Roch Giorgi LERTIM EA3283, Faculty of Medicine, Mediterranean University, Marseille, France Estimation Methods for Relative Survival Presentation and Perspective of the MESURE Project Methods and Application for Population Based Survival September 21, 2010 – Frascati

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 2 Context (1) l Large utilisation of relative survival approach to estimate cancer survival (population-based studies) l Models/Methods used may vary between research centres l New developments are challenges

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 3 Context (2) General registry Specialised registry FRANCIM French Network of Cancers Registries

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 4 Context (3) l Common cancer database Service de Biostatistiques, Hospices Civils de Lyon (SBHCL) l French teams (some) involved in methodology / epidemiology of population-based survival Laboratoire d’Enseignement et de Recherche sur le Traitement de l’Information Médicale, Marseille (LERTIM) SBHCL Service de Biostatistique et Informatique Médicale, Dijon (SBIM) Laboratoire d’Epidémiologie et de Santé Publique, Strasbourg (LESP)

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 5 Context (4) l French teams (some) involved in methodology / epidemiology of population-based survival LERTIM, Marseille SBHCL, Lyon SBIM, Dijon LESP, Strasbourg l International teams (some) involved in methodology / epidemiology of population-based survival Non Communicable Disease Epidemiology Unit, London (NCDEU) Centro Nazionale di Epidemiologia, Instituto Superior di Sanita, Roma (CNE) Department of Epidemiology and Biostatistics, Montreal (DEP)

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 6 Context (5) NCDEU London CEN Roma SBHCL Lyon DEP Montreal SBIM Dijon LESP Strasbourg FRANCIM network Estimation Methods for Relative Survival MESURE Project  Creation of a research network involving methodologists, epidemiologists LERTIM Marseille

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 7 MESURE: Overall Aim l To improve the current methods for estimating cancer survival l To define required specifications for production of large-scale cancer survival statistics useful in Public Health  To obtain more accurate estimates comparable information on cancer survival, on its public health impact

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 8 Funding a Network of Methodologist!

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 9 Network Funding l Some failures… l 2009: Grant from the French Institute for Public Health Research (IRESP): 8,000 euros (R. Giorgi) 1 st seminar (Paris) l 2009: Grant from the French National Research Agency (ANR-09-BLAN-0357): 378,000 euros (R. Giorgi) but Let’s go to work!

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 10 Description of the Work WP1:Comparison of the current methods WP2:Extension/Development of statistical methods WP2.1:Statistical researches WP2.2:Statistical programs WP3:Production of guidelines 5 Deliverables 12 Deliverables 1 Deliverables 12 Deliverables 2 Tasks 4 Tasks 1 Tasks Management 36 months

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 11 Task 0: Project Management l Coordinator of the Project: R. Giorgi Coordination between partners Management of the project, with all the partners l Leader of a task Coordination of the specific researches for the task Respect concerning the schedule/deliverables l Organisation 2 meetings a year with all the partners/external members (Lyon Oct. 2009; Marseille Apr. 2010; Paris Nov. 2010)  Invited collaborators (E. Cambois, J. Stare, M. Pohar-Perme,…) l Deliverables 1.Report of progress (every 6 months) 2.Report of the meetings (every 6 months)

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 12 WP1 – Task 1: Comparisons LeaderSBHCL PartnersSBIM, LERTIM, LESP, CNE, DEP ObjectivesTo highlight the methodological limits and the advantages of the existing models for relative survival analyses Subtasks1.Methodological comparisons 2.Determination of data sets 3.Analyses/real data Deliverables1.Description of the studied models 2.Determination/Constitution data sets 3.Comparison based on real data 4.Report indicating limits/advantages

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 13 WP1 – Task 2: Recommendations LeaderSBIM PartnersSBHCL, LERTIM, LESP, FRANCIM, NCDEU, CNE, DEP ObjectivesTo give advices for users of such relative survival models in their practice SubtasksNone Deliverables1.Report indicating advices for users

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 14 WP2 – Task 3: Life Tables LeaderLERTIM PartnersSBIM, SBHCL, LESP, NCDEU, DEP ObjectivesTo assess the impact of the variable used to stratify the life tables for relative survival analyses Subtasks1.Life tables generation 2.Survival data generation 3.Analyses/simulated data 4.Analyses/real data Deliverables1.Simulations results 2.Real data application

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 15 WP2 – Task 4: Spatial Variations LeaderLERTIM PartnersSBHCL, SBIM, LESP, FRANCIM, CNE ObjectivesTo propose a relative survival model to analyse the geographical variations in cancer survival Subtasks1.Development of the model 2.Survival data generation 3.Analyses/simulated data 4.Analyses/real data 5.Specific statistical program Deliverables1.Model for spatial survival data 2.Simulations results 3.Real data applications 4.Specific statistical program

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 16 WP2 – Task 5: Frailty LeaderSBHCL PartnersLERTIM, LESP, SBIM, FRANCIM, NCDEU, DEP ObjectivesTo take benefits from random effect framework in relative survival Subtasks1.Development of the model 2.Comparison fixed/random effect 3.Analyses/real data 4.Specific statistical program Deliverables1.Flexible frailty relative survival model 2.Comparison of fixed & random effect models 3.Real data applications 4.Specific statistical program

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 17 WP2 – Task 6: Statistical Programs LeaderLESP PartnersLERTIM, SBHCL, NCDEU, DEP ObjectivesTo propose a statistical package to perform relative survival analyses using approaches studied and developed in this project Subtasks1.Specific packages/Programming 2.Assessment existing programs 3.Common package/Language 4.Common package/Programming Deliverables1.Specific programs for Tasks 4 to 6 2.Common statistical program

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 18 WP3 – Task 7: Synthesis LeaderFRANCIM PartnersLERTIM, SBHCL, SBIM, LESP, NCDEU, CNE, DEP ObjectivesTo produce guidelines for cancer survival analysis with population-base data SubtasksNone Deliverables1.Synthesis and recommendations

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 19 Planning

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 20 Planning

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 21 Brief Point l Master’s degree in science C. Danieli: Comparison of methods for estimating net survival N. Graffeo: Assessment of the impact of variables used to stratify the mortality tables involved in the analysis of relative survival Communication A. Belot, R. Giorgi. Joint frailty excess hazard model for recurrent events and death. 31th annual conference of International Society for Clinical Biostatistics, Montpellier, Septembre l 2010-… PhD degree N. Graffeo: Modelling spatial cancer survival with relative survival models M. Mounier: Contribution of relative survival methods in the prognosis of follicular lymphomas

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 22 For the Future… l ANR grant for the MESURE project First grant Useful to apply for other grant applications Project open to other collaborators, funders… l Need to Deepen even more some tasks Go ahead on other themes Increase methodological / epidemiological collaborations for cross-national comparisons with direct application for public health decision makers

© Roch Giorgi, LERTIM, Faculty of Medicine, Mediterranean University 23 MESURE Members l LERTIM – Marseille Roch Giorgi Catherine Jean Gaudart Nathalie Graffeo l SBHCL – Lyon Nadine Bossard Jacques Estève Laurent Remontet Aurélien Belot Laurent Roche l LESP - Strasbourg -> INRS - Nancy Guy Hédelin l NCDEU – London Michel Coleman Bernard Rachet l CNE – Roma Franco Berrino Ricardo Capocaccia l DEP - Montreal Michal Abrahamowicz Amel Mahboubi l SBIM - Dijon Catherine Quantin Christine Binquet l FRANCIM Pascale Grosclaude Marc Colonna Valérie Jooste Anne-Marie Bouvier Morgane Mounier