jiangsu, China – sequence: 33 givenname: Feng surname: Jin fullname: Jin, Feng organization: Ganyu Cancer Registry, Ganyu Center for Disease Control and Prevention, Jiangsu, China – sequence: 34 givenname: Qilong surname: Li fullname: Li, Qilong organization: Jiashan Cancer Registry, Jiashan Institute for Cancer Prevention and Control, Zhejiang, China – sequence: 35 givenname: Yanhua surname: Li fullname: Li, Yanhua organization: Sihui Cancer Registry, Tumor Research Institute of Sihui City, Guangdong, China – sequence: 36 givenname: Tonghao surname: Wu fullname: Wu, Tonghao organization: Donghai Cancer Registry, Donghai Center for Disease Control and Prevention, Jiangsu, China – sequence: 37 givenname: Chunhua surname: Yan fullname: Yan, Chunhua organization: Guanyun Cancer Registry, Guanyun Center for Disease Control and Prevention, Jiangsu, China – sequence: 38 givenname: Jianmei surname: Dong fullname: Dong, Jianmei organization: Lianyungang Cancer Registry, Lianyungang Center for Disease Control and Prevention, Jiangsu, China – sequence: 39 givenname: Zhaolai surname: Hua fullname: Hua, Zhaolai organization: Yangzhong Cancer Registry, Yangzhong Institute for Cancer Prevention and Control, Jiangsu, China – sequence: 40 givenname: Peter surname: Baade fullname: Baade, Peter organization: Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia – sequence: 41 givenname: Freddie surname: Bray fullname: Bray, Freddie organization: Cancer Surveillance Section, International Agency for Research on Cancer, Lyon France – sequence: 42 givenname: Ahmedin surname: Jemal fullname: Jemal, Ahmedin organization: Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA – sequence: 43 givenname: Xue Qin surname: Yu fullname: Yu, Xue Qin organization: Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia – sequence: 44 givenname: Jie surname: He fullname: He, Jie email: hejie@cicams.ac.cn organization: National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29653628$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Adolescent Adult Aged Aged, 80 and over Cancer Survivors - statistics & numerical data Child Child, Preschool China - epidemiology Female Humans Infant Infant, Newborn Male Middle Aged Neoplasms - mortality Registries Survival Rate - trends Young Adult |
| Title | Changing cancer survival in China during 2003–15: a pooled analysis of 17 population-based cancer registries |
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