Conditional survival in pediatric malignancies: Analysis of data from the Childhood Cancer Survivor Study and the Surveillance, Epidemiology, and End Results Program

Abstract

Background Long-term survivors of pediatric cancer are at risk for life-threatening late effects of their cancer. Previous studies have shown excesses in long-term mortality within high-risk groups defined by demographic and treatment characteristics. Methods To investigate conditional survival in a pediatric cancer population, we performed an analysis of conditional survival in the original Childhood Cancer Survivor Study (CCSS) cohort and the Surveillance, Epidemiology and End Results (SEER) database registry. The overall probability of death for patients in 5 years and 10 years after they survived 5, 10, 15, and 20 years since cancer diagnosis, and cause-specific death in 10 years for 5-year survivors were estimated using the cumulative incidence method. Results Among CCSS and SEER patients who were alive 5 years post cancer diagnosis, within each diagnosis group at least 92% are alive in the subsequent 5 years, except leukemia patients of whom only 88% of 5-year survivors remain alive in the subsequent 5 years. The probability of all-cause mortality in the next 10 years on patients who survived at least 5 years after diagnosis, was 8.8% in CCSS and 10.6% in SEER, approximately three quarter of which were due to neoplasms as causes of death. Conclusion The risk of death of pediatric cancer survivors in 10 years can vary between diagnosis groups by at most 12% even up to 20 years post diagnosis. This information is clinically important in counseling patients on their conditional survival, particularly when survivors are seen in long-term follow-up.

The Behavior Rating Inventory of Executive Function (BRIEF) to Identify Pediatric Acute Lymphoblastic Leukemia (ALL) Survivors At Risk for Neurocognitive Impairment

“…Over 90% of children with acute lymphoblastic leukemia (ALL) will be long-term survivors [1]. Even after eliminating cranial radiation from most modern leukemia regimens, systemic and intrathecal chemotherapy continues to place pediatric patients at risk for neurocognitive impairment [2, 3].…”

Long-term mortality among women with epithelial ovarian cancer

“…As the duration from diagnosis increases, other causes of death become more common 7-9 . These findings have been reported for cancers of the prostate 10,11 , kidney 7 , central nervous system 7,12-15 , lung 11,16 , head and neck 8 , and colon. 11,17 In a study 217,573 patients with breast, colorectal, lung, and prostate cancer, the probability of long-term survival increased significantly after patients survived a critical time period following diagnosis.…”

“…7,12,13,15,18,19 . In contrast to other solid tumors, little is known about the causes of death among long-term survivors of ovarian cancer.…”

Curative Surgical Resection of Adrenocortical Carcinoma

“…1,12,13 Although the ENSAT and AJCC/UICC classification may offer important information for general prognostic assessment, survival estimates based on traditional survival curves may not provide accurate information for long-term prognosis as the risk of recurrence or death is often the highest during the initial years after surgery and diminishes with time. 14 …”