A comparison of relative survival and cause-specific survival methods to measure net survival in cancer populations

Cancer Med. 2018 Sep;7(9):4773-4780. doi: 10.1002/cam4.1706. Epub 2018 Aug 1.


Background: Accurate cancer survival statistics are necessary for describing population-level survival patterns and measuring advancements in cancer care. Net cancer survival is measured using two methods: cause-specific survival (CSS) and relative survival (RS). Both are valid methodologies for estimating net survival and are used widely in medical research. In these analyses, we compare CSS to RS at selected cancer sites.

Methods: Using data from 18 SEER registries between 2000 and 2014, five-year RS and CSS estimates were generated overall as well as by age groups and by sex. To assess how closely the two survival methods corresponded, net survival percent difference was calculated with the following formula: ((RS-CSS)/RS)*100.

Results: Discrepancies between estimates obtained from CSS and RS methods varied with cancer site and age, but not by sex. In most cases, CSS was greater than RS, but cancers with available early screening and high survival rate had higher RS than CSS. Net survival percent differences were small in children and adolescents and young adults, and large in adults over the age of 40.

Conclusions: While both CSS and RS aim to quantify net survival, the estimates tend to differ due to the biases present in both methodologies. Error when estimating CSS most frequently stems from misclassification of cause of death, whereas RS is subject to error when no suitable life tables are available. Appropriate use of CSS and RS requires a detailed understanding of the characteristics of the disease that may lead to differences in the estimates generated by these methods.

Keywords: cancer registries; cause of death; life tables; statistical data interpretation; survival analysis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Cause of Death
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Mortality
  • Neoplasm Staging
  • Neoplasms / diagnosis
  • Neoplasms / epidemiology*
  • Neoplasms / mortality
  • Public Health Surveillance
  • SEER Program
  • Sex Factors
  • Young Adult