The technics for the treatment of malignant disease have been greatly revised within the past thirty years. Improved operative methods now permit a bolder surgical approach and the development of high-energy, penetrating x- and gamma-ray sources allows greater flexibility in radiotherapy. To what degree these changes have been reflected in the improved survival of the cancer patient can be determined most directly by comparing the survival rates for patients treated in the past, by the earlier methods, and those treated by the more recent technics. Such a comparison can be made only in a large institution with adequate data extending through this period of transition. The medical records of The Ontario Cancer Institute of Toronto permit such a study, and a broad analysis of the information thus afforded forms the basis of this report. This institution is concerned predominantly with the radiotherapy of cancer. Medical records are continuous over a period of almost forty years, in which time the number of patients registered has risen from 400 in 1922 to 3,165 in 1962. Sixty to sixty-five per cent of the patients have come from metropolitan Toronto and the remainder from other points in Ontario. The records of the clinic represent a sizeable fraction of the cases of malignant disease in the province of Ontario. Deaths among patients with cancer of the breast, for instance, constitute a relatively constant 20 to 25 per cent of the deaths from the disease in the province over this period of time. The basic medical data for each of the 35,000 patients treated at the clinic have been punched on cards. This convenient record includes the date of registration, the diagnosis, and the survival of the patient. The diagnosis is coded by the standard nomenclature. The survival is given at yearly intervals and is calculated from the date of the first specific treatment or, in the few cases where no treatment was given, from the date of registration at this clinic. Records of patients with malignant disease of the breast, cervix, lung, and upper respiratory tract seen at the clinic between 1930 and 1956 represent 11,021 of the 35,000 cases. The distribution was as follows: breast, 5,688; cervix, 3,314; lung, 1,032; upper respiratory tract, 987. Every case with a clinical diagnosis of malignant disease not refuted by histologic examination has been considered in this report and no known selection has been made in the inclusion of patients except that exercised in their referral to the clinic. In order to demonstrate changes in survival figures, it was found necessary to consider large groups of cases together so that statistical fluctuations would not be too large. Patients are divided into four groups, those treated during the years 1930–39, 1940–49, 1950–54, and 1955–56 (1955–57 for cancer of the lung).
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Bruce et al. (1963) studied this question.