Cancer survivors in Israel - National Cancer Registry data · INCR (Israel National Cancer...
Transcript of Cancer survivors in Israel - National Cancer Registry data · INCR (Israel National Cancer...
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Cancer survivors in Israel -National Cancer Registry data
Prof. Lital Keinan Boker, Ministry of Health
Dr. Barbara Silverman, Ministry of Health
Prof. Eliezer Robinson, Israel Cancer Association
Cancer Survivors ConferenceFebruary 6th, 2017
►Aging of the population increases the number of cancer patients
►Early detection and improved treatment increase survival rates
►The number of cancer survivors has been increasing worldwide► now approximately 32.6 million
►A challenge to healthcare providers► High risk group for short- and long-term
health outcomes
BACKGROUND
► Most frequent complaints
► Fatigue
► Pain
► Sleep disorders
► Cognitive dysfunction
► Emotional distress
► Depression
► Anxiety
► Family and work disruptions
► Financial difficulties
► Weight change
► And more
SHORT-TERM OUTCOMES
►May appear years and decades after
cancer diagnosis and treatment ► Prostate cancer - erectile dysfunction and
urinary incontinence
► Breast cancer - arm lymphedema, psychological
morbidity, cardiomyopathy or heart failure and
cardiac event
► Head and neck cancer - swallowing dysfunction
► All cancers – additional primary tumors
► Breast cancer after Hodgkin lymphoma
► Thyroid cancer after childhood cancer; breast cancer
LONG-TERM OUTCOMES
OBJECTIVE
► To report on cancer survival in Israel
in the 50y period of 1960-2009
► in order to provide data on the scope of
the challenge that Israel health care
funds face
INCR (Israel National Cancer Registry)
► Founded in 1960
► A national, population-based, passive
registry
► Cancer reporting by hospitals, pathology
and cytology laboratories, oncology
institutes and other health care providers to
the INCR mandatory since 1982
► Completeness of ascertainment is high► 94% for solid tumors
► Information is collected on ► Malignant tumors (in situ and invasive) excl.
skin SCC and BCC; borderline tumors; benign
neoplasms of the brain and nervous system
METHODS (1)
► The INCR database was used to identify all
invasive cancer cases diagnosed in Israel
during the period 1960 to 2009► Further divided into 5 decades
► 1960-9; 1970-9; 1980-9; 1990-9; 2000-9
► Absolute numbers were used► Appropriate information needed to estimate
disease burden and challenges
► Central Bureau of Statistics data on► Vital status
► Denominators (%)
METHODS (2)
► The number of cancer survivors per
decade and entire study period was
defined as the absolute number of incident
cancer cases diagnosed during each time
period, that were alive by the end of that
time period
► The prevalence of cancer survivors per
decade and entire study period was
computed by dividing the number of
cancer survivors per each time period by
the size of the total Israeli population by
the end of that time period
METHODS (3)
► The significance of the time trends of
cancer survival and prevalence by decade
was assessed using a linear regression
model
► Life table analysis approach was used to
estimate changes in the cumulative
absolute cancer survival for 5, 10 and 15
years following diagnosis by decade
RESULTS (1)
► Around 600,000 Israelis were
diagnosed with an invasive cancer in
1960 through 2009 ► The incidence (absolute numbers) of new
patients increased about 5-fold during
this period
► Of them, 323,809 patients were alive
by the end of 2009, an overall absolute
survival rate of 54% ► The absolute number of survivors
increased 9-fold during this period
SURVIVAL AND PREVALENCE OF CANCER
SURVIVORS, 1960-2009
Time
period
Incident cases
(N) during time
period
Cancer
survivors (N)
by end of time
period
Absolute
survival
(%)
Cancer survivor
prevalence in the
population (%)
1960-1969 40,922 15,860 38.8 0.54
1970-1979 68,338 28,982 42.4 0.76
1980-1989 95,506 44,900 47.0 0.98
1990-1999 165,306 92,256 55.8 1.48
2000-2009 226,481 141,811 62.6 1.88
P for trend 0.002 0.002
RESULTS (2)
► The cumulative absolute survival
following diagnosis increased with
time► 5 year survival
► from 34% in 1960-1969 to 62% in 2000-2009
► 10 year survival ► from 25% in 1960-1969 to 54% in 2000-2009
► 15 year survival ► from 19% in 1960-1969 to 34% in 1990-1999
CUMULATIVE ABSOLUTE SURVIVAL
Time period Cumulative
absolute survival
for 5 years (%)
Cumulative
absolute survival
for 10 years (%)
Cumulative
absolute survival
for 15 years (%)
1960-1969 34 25 19
1970-1979 38 28 21
1980-1989 43 32 23
1990-1999 54 42 34
2000-2009 62 54 Na*
Cumulative absolute survival following diagnosis by decades of diagnosis in Israel, 1960-2009
CONCLUSIONS (1)
► The number of new cancer patients in Israel
increased 5-fold between 1960 and 2009 ► Reflecting population growth, immigration,
aging and increases in the incidence of certain
types of cancer
► The number of cancer survivors increased
9-fold during this period
► Cumulative absolute survival for 5, 10 and
15 years following diagnosis increased by
decade► Suggesting genuinely improved survivorship
► Population screening; earlier diagnosis (relevant and
non-relevant tumors); improved treatment
CONCLUSIONS (2)
► The trend of increasing cancer survivorship
in Israel closely follows that in other
developed countries
► The growing number of cancer survivors –
currently around 1.9% of the Israeli
population - presents an obvious challenge
to the Israeli health system and to other
service providers, expected to address the
special physical, mental, social and other
needs of this unique population
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