Survivors of childhood cancer have increased mortality risk years after diagnosis

Childhood cancer survivors have an increased risk of death from other causes more than 25 years after their initial diagnosis, according to a study published in JAMA (2010 Jul 14;304(2):172-9).

The study, led by Raoul Reulen, PhD, of the University of Birmingham, England, and colleagues examined the long-term cause-specific mortality among 17,981 5-year survivors of childhood cancer, who were diagnosed with cancer before age 15 years.

The results of the study revealed that 77% of the excess number of deaths observed among those surviving beyond 45 years from diagnosis of childhood cancer in Britain are due to second primary cancers and circulatory death. Researchers found that survivors experienced 11 times the number of deaths expected from the general population. The absolute excess risk (AER) for second primary cancers and circulatory disease increased from diagnosis at ages 5-14 years to beyond age 45 years from diagnosis. Survivors after 45 years experienced 3.6 times the number of deaths expected from the general population for a second primary cancer, and nearly 26% of all excess deaths beyond age 45 years from diagnosis attributed to circulatory disease. “Beyond 45 years from diagnosis, recurrence accounted for 7% of the excess number of deaths observed while second primary cancers and circulatory deaths together accounted for 77%,” the authors wrote.

In the press release announcing the findings, the authors explained that the excess mortality due to second primary cancer and circulatory disease is likely attributable to late complications of treatment. “Second primary cancers are a recognized late complication of childhood cancer, largely due to exposure to radiation during treatment, but specific cytotoxic drugs also have been implicated in the development of second primary cancers,” the authors wrote.

“These findings confirm the importance of very long-term outcome data and that survivors should be able to access health care programs even decades after treatment,” the authors wrote. “Finding ways to successfully intervene to reduce these potentially preventable premature deaths will be complex,” the authors concluded.

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