Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Oct 1;100(19):1368-79.
doi: 10.1093/jnci/djn310. Epub 2008 Sep 23.

Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study

Ann C Mertens  1 , Qi Liu, Joseph P Neglia, Karen Wasilewski, Wendy Leisenring, Gregory T Armstrong, Leslie L Robison, Yutaka Yasui
Affiliations

Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study

Ann C Mertens et al. J Natl Cancer Inst. .

Abstract

Background: The proportion of pediatric and adolescent cancer patients surviving 5 years has increased during the past four decades. This growing population of survivors remains at risk for disease- and treatment-associated late mortality.

Methods: A total of 20 483 five-year survivors of childhood and adolescent cancer diagnosed between January 1, 1970, and December 31, 1986, and enrolled in the Childhood Cancer Survivor Study (CCSS) were included in a National Death Index search for deaths occurring between January 1, 1979, and December 31, 2002. Treatment information was abstracted from primary medical records. Survival probabilities, standardized mortality ratios (SMRs), and absolute excess risks were calculated for overall and cause-specific deaths. Diagnosis- and sex-specific survival probabilities were estimated by the product-limit method. All statistical tests were two-sided.

Results: Among the CCSS cohort, 2821 (13.8%) 5-year survivors had died by the end of the follow-up period. The cause of death was obtained for 2534 individuals, with 57.5% of deaths attributed to recurrent disease. Estimated probability of survival 30 years from diagnosis was 82%. When compared with the US population, the absolute excess risk of death from any cause was 7.36 deaths per 1000 person-years. The overall SMR was 8.4 (95% confidence interval [CI] = 8.0 to 8.7). Increases in cause-specific mortality were seen for deaths due to subsequent malignancy (SMR = 15.2, 95% CI = 13.9 to 16.6) and cardiac (SMR = 7.0, 95% CI = 5.9 to 8.2), pulmonary (SMR = 8.8, 95% CI = 6.8 to 11.2), and other medical (SMR = 2.6, 95% CI = 2.3 to 3.0) causes. At 20 years of follow-up (25 years after first cancer diagnosis), the death rate due to a subsequent malignancy exceeded that due to all other causes.

Conclusion: Our extended follow-up of 5-year survivors of pediatric and adolescent cancer indicates that excess mortality persists long after diagnosis. Continued observation is needed to further define lifetime risk and to determine the potential contribution of chronic health conditions and modifiable health behaviors.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Overall survival according to sex in the Childhood Cancer Survivor Study cohort and expected survival based on age-, year-, and sex-matched US population mortality rates.
Figure 2
Figure 2
Overall conditional cumulative mortality curves, conditioned on survival of 5, 10, 15, and 20 years since the original diagnosis. Separate curves were generated for deaths due to any cause, those due to recurrence, and those not due to recurrence or external causes (defined in “Methods”).
Figure 3
Figure 3
Cumulative mortality due to recurrence of cancer, second malignancy, cardiac disease, pulmonary disease, external causes, and all other causes.
See this image and copyright information in PMC

References

    1. Ries LAG, Melbert D, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2004. Bethesda, MD: National Cancer Institute.;
    1. Oeffinger KC, Mertens AC, Sklar CA, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355((15)):1572–1582. - PubMed
    1. Neglia JP, Friedman DL, Yasui Y, et al. Second malignant neoplasms in five-year survivors of childhood cancer: Childhood Cancer Survivor Study. J Natl Cancer Inst. 2001;93((8)):618–629. - PubMed
    1. Adams MJ, Lipshultz SE, Schwartz C, et al. Radiation-associated cardiovascular disease: manifestations and management. Semin Radiat Oncol. 2003;13((3)):346–356. - PubMed
    1. Hudson MM, Rai SN, Nunez C, et al. Noninvasive evaluation of late anthracycline cardiac toxicity in childhood cancer survivors. J Clin Oncol. 2007;25(24):3635–3643. - PubMed

Publication types