Devasia Theresa P, Howlader Nadia, Dewar Ron A, Stevens Jennifer L, Mittu Karen, Mariotto Angela B
Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland.
Cancer Care Program, Nova Scotia Health Authority, Nova Scotia, Canada.
Cancer Epidemiol Biomarkers Prev. 2024 Feb 6;33(2):196-205. doi: 10.1158/1055-9965.EPI-23-1006.
Cancer is becoming more of a chronic disease due to improvements in treatment and early detection for multiple cancer sites. To gain insight on increased life expectancy due to these improvements, we quantified trends in the loss in expectation of life (LEL) due to a cancer diagnosis for six cancer sites from 1975 through 2018.
We focused on patients diagnosed with female breast cancer, chronic myeloid leukemia (CML), colon and rectum cancer, diffuse large B-cell lymphoma (DLBCL), lung cancer, or melanoma between 1975 and 2018 from nine Surveillance, Epidemiology, and End Results cancer registries. Life expectancies for patients with cancer ages 50+ were modeled using flexible parametric survival models. LEL was calculated as the difference between general population life expectancy and life expectancy for patients with cancer.
Over 2 million patients were diagnosed with one of the six cancers between 1975 and 2018. Large increases in life expectancy were observed between 1990 and 2010 for female breast, DLBCL, and CML. Patients with colon and rectum cancer and melanoma had more gradual improvements in life expectancy. Lung cancer LEL only began decreasing after 2005. Increases in life expectancy corresponded with decreases in LEL for patients with cancer.
The reported gains in life expectancy largely correspond to progress in the screening, management, and treatment of these six cancers since 1975.
LEL provides an important public health perspective on how improvements in treatment and early detection and their impacts on survival translate into changes in cancer patients' life expectancy.
由于多种癌症部位的治疗和早期检测取得进展，癌症正日益成为一种慢性病。为深入了解这些进展对预期寿命增加的影响，我们对1975年至2018年六个癌症部位因癌症诊断导致的预期寿命损失（LEL）趋势进行了量化。
我们聚焦于1975年至2018年间在九个监测、流行病学和最终结果癌症登记处被诊断为女性乳腺癌、慢性髓性白血病（CML）、结肠直肠癌、弥漫性大B细胞淋巴瘤（DLBCL）、肺癌或黑色素瘤的患者。使用灵活的参数生存模型对50岁及以上癌症患者的预期寿命进行建模。LEL计算为一般人群预期寿命与癌症患者预期寿命之间的差值。
1975年至2018年间，超过200万患者被诊断患有六种癌症之一。1990年至2010年间，女性乳腺癌、DLBCL和CML患者的预期寿命大幅增加。结肠直肠癌和黑色素瘤患者的预期寿命改善较为缓慢。肺癌LEL直到2005年后才开始下降。预期寿命的增加与癌症患者LEL的下降相对应。
报告的预期寿命增加在很大程度上与自1975年以来这六种癌症在筛查、管理和治疗方面的进展相对应。
LEL为治疗和早期检测的改善及其对生存的影响如何转化为癌症患者预期寿命的变化提供了一个重要的公共卫生视角。
