Cause‐specific long‐term mortality in survivors of childhood cancer in Switzerland: A population‐based study

Abstract

Survivors of childhood cancer have a higher mortality than the general population. We describe cause‐specific long‐term mortality in a population‐based cohort of childhood cancer survivors. We included all children diagnosed with cancer in Switzerland (1976–2007) at age 0–14 years, who survived ≥5 years after diagnosis and followed survivors until December 31, 2012. We obtained causes of death (COD) from the Swiss mortality statistics and used data from the Swiss general population to calculate age‐, calendar year‐, and sex‐standardized mortality ratios (SMR), and absolute excess risks (AER) for different COD, by Poisson regression. We included 3,965 survivors and 49,704 person years at risk. Of these, 246 (6.2%) died, which was 11 times higher than expected (SMR 11.0). Mortality was particularly high for diseases of the respiratory (SMR 14.8) and circulatory system (SMR 12.7), and for second cancers (SMR 11.6). The pattern of cause‐specific mortality differed by primary cancer diagnosis, and changed with time since diagnosis. In the first 10 years after 5‐year survival, 78.9% of excess deaths were caused by recurrence of the original cancer (AER 46.1). Twenty‐five years after diagnosis, only 36.5% (AER 9.1) were caused by recurrence, 21.3% by second cancers (AER 5.3) and 33.3% by circulatory diseases (AER 8.3). Our study confirms an elevated mortality in survivors of childhood cancer for at least 30 years after diagnosis with an increased proportion of deaths caused by late toxicities of the treatment. The results underline the importance of clinical follow‐up continuing years after the end of treatment for childhood cancer.

Communicating “cure” to pediatric oncology patients: A mixed‐methods study

“…As stated in the Erice statement, written by physicians, survivors, psychologists, nurses, and epidemiologists in 2007 and updated in 2018, pediatric oncologists can use the term “cure” in discussions with childhood cancer survivors regardless of remaining uncertainty caused by the type of cancer they had or existing or potential late effects of treatment . This uncertainty includes some remaining risk of relapse, but also excess morbidity and death . Late effects can begin decades after the end of treatment and include physical or psychological and social problems .…”

“…12,13 This uncertainty includes some remaining risk of relapse, but also excess morbidity and death. 14,15 Late effects can begin decades after the end of treatment and include physical 16,17 or psychological and social problems. 18,19 By age 50, 96% of childhood cancer survivors have had a severe to life-threatening chronic condition.…”

Monitoring pulmonary health in Swiss childhood cancer survivors

“…These treatments can lead to lung damage and pulmonary diseases that are a major cause of mortality and morbidity in CCS. CCS have a threefold increased risk of hospitalization due to pulmonary diseases and up to 14 times increased risk of late pulmonary death . In Switzerland, 12% of CCS report one or more pulmonary diseases, possibly caused by cancer treatment .…”

“…CCS have a threefold increased risk of hospitalization due to pulmonary diseases and up to 14 times increased risk of late pulmonary death. [2][3][4] In Switzerland, 12% of CCS report one or more pulmonary diseases, possibly caused by cancer treatment. 1 In the St. Jude Lifetime Cohort, in which all CCS received risk-based screening at a median of 25 years after cancer treatment, 65% of 417 CCS exposed to pulmotoxic treatment had abnormal pulmonary function tests (PFT).…”

Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer

“…Respiratory complications are a common cause of morbidity and a leading cause of late mortality, second only to cancer, among cancer survivors. Diseases of the respiratory system are consistently a leading noncancer cause of late mortality, with survivors demonstrating a 6‐fold to 15‐fold excess risk of dying of a respiratory condition compared with individuals matched from the general population . Survivors also demonstrate high rates of pulmonary dysfunction, including abnormal pulmonary function testing, chronic cough, supplemental oxygen use, fibrotic disease, and recurrent pneumonia .…”