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Years of Life Lost from Cancer and Applications to Research Funding

  • N. G. Burnet
  • S. J. Jefferies
  • F. P. Treasure
Reference work entry

Abstract:

Different measures of mortality can be used to focus attention on different aspects of disease. Cancer statistics provide a useful example of this. Crude mortality is a simple method of expressing the proportion or percentage of deaths attributable to any particular cancer type. It is relatively influenced by common tumours in older patients. ‘Years of life lost’ (YLL) provides a measure of disease burden to society, and  average years of life lost (AYLL) represents the measure burden of disease to the individual patient. These different parameters show different aspects of mortality, and are complementary. Calculation of YLL must be done with an appropriate algorithm to avoid misleading results. Using these YLL and AYLL reveals interesting and important differences in mortality from different tumours. Analysis of this type can identify tumour types with extreme impact, either on society or individual patients.

YLL indicates a relatively higher burden of disease on society from cancers of the cervix and CNS, despite a screening programme for cervix cancer, and a rather low burden from prostate cancer. AYLL reveals striking differences between tumours. Prostate cancer has the lowest individual burden of death, measured as AYLL, at only 6.1 years. Brain and CNS tumours cause over 3 times as much loss of life per affected individual, at just over 20 years, higher than any other adult cancer.

These parameters can be used for comparison to research spending. In the cancer area, such a comparison demonstrates a mis-match between disease burden and funding. In the UK, research spending is very high on leukaemia, colo-rectal (+ anus) and breast cancer, which has the highest level of relative spending. By contrast, research spending is relatively low on several tumour types, including lung cancer, which are typically the less well-publicised cancers. The research spend per year of life lost is over thirty times higher for leukaemia than it is for lung cancer, which is relatively under-funded. There is clear evidence of inequity in research spending, which goes beyond the under-provision for lung cancer research. Better levels of funding are typically associated with well-publicised cancers. Comparing AYLL to research spending reveals 4 ‘Cinderella’ cancers, with individual burden of mortality higher and spending lower than average. These are kidney, melanoma, cervix, and brain and CNS cancers, and of these CNS is the most extreme. Such extreme tumour types, expressed by either statistic, may need special consideration.

Measures of mortality and disease burden may have to develop to include a component related to disease morbidity and treatment toxicity. Comprehensive use of mortality statistics, including YLL and AYLL, would be useful in considering allocation of research funding, and in debates on public health issues.

Keywords

Prostate Cancer Disease Burden Crude Mortality Mortality Statistic Normal Tissue Complication Probability 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:

AYLL

average years of life lost

CNS

central nervous system

IYLL

 individual years of life lost

NCRI

National Cancer Research Institute (in the UK)

NIH

National Institutes of Health (in the USA)

NTCP

 normal tissue complication probability

OPCS

Office of Population Censuses and Surveys

TCP

 tumour control probability

TYLL

 total years of life lost

UK

United Kingdom

USA

United States of America

YLL

years of life lost

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Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • N. G. Burnet
  • S. J. Jefferies
  • F. P. Treasure

There are no affiliations available

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