Misclassification of cause of death in cancer patients

The overall cancer mortality rate could increase by about 1% if all deaths within 1 month of cancer-related surgery were correctly attributed to the underlying cancer rather than the surgical procedure, suggests new research appearing in the July 17 issue of the Journal of the National Cancer Institute.

In making judgments about the progress against cancer, deaths from treatment and diagnosis must also be accounted for, conclude study authors H. Gilbert Welch, M.D., and William C. Black, M.D., of Dartmouth Medical School.

The calculation of cancer mortality depends on the accurate determination of the underlying cause of death. Welch and Black argue that cancer mortality should include deaths from treatment for cancer as well as deaths from the disease. They note, however, that clear guidelines for classifying treatment-related deaths in cancer do not exist.

As a rule, researchers consider deaths within 30 days of a surgical procedure to be treatment-related when calculating mortality from the underlying disease.

To determine if this rule is being applied uniformly to cancer patients, Welch and Black used national cancer registry data to find out the reported cause of death in patients who, between 1994 and 1998, died within 1 month of cancer-related surgery to remove a solid tumor. Among the 4,135 deaths within 1 month of diagnosis and cancer-related surgery, 41% were attributed to a cause other than the cancer. The proportion of cases not attributed to cancer ranged from 13% for cervical cancer to 81% for laryngeal cancer. The authors note that there is a trend toward increasing misclassification among those cancers, such as breast and prostate, in which early detection has increased substantially.

If all deaths within 1 month of cancer-directed surgery were attributed to cancer, cancer mortality would rise by about 1% over current estimates in national trends, they authors say. They note that the proportion of de

Contact: Linda Wang
Journal of the National Cancer Institute

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