Cause-Specific Late Mortality Among 5-Year Survivors of Childhood Cancer: The Childhood Cancer Survivor Study

Abstract

Our extended follow-up of 5-year survivors of pediatric and adolescent cancer indicates that excess mortality persists long after diagnosis. Continued observation is needed to further define lifetime risk and to determine the potential contribution of chronic health conditions and modifiable health behaviors.

Late mortality among 5‐year survivors of early onset cancer: A population‐based register study

“…In line with other childhood and YA cancer studies, early onset cancer survivors showed significantly increased SMRs due to cardiovascular conditions. 4,7,11 In addition to that, the elevated HRs regarding all investigated subgroups of cardiovascular causes of death in early onset cancer survivors compared to siblings emphasized the role of cancer and its therapy on cardiovascular mortality. HR values in the first treatment era did not decrease until 1990 concerning cardiovascular deaths underlining the lacking improvement with respect to cardiovascular late effects of cancer and its therapy.…”

“…23 In our study, cumulative mortality due to cardiovascular disease in both, childhood and YA cancer survivors, showed a markedly increasing tendency particularly after 25 years from diagnosis, emphasizing the necessity for long-term follow-up and surveillance for cardiac complications, as observed in earlier childhood cancer studies. 4,7,25 Among all early onset cancer survivors, HL survivors had the highest late cumulative mortality due to cardiovascular diseases and also the shortest time lag from diagnosis until this increase. In line with our findings, Aleman et al stated that after 10 years from HL diagnosis, mortality causes other than relapse, such as cardiovascular diseases prevailed in this cancer survivor group.…”

“…[1][2][3] Thus far the main focus of late effect research has been on the morbidity and mortality of childhood cancer survivors aged up to 21 years at cancer diagnosis. [4][5][6][7][8][9] Only few studies have investigated those topics for the survivors of young adult (YA) cancer patients aged from 20 to 34 years at cancer diagnosis. [10][11][12] Previous studies have found elevated risks for chronic health conditions which contribute to higher mortality among survivors of childhood cancer patients compared to the general population.…”

“…5,9,13,14 Patterns of increased excess mortality after childhood cancer have been shown to be dependent on time from cancer diagnosis and cause of death. 4,7,11 The success of improved cancer survival is overshadowed by the life-threatening chronic health outcomes that cancer survivors are more likely to suffer from. Thus, the growing population of early onset cancer survivors has a strong need for adequate individualized follow-up to detect and possibly reduce treatment-related morbidities and mortality.…”

“…17,18 Similar to childhood cancer survivors, YA cancer survivors have been found to be at high risk to die from malignant diseases followed by non-malignant causes of death such as circulatory and respiratory conditions. 7,11 After 20 years of follow-up, a recent study found a shift from malignancy as primary cause of death to non-malignant disease among survivors of YA cancer. 10 In contrast to childhood cancer survivors, specific health care guidelines for YA cancer survivors yet remain to be established and hence especially this group of cancer survivors requires special attention.…”