BCell Lymphoma DLBCL Patients 1983 2014 results from analysis of US SEER data Ron Dewar Registry and Analytics Nova Scotia Health Authority Canada Nadia Howlader Angela ID: 916244
Download Presentation The PPT/PDF document "Changes in Life Expectation for Diffuse ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Changes in Life Expectation for Diffuse Large
B-Cell Lymphoma (DLBCL) Patients, 1983 – 2014 results from analysis of US SEER dataRon Dewar, Registry and Analytics,Nova Scotia Health Authority (Canada)Nadia Howlader, Angela Mariotto,National Cancer Institute (USA)Presented to the joint NAACCR / IACR meeting, June 2019
Slide2Overview and Objectives
Diffuse Large B-Cell Lymphoma (DLBCL)Introduce concept of expectation of lifeExpectation of life for general populationExpectation of life for cancer patient populationResults and their interpretationData sourcesSSA projections SEER*Stat (9 SEER registries 1983 – 2014)
Slide3Diffuse Large B-Cell Lymphoma (DLBCL)
B-Cell Lymphomas > 90% of all Non-Hodgkin Lymphoma (SEER 9, 2016)DLBCL ~23% of all B-Cell Lymphoma incidence, ~1/3 of NHL deathsRecent decline in incidence (since 2004) and mortality (since 1998) Improvements in 5-yr survival possibly due introduction of targeted therapies (rituximab) to standard (CHOP) Consider the impact of this disease on the future life expectancy of DLBCL patients in US
Slide4Expectation of Life
Total years lived (or projected to live) by all members of a cohort, divided by the initial cohort sizeGeneral population life expectation is published regularly, based on current (or projected) mortality rates Commonly expressed as ‘life expectancy at birth’, but can be computed from any age starting point (‘residual life expectancy’)Corresponding calculation for cancer patients?
Slide5Expectation of Life: All Cause
Mortality and Proportion Surviving, US women, 2014Mortality rate (all causes)Expectation of lifeAt ageYears081Proportion alive (survival curve)
85
7.1
Slide6Extrapolate patient all causes (observed) survival
Evaluation by T. Andersson (2012) suggests:Model, then extrapolate relative survival (AKA excess hazard) stable for many sites after 7 – 10 yearsCalculate observed survival using expected survival estimate, sinceRS = OS/expected, thenOS = RS * expectedNumerical integration of extrapolated OS curveData sourcesSEER 9, Nov 2016 dataset, ~ 32,000 DLBCL patients (1983 – 2014) covariates: age in years survival time in months
sex
Ann Arbor
Lymphoma (1983
+) Stage
complete life
tables for US (1970 – 2015
) (from SEER*Stat)
Life
Tables for the United States Social Security
Area
(1900-2100)
https://
www.ssa.gov/oact/NOTES/pdf_studies/study120.pdf
Calculation of expectation of life, cancer patients
Slide7Difference between population expectation and expectation for cancer patients
Compute at the individual or summed over all individuals to obtain a population level measure of disease burdenExpress as loss in expectation of life (LEL) in years proportion (%) of future life years lostPossible interpretations population burden of cancer (total years lost) change over time as measure of progress impact of covariate distribution impact on individual with specific covariates (age, sex, stage, …)
Loss in expectation of life
Slide8Expectation of Life, Women in
US, 2015 at age 55showing Loss in Expectation of Life (LEL)YearsPopulation30.4
Years
LEL
%LEL
Population
30.4
DLBCL
22.1
8.4
27.5
Years
Population
30.4
DLBCL
22.1
Slide9Trends in Life Expectancy for DLBCL patients US SEER data (1983 – 2014)
Age atDiagnosisCancer LifeExpectancy1983(years)Cancer Life
Expectancy
2014
(years)
Proportion
Lost
1983
(%)
Proportion
Lost
2014
(%)
55
Women
12
22
58
28
65
7
14
63
33
75
4
8
69
38
85
247444 55Men919613065 613633275 37663685 137343
Slide10DLBCL Life Expectancy by age and sex, 1983 - 2014
8.4 years
Slide11Loss of Life Expectancy (%) by age and sex,
DLBCL 1983 - 201427.5%
Slide12Trends in Life Expectancy* for DLBCL patients
by Ann Arbor (1983+) Lymphoma stageLymphoma Ann Arbor stage (1983)Cancer LifeExpectancy1983(years)
Cancer Life
Expectancy
2014
(years)
Proportion
Lost
1983
(%)
Proportion
Lost
2014
(%)
Women
I
8
14
48
25
II
7
14
55
24
III
5
12
72
32
IV 4117641 MenI7124926II 6125725III 4117334IV
3
9
77
42
*Age
standardised
to 2014 age distribution
Slide13Loss Life Expectancy* (%) for
DLBCL patients by Ann Arbor (1983+) Lymphoma stage*Age standardised to 2014 age distribution
Slide14Conclusions
Recent advances in survival from DLBCL can be seen in the US SEER data across all ages and stage groups (1983 – 2014 data)Disease burden (age standardised % Loss in Life Expectancy) is now similar for Ann Arbor (1983+) Stage I and II at 25% for both men and womenLoss in Expectation of Life can be seen as an adjunct to survival estimates and may improve communication patient – physician interaction managers and planners of the cancer systemCaveats: need a wider conversation around uses, interpretation
availability of projected life tables (ideal, but not entirely necessary)
sensitivity to modeling choices should be evaluated and reported
stage-specific
trends
subject to same caveats as survival trends
Slide15Thanks to:
Nova Scotia Health Authority, Cancer Care ProgramNational Cancer InstituteSEER*StatDr. Paul Lambert, Dr. Therese Andersson (authors of Stata routines)
Slide16Any questions?