Cause of Death From the Death Certificate and Cancer Survival

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097383/  

Should Cause of Death From the Death Certificate Be Used to Examine Cancer-Specific Survival? A Study of Patients With Distant Stage Disease

It is primarily the research, vital and health statistics, and health policy communities that are interested in the specific details of cancer cause of death. The process of determining the underlying cause of death reported on a death certificate requires a number of steps. First, a certifying physician records multiple causes of death for a decedent and arranges them in a sequence to reflect the etiologic relationship of the medical conditions that led to death. Since the early 1970s, a software program, the Automated Classification of Medical Entities (ACME), has been used as a primary method for determining cause of death by taking into account the information on all medical conditions and their relationships to one another for the reported death. The software selects from among all conditions reported by the physician to determine the appropriate cause of death. The 10–15% of deaths that cannot be properly classified using ACME are then manually adjudicated by a trained nosologist (20). This process helps to ensure that causes of death reported on death certificates are as accurate as possible. A recent study of lung cancer mortality by Doria-Rose et al. found that the cause of death reported on the death certificates had an 89% sensitivity and 99% specificity compared to the cause of death determined by a mortality review committee. Their analysis reported that the use of the cause of death from the death certificate compared to the mortality review board determination did not produce a meaningful change in mortality-based outcomes (9).

Some researchers have used overall survival rather than cancer-specific survival for studies of cancer patients (7, 8). Because overall survival includes deaths due to conditions other than cancer, its use can be problematic. This is especially true among the elderly population, which has the highest incidence of cancer. In our analysis, we observed that for 10 of 11 cancers, the portion of patients dying from conditions other than cancer increased with age. In addition, we found that for many cancers, black and Hispanic patients were more likely than white patients to die from conditions other than cancer. These findings underscore the limitations of using all deaths, rather than cancer-specific deaths as a measure of treatment or screening outcomes for cancer patients. It is important to note, however, that overall mortality is a relevant endpoint to consider when assessing the effectiveness of cancer therapies that may increase the risk of other noncancer adverse outcomes (e.g., heart failure) and should be reported alongside cancer-specific mortality.

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• 这种资料对LZ和有些人没有。但是对其他读者有用。赞！ -虎嗅蔷薇- ♀ (0 bytes) () 03/12/2019 postreply 07:24:51