Lies, Damned Lies and Statistics???


I just recently got finished reading a post from AJs Dad (AJ Piniewski, who passed away from childhood cancer earlier this year). In it he compares the way cancer is funded (sheer numbers) versus how it should be funded (by person years lost). Here are his findings:

Cancer

Median Age at Diagnosis

Person Years Life Lost

New Cases 2007

New Cases 2007

5 Year Survival Rate

Person Years Life Lost

ACS Funding (millions)

ACS Funding (%)

Funding $ per PYLL

Prostate

68

9

186,320

19.2%

99%

16,769

$15.0

11.3%

$896

Breast

61

16

184,450

19.0%

90%

295,120

$29.6

22.3%

$100

Melanoma

61

16

62,480

6.4%

92%

79,974

$5.2

3.9%

$65

Leukemia

67

10

44,270

4.6%

51%

216,923

$13.8

10.4%

$64

Colo-Rectal

71

7

148,810

15.4%

66%

354,168

$17.3

13.0%

$49

Ovarian

63

14

21,650

2.2%

45%

166,705

$7.8

5.9%

$47

Pancreatic

72

5

37,680

3.9%

5%

178,980

$6.8

5.1%

$38

Lymphoma

64

13

74,340

7.7%

65%

338,247

$11.2

8.5%

$33

Brain

55

22

21,810

2.3%

34%

316,681

$7.8

5.9%

$25

Childhood

10

67

12,500

1.3%

80%

168,000

$4.1

3.1%

$24

Lung

70

7

215,020

22.2%

16%

1,264,318

$14.2

10.7%

$11

 

As much as I like this spreadsheet, raw numbers rarely tell the full extent of the story. So, I took it farther. Here is the short version of my findings, using the NIH monies, not the ACS (American Cancer Society). Cancer will be funded in 2009 to the tune of $5,654,000,000 ($5.6 billion). Of this, childhood cancer gets bumped up to $30 million per year. If you know of others, let me know, as I want accurate figures.

I have divided my numbers into different groups:

1.       Overall Funding by % total diagnosis – How the funding should break down based on the numbers with this type of cancer, as a percentage of all cases.

2.       Overall funding by % total death (based on 5 year mortality) – How the funding should break down based on the numbers who died (5 year survivability) with this type of cancer, as a percentage of all deaths.

3.       Funding per person – raw number of $3,934.09 per patient as the standard. This is dividing number of dollars total by the number of cases.

4.       Funding per death – raw number of $9,995.58 per death as the standard. This is found by dividing the number of dollars total by the number of deaths.

5.       Funding per PYLL (Person Years Life Lost) – raw number is $1297.10 as the standard. This is found by dividing the number of dollars by the number of years lost. PYLL is found by taking the median diagnosis age and substracting it from the median death age in the US (rounded to 76). This is then multiplied by the number of deaths to get the PYLL. Overall the median age for all cancers yields a PYLL of 4,358,967.

I then took the raw numbers and the over and under funding and turned them into percentages, using the formula ((funding/expected funding)-1)). This is not a perfect calculation, but it works for a raw picture of what we are looking at.

Of the NIH funding, the percentage of the $5.654 trillion breaks down as follows:

1.       Brain – $183 million (3.24% of funding), 1.52% of cases and 2.31% of deaths

2.       Breast – $703 million (12.453% of funding), 12.84% of cases and 7.24% of deaths.

3.       Cervical – $96 million (1.7% of funding), .77% of cases and .68% of deaths

4.       Colo-Rectal – $282 million (4.99% of funding), 10.35% of cases and 8.83% of deaths

5.       Liver – $90 million (1.59% of funding), 1.49% of cases and 3.25% of deaths

6.       Lung – $249 million (4.4% of funding), 14.96% of cases, 28.61% of deaths

7.       Lymphoma – $158 million (2.79% of funding), 5.17% of cases, 3.63% of deaths

8.       Ovarian – $103 million (1.82% of funding), 1.51% of cases, 2.74% of deaths

9.       Prostate – $344 million (6.08% of funding), 13.03% of cases, 5.07% of deaths

10.   Uterine – $22 million (.39% of funding), 2.79% of cases, 1.32% of deaths

11.   Childhood – $30 million (.53% of funding), .87% of cases and .44$ of deaths

Of course, these are just the raw numbers. Since children have an average age, at diagnosis, of 10, their PYLL (Person Years Life Lost) is high (66 years per person who dies).

Findings on Childhood Cancer:

1.       Overall Funding by % total diagnosis – Childhood cancer is underfunded by about $19.18 million with the new level under the Pryce Conquer Childhood Cancer Act.  This means it is underfunded by 39%.

2.       Overall funding by % total death (based on 5 year mortality) – Childhood cancer is overfunded by $5.01 million or 20%.

3.       Funding per person – Childhood cancer is underfunded by $1,534.09 per patient. As expected, this is 39% underfunding.

4.       Funding per death – Childhood cancer is overfunded by $2,004.42, which is 20%.

5.       Funding per PYLL (Person Years Life Lost) – When we go to PYLL, childhood cancer is funded at $181.82 per year lost or, to put it in underfunding amount, underfunded by $1,115.28 per year lost. This is an 86% underfunding.

Other findings

Because of its survivability, prostate cancer is currently the most overfunded cancer by PYLL. It is overfunded by 1006%. Ouch! By deaths, it is overfunded 20% and underfunded by 53% in raw numbers of patients.

Breast cancer is underfunded by 3% when you look at sheer numbers, but it is overfunded by 72% when one looks at either deaths or PYLL. Brain cancer is overfunded by 113% in raw numbers, 40% in deaths, but underfunded by 53% when one looks at PYLL. This is due to the younger median age for brain cancer patients, combined with a low five year survivability (34%).

Colo-Rectal cancer, Lymphoma and Uterine cancer are underfunded no matter how you slice up the numbers. In raw numbers (CR: -52%/LYM: -46%/UT: -86%), raw deaths (CR: -44%/LYM: -23%/UT: -71%), and PYLL (CR: -52%/LYM: -46%/UT: -86%).

Lung cancer also gets the shaft, but this is probably due to a stigma attached to lung cancer, as most lung cancer patients either are, or have been, heavy smokers. Since there is a huge stigma against smoking, this is probably where the bias is. Lung cancer is underfunded by (num: -71%/deaths: -85%/PYLL: -82%).

Cervical cancer is overfunded in raw numbers (120%) and raw deaths (148%), but underfunded in PYLL (-16%). Liver cancer, which has a low survivability (10.8%) is overfunded by 7% in raw numbers, but underfunded by 52% (raw deaths) or 67% (PYLL).  Ovarian Cancer is overfunded by 21% in raw numbers, but underfunded by 34% in number of deaths and 49% in PYLL.

Summary

AJs dad illustrated how childhood cancer is funded more from the number of deaths than any other metric. Looking at PYLL (Person Years Life Lost), we see childhood cancer (-86% of the funding expected using PYLL) as the second most underfunded cancer (Uterine is number 1 at -91%). It is also underfunded by 39% when one looks at raw numbers.

The picture gets a bit worse, when one considers that

The numbers here are likely skewed, as childhood cancer funding numbers are not easily found. It is known that drug companies do not research childhood cancer, as it is not profitable. They will research the use of adult drugs on children, once the drug is profitable, but the majority of childhood cancer research comes from either the National Institute for Health (NIH) or charitable organizations (last year the American Cancer Society put about $4 million into childhood cancer, for example).

If anyone wants the spreadsheet, you can download it here. I am certainly not trying to hide anything, but I do not want to take the time to de-Microsoft the overbearing XHTML from Excel, so I am not posting the table here.

Peace and Grace,
Greg

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