CONTENTS Page Foreword E Acknowledgements F List of Collaborators G Introduction 1 Methodology 4 Overview 13 Commentaries on selected sites 22 Oral cavity cancer 23 Nasopharyngeal cancer 26 Stomach cancer 29 Colon cancer 32 Rectal cancer 35 Liver cancer 38 Laryngeal cancer 41 Lung cancer 44 Skin cancer 47 Breast cancer 50 Cervical cancer 53 Uterine cancer 56 Ovarian cancer 59 Prostate cancer 62 Bladder cancer 65 Thyroid cancer 68 Lymphoma 71 Leukaemia 73 References 75 Appendix 76 A List of Tables Page Table 1 Calculation of observed survival rate by the actuarial (life table) method 7 Table 2 Cohort analysis to derive 5-year survival estimates, based on data of 8 patients diagnosed in 2003-2007 and followed until the end of 2012 Table 3 Data quality by cancer sites in both sexes 13 Table 4 Cancer cases registered in both sexes 14 Table 5 Number of cases and percentage by extension, sexes and periods, 16 Lampang, 1988-2007 Table 6 5-year relative survival in male, Lampang, 1988-2007 19 Table 7 5-year relative survival in female, Lampang, 1988-2007 20 Table 8 5-year relative survival by extent of disease for specific sites, Lampang, 21 1988-2007 Table 9 5- year survival by sex, extent of disease, tumor subsite and periods for 23 oral cavity cancer Table 10 5- year survival by sex, extent of disease and periods for nasopharyngeal 26 cancer Table 11 5- year survival by sex, extent of disease and periods for stomach cancer 29 Table 12 5- year survival by sex, extent of disease and periods for colon cancer 32 Table 13 5- year survival by sex, extent of disease and periods for rectal cancer 35 Table 14 5- year survival by sex, extent of disease, morphology and periods 38 for liver cancer Table 15 5- year survival by sex, extent of disease and periods for laryngeal cancer 41 Table 16 5- year survival by sex, extent of disease, morphology and periods for 44 lung cancer Table 17 5- year survival by sex, extent of disease and periods for skin cancer 47 Table 18 5- year survival by extent of disease and periods for breast cancer 50 Table 19 5- year survival by extent of disease, morphology and periods for 53 cervical cancer Table 20 5- year survival by extent of disease and periods for uterine cancer 56 Table 21 5- year survival by extent of disease and periods for ovarian cancer 59 Table 22 5- year survival by extent of disease and periods for prostate cancer 62 Table 23 5- year survival by sex, extent of disease and periods for bladder cancer 65 Table 24 5- year survival by sex, extent of disease , morphology and periods for 68 thyroid cancer Table 25 5- year survival by sex and periods for lymphoma cancer 71 Table 26 5- year survival by sex and periods for leukemia cancer 73 Table 27 Relative survival by site in Lampang, Thailand, 1988-2007 77 Table 28 Relative survival by site in Lampang, Thailand, 1988-1992 78 Table 29 Relative survival by site in Lampang, Thailand, 1993-1997 79 Table 30 Relative survival by site in Lampang, Thailand, 1998-2002 80 Table 31 Relative survival by site in Lampang, Thailand, 2003-2007 81 Table 32 Percentage of extension by site and periods in Lampang, Thailand 82 B List of Figures Page Figure 1 Map of Lampang, Thailand 3 Figure 2 Source of data 10 Figure 3 Source of data from death certificate only (DCO) 11 Figure 4 Population pyramid of Lampang, 2010 (Census) 12 Figure 5 Top ten most frequent cancers, 1988-2007 15 Figure 6 Extension of all cancer sites in Lampang, 1988-2007 16 Figure 7 Cancer survival by gender in Lampang, 1988-2007 17 Figure 8 Cancer survival by period in Lampang, 1988-2007 18 Figure 9 Top ten cancers by 5-year relative survival rate in Lampang, 1988-2007 18 Figure 10 5-year observed survival rate by extent of disease in Lampang, 1988-2007 20 Figure 11 Overall survival by sex for oral cavity cancer 24 Figure 12 Overall survival by extension for oral cavity cancer 24 Figure 13 Survival by periods for oral cavity cancer 25 Figure 14 Overall survival by sex for nasopharyngeal cancer 27 Figure 15 Overall survival by extension for nasopharyngeal cancer 27 Figure 16 Survival by periods for nasopharyngeal cancer 28 Figure 17 Overall survival by sex for stomach cancer 30 Figure 18 Overall survival by extension for stomach cancer 30 Figure 19 Survival by periods for stomach cancer 31 Figure 20 Overall survival by sex for colon cancer 33 Figure 21 Overall survival by extension for colon cancer 33 Figure 22 Survival by periods for colon cancer 34 Figure 23 Overall survival by sex for rectal cancer 36 Figure 24 Overall survival by extension for rectal cancer 36 Figure 25 Survival by periods for rectal cancer 37 Figure 26 Overall survival by sex for liver cancer 39 Figure 27 Overall survival by extension for liver cancer 39 Figure 28 Survival by periods for liver cancer 40 Figure 29 Overall survival by sex for laryngeal cancer 42 Figure 30 Overall survival by extension for laryngeal cancer 42 Figure 31 Survival by periods for laryngeal cancer 43 Figure 32 Overall survival by sex for lung cancer 45 Figure 33 Overall survival by extension for lung cancer 45 Figure 34 Survival by periods for lung cancer 46 Figure 35 Overall survival by sex for skin cancer 48 Figure 36 Overall survival by extension for skin cancer 48 Figure 37 Survival by periods for skin cancer 49 Figure 38 Overall survival by sex for breast cancer 51 Figure 39 Overall survival by extension for breast cancer 51 Figure 40 Survival by periods for breast cancer 52 Figure 41 Overall survival by sex for cervical cancer 54 Figure 42 Overall survival by extension for cervical cancer 54 Figure 43 Survival by periods for cervical cancer 55 Figure 44 Overall survival by sex for uterine cancer 57 Figure 45 Overall survival by extension for uterine cancer 57 Figure 46 Survival by periods for uterine cancer 58 C List of Figures (Continued) Page Figure 47 Overall survival by sex for ovarian cancer 60 Figure 48 Overall survival by extension for ovarian cancer 60 Figure 49 Survival by periods for ovarian cancer 61 Figure 50 Overall survival by sex for prostate cancer 63 Figure 51 Overall survival by extension for prostate cancer 63 Figure 52 Survival by periods for prostate cancer 64 Figure 53 Overall survival by sex for bladder cancer 66 Figure 54 Overall survival by extension for bladder cancer 66 Figure 55 Survival by periods for bladder cancer 67 Figure 56 Overall survival by sex for thyroid cancer 69 Figure 57 Overall survival by extension for thyroid cancer 69 Figure 58 Survival by periods for thyroid cancer 70 Figure 59 Overall survival by sex for lymphoma 71 Figure 60 Survival by periods for lymphoma 72 Figure 61 Overall survival by sex for leukemia 73 Figure 62 Survival by periods for leukemia 74 D FORWARD Lampang Cancer Hospital is one of the 7 regional cancer hospitals in Thailand. We provide medical services for 12 provinces in the north of Thailand and have duties in all activities of cancer management, including prevention and control, screening and diagnosis, treatment, and supportive and palliative care. The Lampang cancer registry is an important part of infrastructure in cancer services of Lampang cancer hospital. It provides information on cancer burden, including cancer incidence, survival and mortality. Population-based survival reflects a border range of cancer control activities and can be interpreted as the indicator of overall effectiveness of the secondary prevention and treatment of cancer in defined population. There are several statistic indicators such as observed survival and relative survival. Observed survival refers to survival up to point of death from all causes while relative survival measures survival in cancer patients relative to the expected survival of a comparable group in the general population. The Cancer Survival Trends in Lampang, Thailand, 1988-2007 is the twenty first of our cancer registry publications. This publication has presented data mainly in terms of relative survival by sex and periods such as 1988-1992, 1993-1997, 1998-2002 and 2003-2007. Relative survival will be useful for policy makers and health professionals involved in cancer control. We have also included data on observed survival by extent of disease and pathology as this information will be useful for clinicians and patients. In addition, this monograph has incorporated short commentaries from our medical specialists. Finally, we at Lampang Cancer Hospital, along with Cancer Survival Trends in Lampang, Thailand, 1988-2007 Report’s partners, hope that you will find this report to be a valuable reference tool and a stimulus for cancer care and cancer control action. Somkiat Lalitwongsa, M.D. Director of Lampang Cancer Hospital Ministry of Public Health. Lampang , Thailand. E ACKNOWLEDGEMENTS The authors would like to thank all collaborators. This publication would not have been possible without data collected in the provincial hospital of Lampang, all private hospitals, all community hospitals, military hospital of Lampang and Chiang Mai University hospital. The longstanding tradition of cooperation between the registry and clinicians, pathologists, nurses, medical record staffs, information specialists and hospital administrators was the most vital part in developing this project. We would like to acknowledge personals of Lampang Provincial Health Service, who provided the original source of death certificates used in this report and follow-up information. A survival report would not be possible without information on death and follow-up. Special thanks must also go to Associate Professor Hutcha Sriplung, our consultant, who provided training in relative survival analysis.