Unknown Causes of Death in Cancer Patients

Abstract

Objectives: Deaths from an unknown cause are difficult to adjudicate and oncologic studies of comparative effectiveness often demonstrate inconsistencies in incorporating these deaths and competing events (eg, heart disease and stroke) in their analyses. In this study, we identify cancer patients most at risk for death of an unknown cause. Methods: This retrospective, population-based study used cancer registry data from the Surveillance, Epidemiology, and End Results database (1992-2015). The absolute rate of unknown causes of death (COD) cases stratified by sex, marital status, race, treatment, and cancer site were calculated and a multivariable logistic regression model was applied to obtain adjusted odds ratios with 95% CIs. Results: Out of 7,154,779 cancer patients across 22 cancer subtypes extracted from Surveillance, Epidemiology, and End Results, 3,448,927 died during follow-up and 276,068 (7.4%) of these deaths were from unknown causes. Patients with an unknown COD had a shorter mean survival time compared with patients with known COD (36.3 vs 65.7 mo, P < 0.001). The contribution of unknown COD to total mortality was highest in patients with more indolent cancers (eg, prostate [12.7%], thyroid [12.3%], breast [10.7%]) and longer follow-up (eg, >5 to 10 y). One, 3, and 5-year cancer-specific survival (CSS) calculations including unknown COD were significantly decreased compared with CSS estimates excluding cancer patients with unknown COD. Conclusion: Of the patients, 7.4% died of unknown causes during follow-up and the proportion of death was higher with longer follow-up and among more indolent cancers. The attribution of high percentages of unknown COD to cancer or non-cancer causes could impact population-based cancer registry studies or clinical trial outcomes with respect to measures involving CSS and mortality.

Cancer as an Individual Risk Factor for Heart Failure: A Review of Literature

“…However, these efforts are often adequate for a minimal number of cancers. Overall, it is well known that cancer therapy can lead to many other problems, described as possible side effects and affecting distant organs than the one involved by the cancer itself [ 3 ].…”

“…However, these efforts are often adequate for a minimal number of cancers. Overall, it is well known that cancer therapy can lead to many other problems, described as possible side effects and affecting distant organs than the one involved by the cancer itself [3]. Stoltzfus et al described a study amongst 7.5 million cancer patients and identified that those who were diagnosed <40 years of age were more likely to die of heart disease when diagnosed with breast cancer or lymphoma; patients diagnosed >40 years of age were more likely to die from heart disease when diagnosed with prostate, lung, and colorectal cancers [4].…”