Everywhere in Europe the survival rate of cancer has improved. As of today, there are around 10 million European cancer survivors of which more than a third are of working age. Although not being a death sentence anymore, cancer risks to remain a life sentence preventing survivors to resume normal life. Research shows a higher unemployment rate in cancer survivors as compared to the cancer-free population. Also, individual testimonies illustrate challenges in obtaining health/life insurance, loans and mortgage. Using novel individualized algorithms, insurance companies may better define the risk of covering patients with pas history of cancer. Herein is described a novel tool to offer individualized risk assessment for patients with history of cancer.

1. INDIVIDUAL CANCER RISK ASSESSMENTS
USING CONDITIONAL SURVIVAL
Prof. Eric Raymond MD, PhD
Head Medical Oncology @ Paris Saint-Joseph Hospital
Chair of The PAMM Group EORTC
Medical Officer at SCOR – Paris
France
1

2. Challenges
• The incidence of most cancers has been increasing over the last 50 years, while
progresses in the detection and management of cancers have led to significant
increases in both prevalence and survival
• The number of patients newly diagnosed and those deemed long termcancer
‘survivors’ - patients fit and alive at more than five years after diagnosis - has been
increasing worldwide, yielding newchallenges for insurance companies
• Data in 2014 yielded an overall estimate of about 14.5 million cancer survivors in the United
States(>4% of the US population)
• Current epidemiology trends predict that the number of cancer survivors in the US will
increase by 31% by 2024 (19 millions)
• Long-termsurvivors have been constantly challenging insurance companies for
better coverage, who have adapted in return by offering innovative products and
underwriting approaches for these newclasses of customers

3. Cancers & Insurances
• Worldwide increase of cancer survivors: increasing needs of insurance
• Allow access to insurance coverage for access to credit to patient with past history of
cancer
• Cover cancer as a critical illness to cover expansive medical care wherever health care is
not mutualized by public services
• Cover income protection
• Cover disability and dependence
• Underwriting cancer has been mainly based on:
• Cancer type
• Staging: TNM or AJCC stage
• Immediate sequelae or morbidities linked to cancer and/or its treatment
• Possibilities of long-term complications from cancer therapy and/or recurrences
• Frequent updates needed to continuously meet scientific and medical progress:
• Difficult to estimate an individual risk based on current medical publications
• Difficult to implement rapidly changing and constantly evolving knowledge - especially
for oncology - at the forefront of medicine
3

4. 4
CANCER : Overall goal
Generate evidence-based information to improve assessments
Develop a mathematical model based on easily obtainable
variables, which can allow an accurate estimate of the excess
mortality rate of these individuals
How to accurately estimate a risk ?
Estimation of Conditional survival

5. The concept of conditional survival
• Estimation of prognostic at diagnostic is a valuable tool to select the appropriate
treatment strategies ‘chemotherapy, radiotherapy, surgery, targeted agent,
immunotherapy) for individual patients
• TNM, stage, grading classification are routinely used
• Derived Kaplan Meier survival estimate allow to identify groups at specific risk
• We need to understand that the prognostic of individual may evolve over time
(even in high risk patients) as the risk of dying of cancer reduce over time for those
who survive (long termsurvivor are better prognostic group regardless their initial
prognosis)
• Survival estimates need to be reevaluated at various time points after diagnosis to take
into account this paradigm
• This is what we call the estimation of conditional survival (corrected conditional survival
taking further into account the lack of relapse at particular time-points
5

6. Breast and colon cancers
6
Breast cancer
as a paradigm of a heterogeneous cancer type
Colon cancer
as more homogeneous tumor type
Some of the most frequent tumor types
R e f. S C O R U N D E R W R IT IN G C A N C E R P R O JE C T
O P T IM IZ IN G IN D IV ID U A L C A N C E R R A T IN G A S S E S S M E N T S B A S E D O N U P D A T E D A L G O R IT H M S - S C O R JU N E 2 0 1 7

7. 7
Engineered algorithms that used the SEER data set
20 US states registries on all cancer types
9,675,661 detailed cases of patient with cancer (2016)
Data regularly updated and validated
Algorithm Individual risk assessment
R e f. S C O R U N D E R W R IT IN G C A N C E R P R O JE C T
O P T IM IZ IN G IN D IV ID U A L C A N C E R R A T IN G A S S E S S M E N T S B A S E D O N U P D A T E D A L G O R IT H M S - S C O R JU N E 2 0 1 7

8. 8
Overall versus conditional cancer survival
R e f. S C O R U N D E R W R IT IN G C A N C E R P R O JE C T
O P T IM IZ IN G IN D IV ID U A L C A N C E R R A T IN G A S S E S S M E N T S B A S E D O N U P D A T E D A L G O R IT H M S - S C O R JU N E 2 0 1 7

9. Breast cancer
Conditional survival appraisal

10. Mortality estimates according to hormone receptor (HR) expression
10
— The outcome of breast cancer may
vary depending of phenotypic
characteristics:
ØHR positive tumors may have a
better overall prognosis but
keep the same risk of relapse
over time
ØHR negative tumors have a
worst prognosis that is
characterized by a higher risk of
early relapse
but the risk of relapse decreases
over time
R e f. S C O R U N D E R W R IT IN G C A N C E R P R O JE C T
O P T IM IZ IN G IN D IV ID U A L C A N C E R R A T IN G A S S E S S M E N T S B A S E D O N U P D A T E D A L G O R IT H M S - S C O R JU N E 2 0 1 7

11. T1N1M0 invasive ductal breast cancer
11
Corrected survival
Uncorrected survival
Survival at Diagnosis
HR+ HR-
R e f. S C O R U N D E R W R IT IN G C A N C E R P R O JE C T
O P T IM IZ IN G IN D IV ID U A L C A N C E R R A T IN G A S S E S S M E N T S B A S E D O N U P D A T E D A L G O R IT H M S - S C O R JU N E 2 0 1 7

12. Colon cancer
Conditional survival appraisal

13. Conditional survival at 3 years
Correctedsurvival
Uncorrectedsurvival
Survival atDiagnosis
Comparison scoring & KM
pT3N1 grade 3 colon cancer
13R e f. S C O R U N D E R W R IT IN G C A N C E R P R O JE C T
O P T IM IZ IN G IN D IV ID U A L C A N C E R R A T IN G A S S E S S M E N T S B A S E D O N U P D A T E D A L G O R IT H M S - S C O R JU N E 2 0 1 7

14. Conclusion
14
• The evaluation of trends in cancer trends and mortality is
an important part of the risk estimation for insurance
companies
• Cancer stands as one of the most prevalent and costly
disease worldwide with increasing number of long
survivors
• Evidence-based estimations of the risk based on large
databases and novel tools are essential to derive fair rating