Long-term causes of death among pediatric patients with cancer.

Autor: Horn SR; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania., Stoltzfus KC; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania., Mackley HB; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania., Lehrer EJ; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Zhou S; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania., Dandekar SC; Department of Pediatrics, Division of Hematology/Oncology, Penn State Health Children's Hospital, Hershey, Pennsylvania., Fox EJ; Department of Orthopaedics and Rehabilitation, Penn State Hershey College of Medicine, Hershey, Pennsylvania., Rizk EB; Department of Neurosurgery, Penn State Cancer Institute, Hershey, Pennsylvania., Trifiletti DM; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida., Rao PM; Department of Pediatrics, Division of Hematology/Oncology, Penn State Health Children's Hospital, Hershey, Pennsylvania., Zaorsky NG; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania.; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
Jazyk: angličtina
Zdroj: Cancer [Cancer] 2020 Jul 01; Vol. 126 (13), pp. 3102-3113. Date of Electronic Publication: 2020 Apr 16.
DOI: 10.1002/cncr.32885
Abstrakt: Background: The objectives of this study were to characterize the risk of death (1) from the primary cancer vs competing cause of death; and (2) from various causes of death vs the general poplation. The relative risk of death after a pediatric cancer diagnosis versus the general population and the risk of death from a primary cancer diagnosis versus competing causes of death.
Methods: This retrospective, population-based study used the Surveillance, Epidemiology, and End Results database (1980-2015) and included patients aged 0 to 19 years at the time of diagnosis. Observed deaths were calculated; the risk of death versus the general population was assessed with standardized mortality ratios (SMRs). Competing risk models for the cause of death were performed.
Results: There were 58,356 patients who were diagnosed, and the mortality rate was 22.8%. To assess causes of death, 6996 patients who died during the study period were included (45,580 total person-years at risk): 5128 (73%) died of their primary cancer, and 1868 (27%) died of a competing cause. Among all patients, the rate of death from the index cancer was higher than the rate of death from another cause within the first 5 years after diagnosis. The risk of death from a nonprimary cancer began to supersede the rate of death from the primary cancer 10 years after diagnosis for patients with germ cell tumors, lymphomas, and sarcomas. SMRs for the primary cancer were highest within the first 5 years after diagnosis for all cancers (SMRs, 100-50,000; P < .0001). The risk of death from competing causes (heart disease, suicide, and sepsis) was elevated (SMR, >100; P < .001). The risk of dying of heart disease was high, especially for patients with astrocytomas (SMR, 47.84; 95% confidence interval [CI], 27.87-76.59) and neuroblastomas (SMR, 98.59; 95% CI, 47.28-181.32). The risk of dying of suicide was high in most patients, particularly for those with osteosarcomas (SMR, 111.40; 95% CI, 2.82-620.69), Hodgkin lymphomas (SMR, 62.35; 95% CI, 34.89-102.83), and gonadal germ cell tumors (SMR, 28.97; 95% CI, 12.51-57.09).
Conclusions: The cause of death for patients with gonadal germ cell tumors, lymphomas, and sarcomas is more commonly a secondary cancer or noncancerous cause than the primary disease; their risk of death from competing causes (heart disease, suicide, and sepsis) rises throughout life.
(© 2020 American Cancer Society.)
Databáze: MEDLINE