Long-term non-cancer mortality in pediatric and young adult cancer survivors in Finland.

Prasad PK, Signorello LB, Friedman DL, Boice JD, Pukkala E
Pediatr Blood Cancer. 2012 58 (3): 421-7

PMID: 21910209 · PMCID: PMC3237747 · DOI:10.1002/pbc.23296

BACKGROUND - Excess late mortality has been reported among pediatric cancer survivors, but there is a need to further establish risk profiles for non-cancer death and to examine cause-specific mortality among survivors of young adult cancers.

PROCEDURES - In a nationwide record linkage study in Finland, we identified 9,245 5-year cancer survivors diagnosed before age 35 and treated between 1966 and 1999, and followed them for mortality endpoints from 1971 to 2008. Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were calculated to compare the observed number of deaths with those expected in the general Finnish population. Primary endpoints included death from cardiovascular and respiratory diseases; death from malignant diseases was excluded.

RESULTS - Non-malignant disease mortality in the cohort was 90% higher (SMR=1.9, 95% CI: 1.7-2.2) than expected, with SMRs for circulatory and respiratory disease similarly elevated (SMR=1.9, 95% CI: 1.5-2.3 and SMR=2.3, 95% CI: 1.3-3.8, respectively). Important differences were noted amongst patient subgroups, with risk greatest for survivors of central nervous system (CNS) cancer, Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL). The SMR's for circulatory disease were 6.6 (95% CI: 4.8-8.9) for HL and 4.8 (95% CI: 2.6-8.1) for NHL for the entire population; but these risks remained elevated for survivors diagnosed between 15 and 34 years of age.

CONCLUSIONS - Previous studies have shown that there is an elevated risk of non-cancer mortality in childhood cancer survivors; this is one of the first studies that show an increase in cardiovascular and respiratory mortality in long-term survivors of adolescent and young adult cancers.

Copyright © 2011 Wiley Periodicals, Inc.

MeSH Terms (17)

Adolescent Adult Cardiovascular Diseases Cause of Death Child Child, Preschool Female Finland Humans Infant Infant, Newborn Male Mortality Neoplasms Respiratory Tract Diseases Survivors Young Adult

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