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

Abstract

To date, only few studies have been published documenting late mortality among early onset cancer survivors, especially regarding young adulthood (YA) malignancies. Our nation-wide population-based registry study provides information concerning cause-specific long-term mortality among 16,769 5-year survivors of early onset cancer (aged 0-34 years at diagnosis), with follow-up for death extending from 1971 through 2012. A sibling cohort and population data were used as reference. The overall standardized mortality ratio (SMR) of cancer patients was 4.6-fold, (95% CI 4.4-4.8). Highest SMRs were found for malignancies (12.8,3), infectious (4.8, 95%CI 2.9-6.7) and cardiovascular diseases (1.9, 95% CI 1.7-2.1). Malignancies and cardiovascular diseases accounted for the largest number of deaths. Childhood and YA cancer survivors with the same primary cancer site had a similarly elevated overall SMR with the exception of markedly higher SMRs after childhood Hodgkin lymphoma. The highest cumulative non-malignancy-related mortality was due to cardiovascular disease with a steady rise throughout the follow-up, but strongly dependent on the primary cancer site and age at diagnosis. In childhood cancer survivors, the cumulative cardiovascular mortality did not reduce over time. However, overall and malignancyrelated mortality showed a declining tendency towards the most recent periods after both, childhood and YA cancer. Our findings on non-malignancy-related mortality stress the need to set up long-term individual follow-up with a focus on cardiovascular late effects for early onset cancer survivors, especially for YA cancer survivors still lacking those.Advances in therapies for early onset cancer have lead to a substantial increase in 5-year survival rates. 1-3 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. 15 After the survival of childhood cancer, the adoption of a healthy lifestyle including physical activity may lower especially the risk of developing late cardiovascular sequelae. 16 Thus, promoting the control of known cardiovascular risk fa...

Registration of childhood cancer: Moving towards pan-European coverage?

“…Young age also means the potential proportion of life lost to cancer per case is greater than later in life. Five-year survival attains 80% or more [3] but survivors are subject to 8-11-times increased overall mortality [4][5][6], which remains at a 3-fold excess even 45 years after diagnosis [7], compared to the general population. Up to 90% of survivors suffer some late effect [8], including a 3-4-fold increased risk of subsequent malignancies [9,10] years after their first diagnosis.…”

Cardiac Mortality Among 200 000 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age

“…13,14 As yet, the risk of cardiac mortality has not been investigated comprehensively within a large population of TYA cancer survivors. Only 2 studies have analyzed cause-specific mortality within an entire population of TYA cancer survivors, 15,16 but relatively modest cohort sizes (n=9245 and n=16 769) have left important questions unanswered, particularly regarding the mortality risk from cardiac disease and how this risk may vary by cancer type. There is clearly a need for estimates of cardiac mortality risks among such subgroups of survivors of TYA cancer.…”

Cardiovascular medication after cancer at a young age in Finland: A nationwide registry linkage study

“…Previous reports have extensively explored cardiac morbidity and mortality after childhood cancer . Recently, cardiac late effects and mortality have been studied also in YA cancer patients . Our study was unique by analyzing and comparing findings on drug purchases in both childhood and YA cancer patients.…”