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Every year, the Cancer Program looks at overall survival for the
four major cancer diagnoses, and has compared them with a broader
database. Two years ago, since regional data was difficult to
obtain, the St. Joseph Registry (SJH) began to use data from the
National Oncology Data Base, which reflects cancer care across the
United States.
The four most common cancer diagnoses in the SJH are Prostate,
Breast, Lung, and Melanoma. Melanoma may have a falsely high
incidence in comparison to the national data because SJH has a
community wide registry rather than a hospital only registry. The
standard fourth “major cancer diagnosis” is ordinarily Colorectal
cancer in national statistics, so Colorectal cancer data is
reviewed.
The National Oncology Data Base (NODB) uses AJCC staging, which
is more specific than the system used by CSS. Hence, SJH is able to
make comparisons by true staging.
In order to assure that the survival results are comparable, it
is necessary to ensure that the incidence by Stage is comparable.
Survival can be easily affected by stage migration, so fair
comparisons would require fairly comparable incidence by Stage.
According to the 2007 cancer tables below, SJH had a higher % of
early Breast Cancer, and a higher % of Stage 3 Lung Cancer than the
national numbers. True analysis is difficult because SJH had far
fewer numbers of “Unknown Stage” than the national data. This
reflects quite favorably on the excellence of SJH data collection
and completeness of staging.
Percentage of cases by Stage, Breast CA
SJH vs. NODB, 2000-2006
| Stage |
SJH |
NODB |
| 0 |
16.22 |
17.88 |
| 1 |
45.32 |
37.74 |
| 2 |
25.1 |
27.98 |
| 3 |
8.11 |
5.12 |
| 4 |
3.91 |
3.23 |
| unknown |
1.34 |
5.05 |
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Percentage of cases by Stage, Prostate CA
SJH vs. NODB, 2000-2006
| Stage |
SJH |
NODB |
| 0 |
0 |
0.1 |
| 1 |
1.08 |
1.48 |
| 2 |
74.95 |
78.35 |
| 3 |
15.41 |
7.82 |
| 4 |
6.4 |
4.69 |
| unknown |
2.16 |
7.55 |
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Percentage of cases by Stage, Colorectal CA
SJH vs. NODB, 2000-2006
| Stage |
SJH |
NODB |
| 0 |
0.56 |
5.81 |
| 1 |
27.88 |
22.09 |
| 2 |
27.88 |
23.79 |
| 3 |
22.68 |
22.23 |
| 4 |
15.61 |
15.51 |
| unknown |
5.39 |
10.56 |
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Percentage of cases by Stage, Lung CA
SJH vs. NODB, 2000-2006
| Stage |
SJH |
NODB |
| 0 |
0 |
0.4 |
| 1 |
22.51 |
19.19 |
| 2 |
6.91 |
6.44 |
| 3 |
23.79 |
23.75 |
| 4 |
40.15 |
37.31 |
| unknown |
6.65 |
12.92 |
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Survival curves on CHARTS 1 through 4 demonstrate that overall
survival for each of the four major sites is essentially the same
between SJH and NODB.
 Chart 1 |
 Chart 2 |
 Chart 3 |
 Chart 4 |
CHARTS 5 through 8 compare our survival by stage with NODB
survival. The survival curves are close for each cancer and each
stage, although the tables makes it appear that there is a minor
non statistical trend toward slightly less survival at SJH.
There is also a slight discrepancy in late survival that is not
statistically significant and due to small numbers.
Interestingly, the best 5-year survival in Prostate Cancer is
St. Joseph Stage 2 patients, with somewhat better survival
compared to NODB Stage 2 & 3 survival. This is a reflection of
“stage migration” and co morbidities that occur when comparing
different mixes of clinical and pathologically staged cancers.
Because there was an “appearance” of slightly less favorable
survival, the median age for each Cancer and stage was reviewed.
The results are “Overall Survival” and hence an older age would
affect overall survival for the group. Overall the medial age is
older for SJH patients, and one would expect less favorable
survival as a result. The most dramatic difference in age is in
Lung Cancer patients.
 Chart 5 |
 Chart 6 |
 Chart 7 |
 Chart 8 |
In Summary, it appears that, in spite of an
older age group and more accurate staging, SJH survival results
are essentially the same as the survival results of a large
national cancer data bank. This is a favorable finding, and the
secondary outcome of this evaluation is the documentation of
excellent completeness of staging.
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