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Ann Intern Med. 2010 Apr 6;152(7):409-17, W131-8. doi: 10.7326/0003-4819-152-7-201004060-00005.

A model-based estimate of cumulative excess mortality in survivors of childhood cancer.

Author information

  • 1Harvard School of Public Health, Harvard Medical School/Harvard Pilgrim Health Care Institute and Harvard Vanguard Medical Associates, Dana-Farber Cancer Institute and Children's Hospital, Boston, Massachusetts, and Emory University, Atlanta, Georgia, USA. jyeh@hsph.harvard

Abstract

BACKGROUND:

Although childhood cancer survival rates have dramatically increased, survivors face elevated risk for life-threatening late effects, including secondary cancer.

OBJECTIVE:

To estimate the cumulative effect of disease- and treatment-related mortality risks on survivor life expectancy.

DESIGN:

State-transition model to simulate the lifetime clinical course of childhood cancer survivors.

SETTING:

Childhood Cancer Survivor Study.

PATIENTS:

Five-year survivors of childhood cancer.

MEASUREMENTS:

Probabilities of risk for death from the original cancer diagnosis, excess mortality from subsequent cancer and cardiac, pulmonary, external, and other complications, and background mortality (age-specific mortality rates for the general population) were estimated over the lifetime of survivors of childhood cancer.

RESULTS:

For a cohort of 5-year survivors aged 15 years who received a diagnosis of cancer at age 10 years, the average lifetime probability was 0.10 for late-recurrence mortality; 0.15 for treatment-related subsequent cancer and death from cardiac, pulmonary, and external causes; and 0.05 for death from other excess risks. Life expectancy for the cohort of persons aged 15 years was 50.6 years, a loss of 10.4 years (17.1%) compared with the general population. Reduction in life expectancy varied by diagnosis, ranging from 4.0 years (6.0%) for kidney tumor survivors to more than 17.8 years (> or =28.0%) for brain and bone tumor survivors, and was sensitive to late-recurrence mortality risk and duration of excess mortality risk.

LIMITATION:

Estimates are based on data for survivors who received treatment 20 to 40 years ago; patients who received treatment more recently may have more favorable outcomes.

CONCLUSION:

Childhood cancer survivors face considerable mortality during adulthood, with excess risks reducing life expectancy by as much as 28%. Monitoring the health of current survivors and carefully evaluating therapies with known late toxicities in patients with newly diagnosed cancer are needed.

Comment in

PMID:
20368646
[PubMed - indexed for MEDLINE]
PMCID:
PMC3086591
Free PMC Article

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