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Reduction in late mortality among 5-year survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).
Background: Over the past four decades, treatment of many childhood cancers has been modified with the aim of achieving high survival rates while reducing the risk of life-threatening late-effects, and promoting risk-based follow-up care of survivors. Methods: Late mortality was evaluated in 34,033 5-year survivors (diagnosed < 21 years of age from 1970-1999, median follow-up 21 years, range 5-38) using cumulative incidence and Poisson regression models adjusted for demographic and disease factors to calculate relative risk (RR) and 95% confidence intervals (CI). Mortality due to non-recurrence/non-external (NR/NE) causes, which includes deaths that reflect late-effects of cancer therapy, was evaluated. Results: 1,622 (41%) of the 3,958 deaths were attributable to NR/NE causes, including 751 subsequent neoplasm (SN), 243 cardiac, and 136 pulmonary deaths. Changes in therapy by decade included reduced rates of: cranial radiotherapy (RT) for acute lymphoblastic leukemia (ALL, 86%, 54%, 22%), RT for Wilms tumor (WT, 77%, 54%, 49%) and RT for Hodgkin lymphoma (HL, 96%, 88%, 77%). Reductions in 15 year cumulative NR/NE mortality were observed across treatment eras for ALL (p < .001), HL (p = .005), and WT (p = .005). Cardiac deaths decreased in ALL (p = .002), HL (p = .06), and WT (p = .04), and SN deaths decreased in WT (p < .001). Year of diagnosis (adjusted for age, sex, diagnosis, follow-up time) was significantly associated with a reduced risk of all-cause mortality (RR = 0.85, CI 0.83-0.87), NR/NE death (RR = 0.87, CI 0.84-0.91), death from SN (RR = 0.84, CI 0.80-0.89), cardiac death (RR = 0.78, CI 0.69-0.87) and pulmonary death (RR = 0.79, CI 0.68-0.91). Conclusions: The CCSS cohort provides evidence that the strategy of modifying therapy to reduce the occurrence of late-effects, and promotion of early detection, is successfully translating into a significant reduction in observed late mortality.
|Treatment era||All-Cause||NR/NE Causes||SN||Cardiac||Pulmonary|
|P-value||< 0.001||< 0.001||< 0.001||0.001||0.02|
Abstracts by Gregory T. Armstrong:
Increased late mortality in underweight survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.Meeting: 2017 Cancer Survivorship Symposium | Abstract No: 110
Advancing Survivors’ Knowledge (ASK) about skin cancer study: A randomized intervention within the Childhood Cancer Survivor Study (CCSS).Meeting: 2016 Cancer Survivorship Symposium | Abstract No: 255
Impact of health care costs on utilization of needed health care in the Childhood Cancer Survivor Study (CCSS).Meeting: 2016 Cancer Survivorship Symposium | Abstract No: 20
Presentations by Gregory T. Armstrong:
Increasing risk of chronic health conditions in aging survivors of childhood cancer: A report from the childhood cancer survivor study.Meeting: 2012 ASCO Annual Meeting Abstract No: 9514Session: Pediatric Oncology II (Oral Abstract Session)
Impact of traditional cardiovascular disease risk factors on long-term cardiovascular outcome in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.Meeting: 2011 ASCO Annual Meeting Abstract No: 9507Session: Pediatric Oncology I (Oral Abstract Session)
Meeting: 2011 ASCO Annual Meeting
Session: Highlights of the Day II Including Partners in Progress Award (Highlights of the Day)