Life years lost by childhood cancer treatment and health related late effects among childhood cancer survivors

Abstract

Background: Identifying risk factors contributing the most to mortality of childhood cancer survivors is essential to guide harm reduction efforts in childhood cancer treatments, and long-term follow-up of childhood cancer survivors.

Methods: We assessed Life Years Lost from childhood cancer treatments and their health-related late effects among the French Childhood Cancer Survivors Study, a cohort of 7670 5-year childhood cancer survivors. Using a landmark strategy, we also assessed time-varying effects of risk factors, and how the multi-morbidity affects life years lost.

Results: We found subsequent malignant neoplasm (9.0 years [95 %CI: 4.3-13.7]), severe cardiac disease (8.0 years [95 %CI: 1.2-14.9]), and the use of radiotherapy (6.0 years [95 %CI: 4.7-7.3]) to be the highest contributors to Life Years Lost among childhood cancer survivors. We found no interaction impact on life years lost between health related late effects considered.

Conclusions: Those findings suggest that radiotherapy is the root cause of early mortality among childhood cancer survivors. Moreover patients experiencing a subsequent malignant neoplasm or a cardiac disease should be monitored closely after the event, as comorbidity is common and causes premature deaths.

Keywords: Childhood cancer survivors; Iatrogenic effect; Landmark; Late mortality; Life years lost; Pseudo observations; Years of life lost.