Late mortality experience in five-year survivors of childhood and adolescent cancer: the Childhood Cancer Survivor Study
| Autor: | W. Anthony Smithson, John D. Potter, Mark E. Nesbit, Leslie L. Robison, Kathy Ruccione, Joseph P. Neglia, Ann C. Mertens, Yutaka Yasui |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Male Risk Cancer Research Pediatrics medicine.medical_specialty Time Factors Adolescent Population Antineoplastic Agents Childhood Cancer Survivor Study Cause of Death Neoplasms medicine Humans Age of Onset Sex Distribution education Child Cause of death Retrospective Studies education.field_of_study Radiotherapy business.industry Infant Newborn Cancer Infant Retrospective cohort study medicine.disease United States Oncology Child Preschool Cohort Multivariate Analysis Regression Analysis Female Age of onset Neoplasm Recurrence Local business Cohort study |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 19(13) |
| ISSN: | 0732-183X |
| Popis: | PURPOSE: Survivors of childhood and adolescent cancer are at risk for long-term effects of disease and treatment. The Childhood Cancer Survivor Study assessed overall and cause-specific mortality in a retrospective cohort of 20,227 5-year survivors. PATIENTS AND METHODS: Eligible subjects were individuals diagnosed with cancer (from 1970 to 1986) before the age of 21 who had survived 5 years from diagnosis. Underlying cause of death was obtained from death certificates and other sources and coded and categorized as recurrent disease, sequelae of cancer treatment, or non–cancer-related. Age and sex standardized mortality ratios (SMRs) were calculated using United States population mortality data. RESULTS: The cohort, including 208,947 person-years of follow-up, demonstrated a 10.8-fold excess in overall mortality (95% confidence interval, 10.3 to 11.3). Risk of death was statistically significantly higher in females (SMR = 18.2), individuals diagnosed with cancer before the age of 5 years (SMR = 14.0), and those with an initial diagnosis of leukemia (SMR = 15.5) or CNS tumor (SMR = 15.7). Recurrence of the original cancer was the leading cause of death among 5-year survivors, accounting for 67% of deaths. Statistically significant excess mortality rates were seen due to subsequent malignancies (SMR = 19.4), along with cardiac (SMR = 8.2), pulmonary (SMR = 9.2), and other causes (SMR = 3.3). Treatment-related associations were present for subsequent cancer mortality (radiation, alkylating agents, epipodophyllotoxins), cardiac mortality (chest irradiation, bleomycin), and other deaths (radiation, anthracyclines). No excess mortality was observed for external causes (SMR = 0.8). CONCLUSION: While recurrent disease remains a major contributor to late mortality in 5-year survivors of childhood cancer, significant excesses in mortality risk associated with treatment-related complications exist up to 25 years after the initial cancer diagnosis. |
| Databáze: | OpenAIRE |
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