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Comparison of different approaches to estimating age standardized net survival.

Lambert PC, Dickman PW, Rutherford MJ - BMC Med Res Methodol (2015)

Bottom Line: We compare lifetable-based estimates (Ederer II), a new unbiased method based on inverse probability of censoring weights (Pohar Perme) and model-based estimates.However, both the Ederer II and modelling approaches have some advantages over the Pohar Perme method in terms of greater precision, particularly for longer-term follow-up (10 and 15 years).We have also shown advantages in using the more traditional and modelling methods.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK. paul.lambert@le.ac.uk.

ABSTRACT

Background: Age-standardized net survival provides an important population-based summary of cancer survival that appropriately accounts for differences in other-cause mortality rates and standardizes the population age distribution to allow fair comparisons. Recently, there has been debate over the most appropriate method for estimating this quantity, with the traditional Ederer II approach being shown to have potential bias.

Methods: We compare lifetable-based estimates (Ederer II), a new unbiased method based on inverse probability of censoring weights (Pohar Perme) and model-based estimates. We make the comparison in a simulation setting; generating scenarios where we would expect to see a large theoretical bias.

Results: Our simulations demonstrate that even in relatively extreme scenarios there is negligible bias in age-standardized net survival when using the age-standardized Ederer II method, modelling with continuous age or using the Pohar Perme method. However, both the Ederer II and modelling approaches have some advantages over the Pohar Perme method in terms of greater precision, particularly for longer-term follow-up (10 and 15 years).

Conclusions: Our results show that, when age-standardizing, concern over bias with the traditional methods is unfounded. We have also shown advantages in using the more traditional and modelling methods.

No MeSH data available.


Related in: MedlinePlus

Scenario 1: Scatter Plot of Estimated Externally Age Standardized Net Survival for the 1000 Different Estimates for each of the Methods. The True Value is Shown by a Reference Line
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Fig4: Scenario 1: Scatter Plot of Estimated Externally Age Standardized Net Survival for the 1000 Different Estimates for each of the Methods. The True Value is Shown by a Reference Line

Mentions: Table 3 shows the bias, MSE and coverage for scenario 1. The bias is low for all methods for both internal and external age standardization. At five years the largest bias was less than 0.27 percentage points (model-based grouped age). Coverage was good for all methods with the exception of the model-based grouped age estimate. With the exception of model-based grouped age, there was more variation in the Pohar-Perme estimate at 5, and particularly 10 and 15 years, reflected in the larger MSEs. This is demonstrated in a scatter plot of the estimates from each simulation in Fig. 3 (internal age standardization) and Fig. 4 (external age standardization). The smallest variation is for the all-age Ederer II method.Fig. 3


Comparison of different approaches to estimating age standardized net survival.

Lambert PC, Dickman PW, Rutherford MJ - BMC Med Res Methodol (2015)

Scenario 1: Scatter Plot of Estimated Externally Age Standardized Net Survival for the 1000 Different Estimates for each of the Methods. The True Value is Shown by a Reference Line
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4537569&req=5

Fig4: Scenario 1: Scatter Plot of Estimated Externally Age Standardized Net Survival for the 1000 Different Estimates for each of the Methods. The True Value is Shown by a Reference Line
Mentions: Table 3 shows the bias, MSE and coverage for scenario 1. The bias is low for all methods for both internal and external age standardization. At five years the largest bias was less than 0.27 percentage points (model-based grouped age). Coverage was good for all methods with the exception of the model-based grouped age estimate. With the exception of model-based grouped age, there was more variation in the Pohar-Perme estimate at 5, and particularly 10 and 15 years, reflected in the larger MSEs. This is demonstrated in a scatter plot of the estimates from each simulation in Fig. 3 (internal age standardization) and Fig. 4 (external age standardization). The smallest variation is for the all-age Ederer II method.Fig. 3

Bottom Line: We compare lifetable-based estimates (Ederer II), a new unbiased method based on inverse probability of censoring weights (Pohar Perme) and model-based estimates.However, both the Ederer II and modelling approaches have some advantages over the Pohar Perme method in terms of greater precision, particularly for longer-term follow-up (10 and 15 years).We have also shown advantages in using the more traditional and modelling methods.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK. paul.lambert@le.ac.uk.

ABSTRACT

Background: Age-standardized net survival provides an important population-based summary of cancer survival that appropriately accounts for differences in other-cause mortality rates and standardizes the population age distribution to allow fair comparisons. Recently, there has been debate over the most appropriate method for estimating this quantity, with the traditional Ederer II approach being shown to have potential bias.

Methods: We compare lifetable-based estimates (Ederer II), a new unbiased method based on inverse probability of censoring weights (Pohar Perme) and model-based estimates. We make the comparison in a simulation setting; generating scenarios where we would expect to see a large theoretical bias.

Results: Our simulations demonstrate that even in relatively extreme scenarios there is negligible bias in age-standardized net survival when using the age-standardized Ederer II method, modelling with continuous age or using the Pohar Perme method. However, both the Ederer II and modelling approaches have some advantages over the Pohar Perme method in terms of greater precision, particularly for longer-term follow-up (10 and 15 years).

Conclusions: Our results show that, when age-standardizing, concern over bias with the traditional methods is unfounded. We have also shown advantages in using the more traditional and modelling methods.

No MeSH data available.


Related in: MedlinePlus