Please use this identifier to cite or link to this item:
Title: Comparison of different approaches to estimating age standardized net survival
Authors: Lambert, Paul Christopher
Dickman, P. W.
Rutherford, Mark J.
First Published: 15-Aug-2015
Publisher: BioMed Central
Citation: BMC Medical Research Methodology, 2015, 15 : 64
Abstract: BACKGROUND: Age-standardized net survival provides an important population-based summary of cancer survival that appropriately accounts for differences in other-cause mortality rates and standardizes the population age distribution to allow fair comparisons. Recently, there has been debate over the most appropriate method for estimating this quantity, with the traditional Ederer II approach being shown to have potential bias. METHODS: We compare lifetable-based estimates (Ederer II), a new unbiased method based on inverse probability of censoring weights (Pohar Perme) and model-based estimates. We make the comparison in a simulation setting; generating scenarios where we would expect to see a large theoretical bias. RESULTS: Our simulations demonstrate that even in relatively extreme scenarios there is negligible bias in age-standardized net survival when using the age-standardized Ederer II method, modelling with continuous age or using the Pohar Perme method. However, both the Ederer II and modelling approaches have some advantages over the Pohar Perme method in terms of greater precision, particularly for longer-term follow-up (10 and 15 years). CONCLUSIONS: Our results show that, when age-standardizing, concern over bias with the traditional methods is unfounded. We have also shown advantages in using the more traditional and modelling methods.
DOI Link: 10.1186/s12874-015-0057-3
eISSN: 1471-2288
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © Lambert et al. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Appears in Collections:Published Articles, Dept. of Health Sciences

Files in This Item:
File Description SizeFormat 
Comparison of different approaches to estimating age standardized net survival..pdfPublished (publisher PDF)2.39 MBAdobe PDFView/Open

Items in LRA are protected by copyright, with all rights reserved, unless otherwise indicated.