The impact of cancer survivors’ extra risk of noncancer mortality on net survival estimation - Scorecard - MDSpire

The impact of cancer survivors’ extra risk of noncancer mortality on net survival estimation

  • By

  • Laura Botta

  • Riccardo Capocaccia

  • Alice Bernasconi

  • Silvia Rossi

  • Jaume Galceran

  • Luigino Dal Maso

  • Come Lepage

  • Florence Molinié

  • Anne-Marie Bouvier

  • Rafael Marcos-Gragera

  • Claudia Vener

  • Marcela Guevara

  • Deirdre Murray

  • Rosalia Ragusa

  • Gemma Gatta

  • Valerie Jooste

  • the EUROCARE-6 WG

  • M Hackl

  • E Van Eycken

  • N Van Damme

  • Z Valerianova

  • M Sekerija

  • V Scoutellas

  • A Demetriou

  • L Dušek

  • D Krejici

  • H Storm

  • M Mägi

  • K Innos

  • J Pitkäniemi

  • M Velten

  • X Troussard

  • A M Bouvier

  • V Jooste

  • A V Guizard

  • G Launoy

  • S Dabakuyo Yonli

  • M Maynadié

  • A S Woronoff

  • J B Nousbaum

  • G Coureau

  • A Monnereau

  • I Baldi

  • K Hammas

  • B Tretarre

  • M Colonna

  • S Plouvier

  • T D'Almeida

  • F Molinié

  • A Cowppli-Bony

  • S Bara

  • A Debreuve

  • G Defossez

  • B Lapôtre-Ledoux

  • P Grosclaude

  • L Daubisse-Marliac

  • S Luttmann

  • A Eberle

  • R Stabenow

  • A Nennecke

  • J Kieschke

  • S Zeissig

  • B Holleczek

  • A Katalinic

  • H Birgisson

  • D Murray

  • P M Walsh

  • G Mazzoleni

  • F Vittadello

  • F Cuccaro

  • R Galasso

  • G Sampietro

  • S Rosso

  • C Gasparotti

  • G Maifredi

  • M Ferrante

  • R Ragusa

  • A Sutera Sardo

  • M L Gambino

  • M Lanzoni

  • P Ballotari

  • E Giacomazzi

  • S Ferretti

  • A Caldarella

  • G Manneschi

  • G Gatta

  • M Sant

  • P Baili

  • F Berrino

  • L Botta

  • A Trama

  • R Lillini

  • A Bernasconi

  • S Bonfarnuzzo

  • C Vener

  • F Didonè

  • P Lasalvia

  • L Buratti

  • G Tagliabue

  • D Serraino

  • L Dal Maso

  • R Capocaccia

  • R De Angelis

  • E Demuru

  • F Cerza

  • F Di Mari

  • C Di Benedetto

  • S Rossi

  • M Santaquilani

  • S Venanzi

  • M Tallon

  • L Boni

  • S Iacovacci

  • V Gennaro

  • A G Russo

  • F Gervasi

  • G Spagnoli

  • L Cavalieri d'Oro

  • M Fusco

  • M F Vitale

  • P Pinna

  • W Mazzucco

  • M Michiara

  • G Chiranda

  • G Cascone

  • M C Giurdanella

  • L Mangone

  • F Falcini

  • R Cavallo

  • D Piras

  • A Madeddu

  • F Bella

  • A C Fanetti

  • S Minerba

  • G Candela

  • T Scuderi

  • R V Rizzello

  • F Stracci

  • M Zorzi

  • S Guzzinati

  • A Brustolin

  • S Pildava

  • I Vincerzevskiene

  • M Azzopardi

  • T B Johannesen

  • J Didkowska

  • U Wojciechowska

  • M Bielska-Lasota

  • A Pais

  • M J Bento

  • C Alves-Rodrigues

  • A Lourenço

  • A Mayer

  • C Safaei Diba

  • V Zadnik

  • T Zagar

  • C Sánchez-Contador Escudero

  • P Franch Sureda

  • A Lopez de Munain

  • M De-La-Cruz

  • M D Rojas

  • A Aleman

  • A Vizcaino

  • R Marcos-Gragera

  • A Sanvisens

  • M J Sanchez

  • M D Chirlaque Lopez

  • A Sanchez-Gil

  • M Guevara

  • E Ardanaz

  • J Galceran

  • M Carulla

  • Y Bergeron

  • E Rapiti

  • R Schaffar

  • S Mohsen Mousavi

  • P Went

  • S Mohsen Mousavi

  • M Blum

  • A Bordoni

  • O Visser

  • S Siesling

  • S Stevens

  • J Broggio

  • D Bennett

  • A Gavin

  • D Morrison

  • D W Huws

  • August 19, 2025

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Clinical Scorecard: Assessing the Influence of Increased Noncancer Mortality Risk in Cancer Survivors on Net Survival Estimates

At a Glance

CategoryDetail
ConditionCancer survivorship with increased noncancer mortality risk
Key MechanismsNet survival estimation assumes equal noncancer mortality risk between cancer patients and general population; however, cancer survivors often have higher noncancer mortality due to treatment effects and comorbidities, biasing survival estimates.
Target PopulationCancer patients and survivors, including subgroups by cancer type, age, sex, and time since diagnosis
Care SettingPopulation-based cancer registries and epidemiological studies; clinical surveillance and palliative care planning

Key Highlights

  • Relative survival (RS) commonly used as proxy for net survival (NS) assumes equal risk of noncancer death between cancer patients and general population, which may not hold true.
  • Cancer survivors often have increased risk of death from other causes due to treatment side effects and comorbidities, leading RS to underestimate true NS when relative risk (RR) > 1.
  • Differences between RS and NS vary by cancer type, age, sex, and time since diagnosis, with larger biases in older patients and longer follow-up.

Guideline-Based Recommendations

Diagnosis

  • Use net survival (NS) to estimate cancer-specific survival, acknowledging that RS may be biased if noncancer mortality risk differs from general population.

Management

  • Consider the increased noncancer mortality risk in cancer survivors when planning post-treatment clinical surveillance and palliative care.
  • Recognize that NS reflects death due to cancer progression only, guiding clinical decision-making distinct from other mortality risks.

Monitoring & Follow-up

  • Monitor long-term survivors for noncancer mortality risks related to treatment side effects and comorbidities, especially in older patients.
  • Use appropriate statistical models that account for increased noncancer mortality risk to accurately estimate survival.

Risks

  • Assuming equal noncancer mortality risk between cancer patients and general population can bias survival estimates, potentially underestimating net survival.
  • Noncancer mortality risks include treatment-related adverse effects, second cancers, and chronic diseases linked to cancer risk factors.

Patient & Prescribing Data

Cancer survivors across various cancer types, ages, sexes, and follow-up durations

Treatment-related risks contribute to increased noncancer mortality; survival estimates should consider these to avoid underestimation of net survival.

Clinical Best Practices

  • Use net survival estimates that adjust for increased noncancer mortality risk in cancer survivors rather than relying solely on relative survival.
  • Tailor post-treatment surveillance and care plans based on accurate survival estimates reflecting cancer-specific mortality.
  • Interpret relative survival estimates cautiously, especially in older patients and long-term survivors where biases are larger.
  • Incorporate modeling approaches that separate cancer-specific mortality from other causes to improve epidemiological accuracy.

References

Original Source(s)

The impact of cancer survivors’ extra risk of noncancer mortality on net survival estimation

  • by Laura Botta, Riccardo Capocaccia, Alice Bernasconi, Silvia Rossi, Jaume Galceran, Luigino Dal Maso, Come Lepage, Florence Molinié, Anne-Marie Bouvier, Rafael Marcos-Gragera, Claudia Vener, Marcela Guevara, Deirdre Murray, Rosalia Ragusa, Gemma Gatta, Valerie Jooste, the EUROCARE-6 WG, M Hackl, E Van Eycken, N Van Damme, Z Valerianova, M Sekerija, V Scoutellas, A Demetriou, L Dušek, D Krejici, H Storm, M Mägi, K Innos, J Pitkäniemi, M Velten, X Troussard, A M Bouvier, V Jooste, A V Guizard, G Launoy, S Dabakuyo Yonli, M Maynadié, A S Woronoff, J B Nousbaum, G Coureau, A Monnereau, I Baldi, K Hammas, B Tretarre, M Colonna, S Plouvier, T D'Almeida, F Molinié, A Cowppli-Bony, S Bara, A Debreuve, G Defossez, B Lapôtre-Ledoux, P Grosclaude, L Daubisse-Marliac, S Luttmann, A Eberle, R Stabenow, A Nennecke, J Kieschke, S Zeissig, B Holleczek, A Katalinic, H Birgisson, D Murray, P M Walsh, G Mazzoleni, F Vittadello, F Cuccaro, R Galasso, G Sampietro, S Rosso, C Gasparotti, G Maifredi, M Ferrante, R Ragusa, A Sutera Sardo, M L Gambino, M Lanzoni, P Ballotari, E Giacomazzi, S Ferretti, A Caldarella, G Manneschi, G Gatta, M Sant, P Baili, F Berrino, L Botta, A Trama, R Lillini, A Bernasconi, S Bonfarnuzzo, C Vener, F Didonè, P Lasalvia, L Buratti, G Tagliabue, D Serraino, L Dal Maso, R Capocaccia, R De Angelis, E Demuru, F Cerza, F Di Mari, C Di Benedetto, S Rossi, M Santaquilani, S Venanzi, M Tallon, L Boni, S Iacovacci, V Gennaro, A G Russo, F Gervasi, G Spagnoli, L Cavalieri d'Oro, M Fusco, M F Vitale, P Pinna, W Mazzucco, M Michiara, G Chiranda, G Cascone, M C Giurdanella, L Mangone, F Falcini, R Cavallo, D Piras, A Madeddu, F Bella, A C Fanetti, S Minerba, G Candela, T Scuderi, R V Rizzello, F Stracci, M Zorzi, S Guzzinati, A Brustolin, S Pildava, I Vincerzevskiene, M Azzopardi, T B Johannesen, J Didkowska, U Wojciechowska, M Bielska-Lasota, A Pais, M J Bento, C Alves-Rodrigues, A Lourenço, A Mayer, C Safaei Diba, V Zadnik, T Zagar, C Sánchez-Contador Escudero, P Franch Sureda, A Lopez de Munain, M De-La-Cruz, M D Rojas, A Aleman, A Vizcaino, R Marcos-Gragera, A Sanvisens, M J Sanchez, M D Chirlaque Lopez, A Sanchez-Gil, M Guevara, E Ardanaz, J Galceran, M Carulla, Y Bergeron, E Rapiti, R Schaffar, S Mohsen Mousavi, P Went, S Mohsen Mousavi, M Blum, A Bordoni, O Visser, S Siesling, S Stevens, J Broggio, D Bennett, A Gavin, D Morrison, D W Huws

  • August 19, 2025

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