Long term cause specific mortality among 34 489 five year survivors of childhood cancer in Great Britain: population based cohort study

Abstract

Objective To determine whether modern treatments for cancer are associated with a net increased or decreased risk of death from neoplastic and non-neoplastic causes among survivors of childhood cancer.Design Population based cohort study.Setting British Childhood Cancer Survivor Study.Participants Nationwide population based cohort of 34 489 five year survivors of childhood cancer with a diagnosis from 1940 to 2006 and followed up until 28 February 2014.Main outcome measures Cause specific standardised mortality ratios and absolute excess risks are reported. Multivariable Poisson regression models were utilised to evaluate the simultaneous effect of risk factors. Likelihood ratio tests were used to test for heterogeneity or trend.Results Overall, 4475 deaths were observed, which was 9.1 (95% confidence interval 8.9 to 9.4) times that expected in the general population, corresponding to 64.2 (95% confidence interval 62.1 to 66.3) excess deaths per 10 000 person years. The number of excess deaths from all causes declined among those treated more recently; those treated during 1990-2006 experienced 30% of the excess number of deaths experienced by those treated before 1970. The corresponding percentages for the decline in excess deaths from recurrence or progression and non-neoplastic causes were 30% and 60%, respectively. Among survivors aged 50-59 years, 41% and 22% of excess deaths were attributable to subsequent primary neoplasms and circulatory conditions, respectively, whereas the corresponding percentages among those aged 60 years or more were 31% and 37%.Conclusions The net effects of changes in cancer treatments, and surveillance and management for late effects, over the period 1940 to 2006 was to reduce the excess number of deaths from both recurrence or progression and non-neoplastic causes among those treated more recently. Among survivors aged 60 years or more, the excess number of deaths from circulatory causes exceeds the excess number of deaths from subsequent primary neoplasms. The important message for the evidence based surveillance aimed at preventing excess mortality and morbidity in survivors aged 60 years or more is that circulatory disease overtakes subsequent primary neoplasms as the leading cause of excess mortality.

Respiratory morbidity in young people surviving cancer: Population‐based study of hospital admissions, treatment‐related risk factors and subsequent mortality

“…Respiratory conditions are a leading cause of late mortality and morbidity in long‐term childhood cancer survivors (CCS). Standardised mortality ratios for respiratory disease are between 3 and 9 times higher for CCS compared to the general population . However, a decrease in the risk of death from respiratory diseases has been observed for children diagnosed more recently as cancer treatments have been modified to reduce long‐term side effects .…”

Suicide and violent deaths in survivors of cancer in childhood, adolescence and young adulthood-A national cohort study

“…One Swedish study of cancer survivors diagnosed between 15 and 30 years of age found a 1.6‐fold increase in risk of suicidal behavior (completed suicide and suicide attempts combined) . Previous studies of late mortality (all causes) in childhood cancer survivor (CCS) populations (surviving >5 years from diagnosis) have not found an increase in the risk of death from external causes or suicide, except for a recent publication from the British Childhood Cancer Survivor Study, where a standardized mortality ratio (SMR) of 1.2 [95% confidence interval (CI) 1.1–1.4] for (all) external causes of death was found . Suicidal ideation, however, appear to be increased in CCS, at least in a selected, US population …”

Temporal changes in treatments and outcomes after acute myocardial infarction among cancer survivors and patients without cancer, 1995 to 2013

“…The current study has clinical implications. Although the continuing decline in mortality after AMI is encouraging, cardiovascular disease likely continues to be a leading cause of death among cancer survivors . It is reassuring that a cancer diagnosis is not a deterrent to receiving invasive coronary strategy or pharmacotherapies after AMI.…”

“…Although the continuing decline in mortality after AMI is encouraging, cardiovascular disease likely continues to be a leading cause of death among cancer survivors. 40 It is reassuring that a cancer diagnosis is not a deterrent to receiving invasive coronary strategy or pharmacotherapies after AMI. However, our results also highlight the importance of continued vigilance in cardiac risk surveillance during survivorship.…”