I asked my wife what she looked for when she went shopping. She said a good deal. So how do you determine a good deal? You compare the cost to what you get. One way of doing this is through statistics. If 1 gallon of milk is $4.00 at Kroger, and 1/2 gallon of milk is $1.90 at WalMart; you buy the $4 milk at Kroger because WalMart buys everything from China and whips its workers. No, you get my point. So, if I was shopping for value in the cancer research department, what aisle would I go down? Where do you get the most value?
There are thousands of sets of statistics available on cancer. You can easily determine your risk to develop any specific type of cancer based on age, race, lifestyle, geographic location, level of education, insurance status, if you're overweight, in a gym class, smoke, with or without leisure time activity for both with and without a high school education! The analyses are so in depth that they literally lose any meaning. Any time you try to analyze public health data, it seems the goal should be where to put future effort, i.e. funding. Where do you get the most value for your money?
Well, it depends on how you define value. Should we as a society try to cure the most prevalent type of cancer, just focus our resources on curing it regardless of age, race, lifestyle, geographic location, level of education and insurance status ? Should we try to cure the cancer that has the highest mortality? Or should we try to cure the cancer that can minimize the number person-years of life lost (PYLL)? Difficult questions and your answer I'm sure depends on your circumstances. I know what mine is.
The current answer turns out to be a mixed bag. I reviewed the National Cancer Institute's (NCI) 2007 Fact Book and its "Snapshot of Pediatric Cancer". I reviewed the Surveillance Epidemiology and End Results (SEER) website, part of the National Cancer Institute's program to make the data available to the public. Specifically, the SEER Cancer Statistics Review, 1975-2005. I reviewed the American Cancer Society's (ACS) Cancer Facts & Figures 2008. All data referenced here was obtained from these reports or CureSearch for childhood cancer data. (the average age for childhood cancer was difficult to determine, since it involves so many types of cancers. I used 10 years old although much evidence suggests younger, perhaps 7. This gives the numbers some conservatisim since they are calculated by a biased advocate) The reports contain many interesting pieces of information. One from Tables I-11 and I-13 of the SEER report jumps right out at you, the average age of a cancer patient at diagnosis is 67. The average age of a cancer patient at death is 73. Does this mean that after all this time and money we have succeeded in adding 6 years of life to the average cancer patient? Not letting that stop me, I plunged ahead.
I looked at data for the 10 most prevalent adult cancers, and compared it with childhood cancer statistics. The ten cancers are, in order of decreasing occurrence:
These are the data that I considered:
I was able to locate some 2007 NCI funding for specific cancer type. No data was available specifically documenting funding for childhood cancer. However, comparing the funding amounts for the ACS and the NCI, the funds devoted to the 10 most prevalent cancers were relatively the same on a percentage basis, with an average difference of 0.3%. So we can assume the NCI funding is relatively equal, on a percentage basis, to the ACS funding. But remember, the NCI budget is $4.7 Billion and the ACS budget is about $1 Billion.
(Last comment on ACS, they recently were downgraded to a two-star (out of 4) charity by Charity Navigator one of the country's most reputable watchdog groups. This is due to bloated overhead and poor allocation of funds. It takes them $0.21 to earn a $1 to give, and they only earned the second star because they continue to raise more and more money each year. Approximately 65% of every dollar ACS raises goes towards "programs". For comparison, CureSearch earned a 4-star rating and spends $0.02 to earn a $1. And 95% of every dollar CS raises goes towards programs. ACS has $1 billion in revenue and CureSearch $54 million. CureSearch events can be found at CureSearch Events.)
So, I put all this data into a table and also considered a nasty little acronym called PYLL. It stands for Person Years of Life Lost. In other words, for all newly diagnosed cancer patitients, the median age is 67. You subtract that from the average age of death (from ALL causes) for a US citizen today of 77, and calculate a PYLL of 10. Ten possible life years lost to cancer. Alternatively, for a child diagnosed at 10, the PYLL is 67. Now you see why it's important to know the median age at diagnosis.
|Median Age at Diagnosis||Person Years Life Lost||New Cases 2007||5 Year Survival Rate||Person Years Life Lost||ACS Funding (millions)||ACS Funding (%)||Funding $ per PYLL|
So again, the chart shows, the median age at diagnosis for the type of cancer, how many years are lost if the person dies (compared to average life expectancy of 77), the number of new cases and the 5-year survival rate for that cancer in 2007, the number of person-year life lost (using the 5-year survival rate), and how much ACS funds each cancer (in millions)
The final calculation done was to divide the ACS funding amount ($) by the PYLL for each cancer type. This shows how many dollars are being spent per year of life lost for each cancer.
What do you think it means? I provided the data. I posted on the problems. To make a difference we need to be able to discuss the problem with those who make these decisions, whoever they are. Get familiar with the information. Ask yourself why it is like it is. Isn't a ground truth of America to make the world a better place for our children? Wouldn't each parent and grandparent of a childhood cancer kid sacrifice their own life? When I get to the median age of 67 and get cancer, will I be fighting for more funding so I can go beyond those extra 6 years? How about you? These are the data. I welcome your comments.
- Greg, Dad to Miranda, took the the whole PYLL concept a bit farther, getting to actual percentages of over or under funding:
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