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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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