Conditional 5-year relative survival

Published

04 Feb, 2019

Cancer survival can be used as an indicator of cancer prognosis at a population level as well as an indicator of effectiveness of treatments provided.¹

The measure conditional 5-year relative survival (referred to as ‘conditional survival’ hereafter) answers the question: "now that an individual has survived for X years, what is the probability of surviving another five years?”² This indicator may be used at the population-level to provide a measure of the efficacy of management of people affected by cancer.²

Summary

The longer a person has already survived after being diagnosed with cancer, the higher the likelihood that they will survive their cancer for at least another 5 yearsFor the individual cancer types analysed for the period 2010-14, the likelihood of surviving another 5 years increased if the person had already survived multiple years since diagnosis (i.e. from 1 to 5 years). 
The only exception was prostate cancer, which had high (between 95% and 96%) conditional survival regardless of the number of years already survived.

Cancers of the pancreas, brain, oesophagus, lung, liver, and unknown primary site had the largest increases in conditional survival at 1 year and 3 years following diagnosisFor these cancer types the likelihood of survival increased by at least 20 percentage points between 1 year and 3 years following diagnosis. 

Indigenous Australians who have survived 1 year after diagnosis have lower observed survival outcomes compared to non-Indigenous AustraliansIndigenous Australians had lower conditional observed survival outcomes for all cancers combined than non-Indigenous Australians after surviving 1 year from diagnosis (63% and 70%, respectively). 

Indigenous Australians who had already survived 3 or 5 years after diagnosis had similar observed survival outcomes compared to non-Indigenous AustraliansFor Indigenous Australians who had already survived 3 years or 5 years after diagnosis, conditional observed survival was similar to non-Indigenous Australians (75% and 77% for 3 years, respectively; 77% and 78% for 5 years, respectively).

Conditional survival increased with increasing socioeconomic statusFor people who had already survived 1 or 5 years after diagnosis, conditional observed survival was 69% and 78% in the lowest SES areas (SES1) and 76% and 83% in the highest SES areas (SES 5) respectively. 

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Notes

• Data sourced from AIHW Australian Cancer Database 2014.
• Error bars indicate 95% confidence intervals.
• Conditional relative survival was calculated with the period method, using the period 2010–2014. Note that this period does not contain incidence data for 2014 for NSW because those data were not available.

Conditional 5-year relative survival for all cancers combined and selected cancer types, by sex, 2010–2014
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Notes

• Data sourced from AIHW Australian Cancer Database 2014.
• Error bars indicate 95% confidence intervals.
• Conditional relative survival was calculated with the period method, using the period 2010–2014. Note that this period does not contain incidence data for 2014 for NSW because those data were not available.
• Data for some categories that do not appear in the charts have been deliberately suppressed due to small numbers, confidentiality, and/or reliability concerns

Conditional 5-year relative survival for all cancers combined and selected cancer types by age and sex, 2010-2014
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Cancer type

Notes

• Data sourced from AIHW Cancer Database 2014.
• Error bars represent 95% confidence intervals.
• Observed survival was calculated with the period method, using the period 2010–2014.
• Data are for NSW, Qld, WA and NT, and for Vic from 2008 only. Incidence data for the period 2013-2014 are not included for NSW as these data were not available.
• Data for some categories that do not appear in the charts have been deliberately suppressed due to small numbers, confidentiality, and/or reliability concerns.

Conditional 5-year observed survival survival for selected cancers and all cancers combined, by sex and Indigenous status, 2010-2014
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Notes

• Data sourced from AIHW Australian Cancer Database 2014.
• Error bars indicate 95% confidence intervals.
• Observed survival was calculated with the period method, using the period 2010–2014. Note that this period does not contain incidence data for 2013–2014 for NSW because those data were not available.
• Remoteness areas are classified according to the Australian Standard Geographical Classification (ASGC) Remoteness Area (2011).
• Data for some categories that do not appear in the charts have been deliberately suppressed due to small numbers, confidentiality, and/or reliability concerns.

Conditional 5-year observed survival for selected cancers and all cancers combined, by sex and remoteness, 2010–2014
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Filter graph by:
Select the type of variables in order to filter the graph shown above.
Sex
Cancer type

Notes

• Data sourced from AIHW Australian Cancer Database 2014.
• Error bars indicate 95% confidence intervals.
• Observed survival was calculated with the period method, using the period 2010–2014. Note that this period does not contain incidence data for 2013–2014 for NSW because those data were not available.
• SES area is classified according to the patient's usual place of residence at diagnosis using the ABS SEIFA Index of Relative Socioeconomic Disadvantage, 2011. See 'About the data' for more detail.
• Data for some categories that do not appear in the charts have been deliberately suppressed due to small numbers, confidentiality, and/or reliability concerns.

Conditional 5-year observed survival for selected cancers and all cancers combined, by sex and SES, 2010–2014

About this measure

Survival from cancer is dependent on various factors including demographic characteristics, tumour type, stage of the cancer at diagnosis, other prognostic indicators and treatment. Cancer survival refers to the proportion of patients alive at a specified point following a cancer diagnosis, or from some designated point after diagnosis (conditional survival). It is commonly presented as the probability of surviving an additional specified amount of time, e.g. 5 or 10-years.^1,3

The conditional survival estimates in this analysis were derived from relative survival estimates for age and sex groupings. Conditional survival estimates analysed by Indigenous status, remoteness area, or socioeconomic status are presented for observed survival (rather than relative survival) due to the absence of relevant life tables at the time of publication.

Cancer survival statistics are made available by the Australian Institute of Health and Welfare (AIHW) for individual cancer types and groupings. These cancer types and groupings are classified using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).¹

Current status

Conditional survival for all cancers combined

In the period 2010-14, the conditional 5-year survival for all cancers combined increased as the number of years already survived increases, from 1 year (82%), 3 years (89%) and 5 years (92%). This means that the longer a person has already survived after being diagnosed with cancer, the higher the likelihood of survival for another 5 years.

Age and sex

Conditional survival for all cancers combined was:

Similar for males and females who had already survived 1, 3 or 5 years (82%, 89%, and 92%, respectively).
Similar for people in age groups less than 35 years old, but gradually decreased with increasing age.
Lowest for people aged 85 years and over who had already survived 1, 3 or 5 years (64%, 77% and 84%, respectively).

Males and females generally had similar conditional survival outcomes across the different age groups, except for people aged 85 years and over. Females in this age group had higher conditional survival than males who had already survived 1 year (68% compared to 61%), 3 years (83% compared to 71%); or 5 years (89% compared to 78%).

Aboriginal and Torres Strait Islander peoples

Conditional survival data for Indigenous persons are presented for observed survival for rather than for relative survival due to the absence of relevant life tables at the time of publication.

In the period 2010-14:

Conditional survival for all cancers combined among Indigenous persons was:

Lower than non-Indigenous persons who had already survived 1 year (63% compared to 70%);
Similar to non-Indigenous persons who had already survived 3 years (75% compared to 77%) or 5 years (77% and 78%).

Conditional survival was generally lower among males than females for both population groups.

For Indigenous persons conditional survival among males was:

Lower than females who had already survived 1 year (59% compared to 66%) or 3 years (72% compared to 77%);
Generally lower than females who had already survived 5 years (75% compared to 79%), however this was not statistically significant.

For non-Indigenous persons, conditional survival among males was:

Lower than females who had already survived 1 year (68% compared to 73%), 3 years (74% compared to 80%), or 5 years (75% compared to 82%).

Differences in conditional survival by Indigenous status may be influenced by a number of factors, such as cancer stage at diagnosis, differences in treatment and prevalence of co-morbidities.¹

Remoteness

Conditional survival by remoteness area is presented using observed survival rather than relative survival due to the absence of relevant life tables at the time of publication.

In the period 2010-14, conditional survival was similar across remoteness areas for people who had already survived 1 year (ranging between 72% and 73%).

In the period 2010-14:

Conditional survival for people living in Remote and Very Remote areas who had already survived 5 years (83%) was:

Similar to people living in Major Cities (81%), Inner Regional areas (79%), or Outer Regional areas (80%).

Socioeconomic status (SES)

Conditional survival by SES areas is presented using observed survival rather than relative survival due to the absence of relevant life tables at the time of publication.

In the period 2010-14:

Conditional survival increased with increasing socioeconomic status from the lowest SES areas (SES1) to the highest SES areas (SES5):

From 69% to 76% for people who had already survived 1 year; and
From 78% to 83% for people who had already survived 5 years.

Conditional survival increased with increasing socioeconomic status for both males and females.

Conditional survival by cancer type

In the period 2010-14, for most of the 19 selected cancer types analysed (see Table 1 in ‘About the Data’), the probability of surviving at least 5 more years increased as the number of years already survived increased. The only exception was for prostate cancer, which had similar high conditional survival regardless of the number of years already survived (between 95% and 96%).

Some cancer types had notable increases in survival if a person had already survived multiple years since being diagnosed with cancer. Cancers of the pancreas, brain, oesophagus, lung, liver, and unknown primary site had the largest increases in conditional survival prospects between 1 year and 3 years following diagnosis. For each of these cancer types, conditional survival increased by at least 20 percentage points between 1 year and 3 years following diagnosis. Conditional survival increased further for these cancer types for people who had already survived 5 years after diagnosis.

Age and sex

In the period 2010-14, conditional survival generally decreased with increasing age for the cancer types analysed. The ages at which decreases in conditional survival were observed and the extent to which these patterns were observed varied by cancer type. For breast (females) cancer, prostate cancer and melanoma, conditional survival only decreased among those aged 65 years and older

In the period 2010-14 for the cancer types analysed conditional survival among males who had already survived:

1 year was:
- Lower than females for cancers of the brain, head and neck (including lip), lung, melanoma and rectum.
- Higher than females for cancers of unknown primary site.
3 years was lower than females for colon, colorectal, head and neck (including lip) and lung.
5 years was similar to females for all of the cancer types analysed.

Aboriginal and Torres Strait Islander peoples

Conditional survival outcomes for Indigenous Australians are presented using observed survival rather than relative survival due to an absence of relevant life tables at the time of publication.

In the period 2010-2014, conditional survival among Indigenous persons was:

Lower than non-Indigenous persons who had already survived 1 year for head and neck (including lip) cancers (53% compared to 65%).
Similar to non-Indigenous persons who had already survived 3 or 5 years for all the cancer types analysed.

In the period 2010-2014, conditional survival among Indigenous males was:

Lower than non-Indigenous males who had already survived 1 year for cancers of the head and neck (including lip) and prostate.
Lower than non-Indigenous males who had already survived 3 years or 5 years for prostate cancer.
Higher than non-Indigenous males who had already survived 5 years for colon cancer.

In the period 2010-2014, conditional survival among Indigenous females was:

Lower than non-Indigenous females who had already survived 1 year for breast, cervical, colon, colorectal and lung cancers.
Lower than non-Indigenous females who had already survived 3 years or 5 years after diagnosis for breast cancer.

The difference in survival by Indigenous status may be influenced by a number of factors, such as cancer stage at diagnosis, differences in treatments received and prevalence of co-morbidities.1

Remoteness

Conditional survival by remoteness area is presented using observed survival rather than relative survival due to an absence of life tables at the time of publication.

Conditional survival was higher for people who had already survived 1 year living in:

Major Cities compared to other remoteness areas for cancers of the head and neck (including lip), liver and rectum.
Remote and Very Remote areas compared to other remoteness areas for melanoma.

For people who had already survived 5 years, those living in Remote and Very Remote areas had higher conditional survival compared to those from other remoteness areas for cancers of the colon, colorectal and melanoma.

Socioeconomic status (SES)

Conditional survival data by SES areas are presented using observed survival rather than relative survival due to the absence of relevant life tables at the time of publication.

For people who had already survived 1 year and 5 years after diagnosis, those living in the highest SES areas (SES 5) had higher conditional survival compared to those from other SES areas for the selected cancer types analysed except cancers of the bladder, brain, unknown primary site, liver, oesophagus, ovary (females), pancreas, uterus (females) and non-Hodgkin lymphoma.

Trends

Trend data are not available.

About the data

Conditional relative survival refers to the probability of surviving a number of additional years (e.g. 5 years) after already surviving a specified period of time after cancer diagnosis (e.g. 1 year, 3 years or 5 years). Where possible, the conditional relative survival in this analysis was derived using relative survival. For more information on the calculation of conditional relative survival, refer to AIHW’s Cancer in Australia 2017.

Relative survival at diagnosis is defined as a ratio of the proportion of people who are alive following a specified amount of time (e.g. 1 year, 5 years or 10 years) after diagnosis of cancer (observed survival) to the proportion of people in the general population alive over the same time interval (expected survival), matched for age, sex and calendar year. Observed survival has been calculated from population-based cancer data. Expected survival has been calculated from life tables for the entire Australian population.^1,3

Relative survival was calculated using the period method for all reported time periods. This method calculates survival from a given follow-up or at-risk period. Survival estimates are based on the survival experience of people who were diagnosed before or during this period, and who were at risk of dying during this period.¹

International comparisons of cancer survival are generally not available, due to differences in cancer collection, coding, and reporting practices, as well as differences in the methodologies used for calculating survival.¹

Table 1 presents relevant ICD-10 codes for all cancers combined and individual cancer types reported in this analysis.

Table 1. ICD-10 codes for all cancers combine and individual cancer types reported in this analysis

Cancer site/type	ICD-10 codes
All cancers combined	C00-C97, D45-D46, D47.1, D47.3-D47.5, except basal and squamous cell carcinomas of the skin which are part of C44
Bladder	C67
Brain	C71
Breast in females	C50
Cancer of unknown primary site	C80
Cervix	C53
Colon	C18
Colorectal	C18-20
Head and neck	C00-C14, C30-C32
Liver	C22
Lung	C33-C34
Melanoma of the skin	C43
Non-Hodgkin Lymphoma	C82–C86
Oesophageal	C15
Ovary	C56
Pancreas	C25
Prostate	C61
Rectum	C19-20
Uterus	C54-C55

Data source:

All Australian states and territories have legislation that makes cancer a notifiable disease. Various designated bodies, e.g. hospitals, pathology laboratories and registries of births, deaths and marriages, are required to report cancer and cancer deaths to their jurisdictional cancer registries.
Cancer survival data are made available by the Australian Institute of Health and Welfare (AIHW) for individual cancer types and cancer groupings. These cancer types and groupings are classified using ICD-10 codes.¹

Data caveat:

All cancers combined include ICD-10 codes C00-C97, D45-D46, D47.1, D47.3-D47.5, except basal and squamous cell carcinomas of the skin which are part of C44.
Relative survival was calculated using the period method for the period 2010-14. Note that this period does not contain incidence data for 2014 for NSW because those data were not available at the time of analysis.
Remoteness areas are classified according to the 2011 Australian Statistical Geography Standard (ASGS) Remoteness Areas. Disaggregation by remoteness area is based on Statistical Area Level 2 (SA2) of usual residence at time of diagnosis. The accuracy of these classifications decreases over time due to changes in infrastructure within SA2 boundaries since 2011.
Socioeconomic groups are classified according to the SEIFA quintile using the Index of Relative Socioeconomic Disadvantage (IRSD). Disaggregation by SEIFA quintile is based on 2011 classifications of Statistical Areas Level 2 (SA2) of usual residence at time of diagnosis. The accuracy of these classifications decreases over time due to changes in infrastructure within SA2 boundaries since 2011.
All figures are rounded to whole numbers where relevant.

References

Activity in this area:

Australian Institute of Health and Welfare 2017. Cancer in Australia 2017. Cancer series no.101. Cat. no. CAN 100. Canberra: AIHW.

Australian Institute of Health and Welfare 2012. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Cancer Series no. 69. Cat. no. CAN 65. Canberra: AIHW.

References

1. Australian Institute of Health and Welfare 2017. Cancer in Australia 2017. Cancer series no.101.Cat. no. CAN 100. Canberra: AIHW

2. Yu XQ, Baade PD & O'Connell DL 2012. Conditional survival of cancer patients: an Australian perspective. BMC Cancer 12:460.

3. National Cancer Institute. Population-based Cancer Survival Statistics Overview. Bethesda: NCI; 2015 [Accessed January 2017]; Available at: https://surveillance.cancer.gov/survival/.

Revision Type

Major

Version Number

2.0

National Cancer Control Indicators

Conditional 5-year relative survival

Summary

The longer a person has already survived after being diagnosed with cancer, the higher the likelihood that they will survive their cancer for at least another 5 years

Cancers of the pancreas, brain, oesophagus, lung, liver, and unknown primary site had the largest increases in conditional survival at 1 year and 3 years following diagnosis

Indigenous Australians who have survived 1 year after diagnosis have lower observed survival outcomes compared to non-Indigenous Australians

Indigenous Australians who had already survived 3 or 5 years after diagnosis had similar observed survival outcomes compared to non-Indigenous Australians

Conditional survival increased with increasing socioeconomic status

Data

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Summary

The longer a person has already survived after being diagnosed with cancer, the higher the likelihood that they will survive their cancer for at least another 5 years

Cancers of the pancreas, brain, oesophagus, lung, liver, and unknown primary site had the largest increases in conditional survival at 1 year and 3 years following diagnosis

Indigenous Australians who have survived 1 year after diagnosis have lower observed survival outcomes compared to non-Indigenous Australians

Indigenous Australians who had already survived 3 or 5 years after diagnosis had similar observed survival outcomes compared to non-Indigenous Australians

Conditional survival increased with increasing socioeconomic status

Data

Related features

Relative survival by stage at diagnosis 2011-2016, a snapshot in time

National childhood cancer stage at diagnosis data (first release)