Lifetime risks, loss of life expectancy, and health care expenditures for 19 types of cancer in Taiwan

Abstract

BackgroundThe mortality rates for different cancers are no longer an efficient tool for making national policy. The purpose of this study were to quantify the lifetime risks, life expectancies (LEs) after diagnosis, expected years of life lost (EYLL), and lifetime health care expenditures for 19 major cancers in Taiwan.MethodsA total of 831,314 patients with 19 pathologically proven cancers were abstracted from the Taiwan Cancer Registry from 1998 to 2012. They were linked to the National Mortality Registry (1998–2014) and National Health Insurance reimbursement database (1998–2013) for survival and health care costs. We estimated the cumulative incidence rate for ages 0–79 years and the lifetime survival function for patients with different cancer sites. The EYLL was calculated by subtracting the LE of each cancer cohort from that of the age- and sex-matched referents simulated from national life tables. The estimated lifetime cost was calculated by adding up the product of survival probability and mean cost at the corresponding duration-to-date after adjustment for the inflation to the year of 2013.ResultsThere were 5 cancers with a lifetime risk exceeding 4%: colorectal, liver, lung, and prostate in males, and breast and colorectal in females. Cancers with EYLL of >10 years were: esophageal, intrahepatic bile ducts, liver, pancreas, oral, nasopharyngeal, leukemia, lung, and gallbladder, extrahepatic bile ducts and biliary tract in males, and intrahepatic bile ducts, pancreas, nasopharyngeal, lung, esophageal, leukemia, liver, gallbladder, extrahepatic bile ducts and biliary tract, ovary, and stomach in females. Cancers with lifetime health care expenditures exceeding US$50,000 to the National Health Insurance were as follows: leukemia, kidney, testis, renal pelvis and ureter in males, and renal pelvis and ureter, leukemia, breast, urinary bladder, kidney, ovary, and nasopharyngeal in females. All these impacts should be considered in health policy decisions.ConclusionThe impacts of cancer in Taiwan are very large. Future studies must consider both quality of life and the entire impact from societal perspectives.

Lifetime risks, expected years of life lost, and cost-per-life year of esophageal cancer in Taiwan

“…Another relevant indicator of societal burden is the lifetime spending for healthcare services of cancer, as summarized in Table 4. Lifetime cost for unknown staging of esophageal cancer in Taiwan male patients was US$ 30,778, which seems to be consistent with that (US$ 25,900) reported by Wu TY et al 19 . In the typical studies of cost-effectiveness, researcher hope to quantify the incremental cost-effectiveness ratio (ICER), which is an overall measure representing the economic value of an intervention, compared with an alternative (comparator) 31 .…”

“…1). The LE of esophageal cancer without staging information in Taiwan (1998~2012) was 3.1 years, as reported by Wu TY et al 19 , indicating very limited or no improvement in prognosis. Regarding the prognosis of different pathological types, we found that the loss-of-LE of patients with adenocarcinoma was significantly lower than that of squamous cell carcinoma, which corroborate with previous reports 20,21 .…”

“…1) revealed a slight but consistent shift in the highest incidence rate toward a younger age-group, namely, from 60-69 y/o in 2008-2010 to 50-59 y/o in 2013-2014 in males with squamous esophageal cancer in Taiwan. Accordingly, the mean age at diagnosis of squamous esophageal cancer in Taiwanese males moved from 60 (1998~2007) 13 , and 59.1(1998-2012) years old 19 , down to 58 y/o (2008~2014) ( Table 1). We conjectured that such a slight shift could be partially explained by an increased proportion of younger patients diagnosed at stage 3 in comparison to stage 4 in recent years (calendar periods of 2008-10 v.s.2011-2 and 2013-4, in Table 3).…”

“…where IR i is the incidence rate for the i-th age group and Δt i = 5 year age range. The extrapolation of the survival function was estimated using a rolling extrapolation algorithm, aided by the age-and sex-matched referents simulated from the National Vital Statistics life tables, as detailed in previous literature 19,34 . The method could be briefly summarized as follows: First, for every patient in our cohort, we generated the age-, sex-, and calendar year of diagnosis-matched referents based on the life tables of Taiwan during www.nature.com/scientificreports www.nature.com/scientificreports/ the study period and estimated the Kaplan-Meier's lifetime survival function.…”

Estrogen‐related receptor‐α promotes gallbladder cancer development by enhancing the transcription of Nectin‐4

“…Gallbladder cancer, as a highly lethal neoplasm, features late diagnosis, unsatisfactory treatment, and unfavorable prognosis with conventional therapy . Thus, it is critical and urgent to determine novel prognostic biomarkers and to discover the underlying mechanisms of GBC progression, thereby identifying targeted therapeutics for GBC.…”