Abstract
BACKGROUND: Along with incidence and mortality, temporal trends of cancer survival are a crucial part of cancer surveillance and control. The most common reported statistic is net survival, usually age standardized to an external reference population. However, net survival has an awkward interpretation, which has led to confusion and misunderstanding. METHODS: We describe the use of reference-adjusted all-cause survival, and the crude probability of death as an alternative to net survival for the analysis of temporal trends in cancer survival. Reference-adjusted measures aim to enable fair comparisons by incorporating additional reference-expected mortality rates into the estimation process. The different approaches are illustrated using data on 95,285 women diagnosed with breast cancer in Norway from 1986 to 2021. RESULTS: We compare different age distributions for age standardization and describe how using a recent calendar period for both the reference-expected mortality rates and age distribution for standardization leads to simple interpretation. CONCLUSIONS: Reference-adjusted measures for monitoring temporal trends in cancer survival can lead to improved understanding and is of more relevance to patients and policy makers who live and make decisions in the real world. Using the most recent calendar period for both the age standard and the reference-expected mortality rates leads to simple and useful interpretation of the measures. IMPACT: Increasing the use of reference-adjusted measures in the analysis of population-based cancer studies will enhance the understanding of cancer survival trends. The freely available software increases the likelihood of uptake.