Temporal trends in cause-specific late mortality among 5-year survivors of childhood cancer

Gregory Armstrong, Zhenyu Pan, Kirsten K. Ness, Deokumar Srivastava, Leslie L. Robison

Research output: Contribution to journalArticle

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Abstract

Purpose: Five-year survival rates for childhood cancer have improved over the past four decades. However, it is unknown whether changes in primary cancer therapy have improved rates of long-term (> 5 years from diagnosis) durable remissions and reduced treatment-related deaths. We investigated changes in patterns of late mortality over time and cause-specific attribution of late-mortality among 5-year survivors. Patients and Methods: Using data from the Surveillance, Epidemiology and End Results (SEER) population-based registry, we assessed all-cause and cause-specific (recurrence/progression of primary disease, external cause, and nonrecurrence/nonexternal cause) late mortality during four consecutive time periods from 1974 through 2000 among 26,643 5-year survivors of childhood cancer. Results: All-cause late mortality improved during more recent eras, dropping from 7.1% (95% CI, 6.4% to 7.8%) among children diagnosed during 1974 to 1980 to 3.9% (95% CI, 3.3% to 4.4%) among children diagnosed during 1995 to 2000 (P < .001), largely because of reduced mortality from recurrence or progression. While there was no significant reduction in mortality attributable to other health conditions (including treatment-related health conditions), analysis controlling for demographic characteristics identified a trend toward reduced risk during more recent eras (P = .007). Disparity by race/ethnicity was identified, with higher mortality among non-Hispanic blacks than among non-Hispanic whites for all-cause and nonrecurrence/nonexternal -cause late mortality. Conclusion: While overall patterns of mortality from other health conditions do not differ over time, adjustment for demographic characteristics provides evidence that risk of treatment-related mortality may be lower in more recent eras. Disparities in health care utilization among survivors should be explored.

Original languageEnglish (US)
Pages (from-to)1224-1231
Number of pages8
JournalJournal of Clinical Oncology
Volume28
Issue number7
DOIs
StatePublished - Mar 1 2010

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Survivors
Mortality
Neoplasms
Health
Patient Acceptance of Health Care
Demography
Recurrence
Therapeutics
Registries
Disease Progression
Epidemiology
Survival Rate
Population

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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Temporal trends in cause-specific late mortality among 5-year survivors of childhood cancer. / Armstrong, Gregory; Pan, Zhenyu; Ness, Kirsten K.; Srivastava, Deokumar; Robison, Leslie L.

In: Journal of Clinical Oncology, Vol. 28, No. 7, 01.03.2010, p. 1224-1231.

Research output: Contribution to journalArticle

Armstrong, Gregory ; Pan, Zhenyu ; Ness, Kirsten K. ; Srivastava, Deokumar ; Robison, Leslie L. / Temporal trends in cause-specific late mortality among 5-year survivors of childhood cancer. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 7. pp. 1224-1231.
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abstract = "Purpose: Five-year survival rates for childhood cancer have improved over the past four decades. However, it is unknown whether changes in primary cancer therapy have improved rates of long-term (> 5 years from diagnosis) durable remissions and reduced treatment-related deaths. We investigated changes in patterns of late mortality over time and cause-specific attribution of late-mortality among 5-year survivors. Patients and Methods: Using data from the Surveillance, Epidemiology and End Results (SEER) population-based registry, we assessed all-cause and cause-specific (recurrence/progression of primary disease, external cause, and nonrecurrence/nonexternal cause) late mortality during four consecutive time periods from 1974 through 2000 among 26,643 5-year survivors of childhood cancer. Results: All-cause late mortality improved during more recent eras, dropping from 7.1{\%} (95{\%} CI, 6.4{\%} to 7.8{\%}) among children diagnosed during 1974 to 1980 to 3.9{\%} (95{\%} CI, 3.3{\%} to 4.4{\%}) among children diagnosed during 1995 to 2000 (P < .001), largely because of reduced mortality from recurrence or progression. While there was no significant reduction in mortality attributable to other health conditions (including treatment-related health conditions), analysis controlling for demographic characteristics identified a trend toward reduced risk during more recent eras (P = .007). Disparity by race/ethnicity was identified, with higher mortality among non-Hispanic blacks than among non-Hispanic whites for all-cause and nonrecurrence/nonexternal -cause late mortality. Conclusion: While overall patterns of mortality from other health conditions do not differ over time, adjustment for demographic characteristics provides evidence that risk of treatment-related mortality may be lower in more recent eras. Disparities in health care utilization among survivors should be explored.",
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