Mortality risk among 5‐year survivors of childhood cancer in Germany—Results from the CVSS study (Cardiac and Vascular late Sequelae in long‐term Survivors of childhood cancer study)

Abstract

The growing population of long‐term childhood cancer survivors is at increased risk for severe, therapy‐related late effects and premature mortality. The cardiac and vascular late sequelae in long‐term survivors of childhood cancer (CVSS) study is a cohort of patients from Germany diagnosed with a neoplasia prior to 15 years of age in the time period 1980 to 1990. Late mortality was evaluated in a total of 4505 individuals who survived 5 years or more after the initial diagnosis (5‐year survivors). Survivors with a second primary tumor were excluded. Standardized mortality ratios (SMRs) were calculated. By December 2014, 400 patients had died. Available cause of death information from 188 individuals was used to estimate cause‐specific mortality for all deceased persons. Compared to the population of (former) West Germany, we observed an excess overall mortality risk (SMR = 9.53, 95% confidence interval [CI] = 8.62‐10.51). After correcting for missing cause of death information, an increased cancer mortality (SMR = 43.50, 95% CI = 25.79‐73.50) in the 5‐year survivors was detected. Cardiac death was ascertained in 14 individuals, resulting in an SMR of 10.85 (95% CI = 2.80‐32.02) after correcting for missing values. In conclusion, childhood cancer survivors diagnosed in Germany in 1980 to 1990 have a higher mortality risk overall and an elevated risk of dying from cancer and cardiac causes in particular. The results are consistent with those of international cohort studies. However, the reported results are based on few cases and individuals with secondary cancers were excluded.

Late mortality among 5‐year survivors of childhood cancer: A systematic review and meta‐analysis

“…Eightyfour were assessed for full-text eligibility, and 19 met final inclusion criteria (see Figure S1). 3,6,7,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]…”

“…Wilson et al included survivors who remained disease-free 5 years after achieving remission, 26 and Bagnasco et al included 5-year survivors who reached their elective end of therapy in the absence of active disease. 7 Childhood cancer diagnoses were identified from regional or national population-based cancer registries (n = 11), 6,24,25,[28][29][30][31][32][33][34][35] hospital records or hospital registries (n = 7), 7,23,26,27,[36][37][38] or a combination of sources (n = 1). 3 Vital status was ascertained through linkage to a death registry (n = 15), 3,[24][25][26][27][28][29][30][31][32][33][34][36][37][38] hospital records/ physician survey/municipal records (n = 1), 23 cancer registry (n = 1), 35 municipal records (n = 1), 6 and census bureau postal survey/death registry (n = 1).…”

“…7 Childhood cancer diagnoses were identified from regional or national population-based cancer registries (n = 11), 6,24,25,[28][29][30][31][32][33][34][35] hospital records or hospital registries (n = 7), 7,23,26,27,[36][37][38] or a combination of sources (n = 1). 3 Vital status was ascertained through linkage to a death registry (n = 15), 3,[24][25][26][27][28][29][30][31][32][33][34][36][37][38] hospital records/ physician survey/municipal records (n = 1), 23 cancer registry (n = 1), 35 municipal records (n = 1), 6 and census bureau postal survey/death registry (n = 1). 7 All but two studies 33,34 reported causespecific mortality using counts and/or risk measures.…”

Long-term care, care needs and wellbeing of individuals after cancer in childhood or adolescence (VersKiK): study protocol of a large scale multi-methods non-interventional study

“…A large proportion of data available originates either from interviews with cancer survivors [ 7 – 9 ] or from large, population-based cancer registries [ 10 – 16 ]. For Germany, only limited information on late effects of childhood cancer is available [ 17 , 18 ].…”

Cancer Cure and Consequences on Survivorship Care: Position Paper from the Italian Alliance Against Cancer (ACC) Survivorship Care Working Group

“…Among children with cancer, overall 5-year survival is above 80% [35][36][37] and even longer (ie, 15-year) survival was only slightly lower (<4% in children and <5% in adolescents) than 5-year survival. 36 Although a higher risk of death (for the specific neoplasm as well as for other diseases) has been reported among childhood cancer survivors as compared to their peers in the general population, [38][39][40] the vast majority of cured children requires personalized organ-specific followup aimed at anticipating and controlling possible long-term side effects of treatment (eg, second neoplasms, cardiac, pulmonary, or endocrine complications) and supporting social rehabilitation. 41 Possible Consequence of Evidence of Cancer Cure on Cancer Survivorship Care A New Paradigm Based on Cancer Cure to Be Integrated in the Cancer Care Pathway Cancer is not a single disease, but it is made up of many different biological entities.…”