Reduction in Late Mortality among 5-Year Survivors of Childhood Cancer

Abstract

Background Previously, eighteen percent of childhood cancer patients who survived five years died within the subsequent 25 years. In recent decades, cancer treatment regimens have been modified with the goal of reducing risk for life-threatening late effects. Methods Late mortality was evaluated in 34,033 five-year survivors of childhood cancer (diagnosed <21 years of age from 1970-1999, median follow-up 21 years, range 5-38). Demographic and disease factors associated with mortality due to health-related causes, which exclude recurrence/progression of the original cancer but include deaths that reflect late effects of cancer therapy, were evaluated using cumulative incidence and piecewise exponential models estimating relative rates (RRs) and 95% confidence intervals (CI). Results 1,618 (41%) of the 3,958 deaths were attributable to health-related causes, including 746 subsequent neoplasm, 241 cardiac, and 137 pulmonary deaths. Reduction in 15-year mortality was observed for all-cause (12.4% to 6.0%, P for trend <0.001) and health-related mortality (3.5% to 2.1%, P for trend <0.001), attributable to reductions in subsequent neoplasm (P<0.001), cardiac (P<0.001) and pulmonary death (P<0.001). Changes in therapy by decade included reduced rates of: cranial radiotherapy for acute lymphoblastic leukemia (1970s 85%, 1980s 51%, 1990s 19%), abdominal radiotherapy for Wilms’ tumor (78%, 53%, 43%), chest radiotherapy for Hodgkin's lymphoma (87%, 79%, 61%), and anthracycline exposure. Reduction in treatment exposure was associated with reduced late mortality among lymphoblastic leukemia and Wilms’ tumor survivors. Conclusion The strategy of lowering therapeutic exposure has successfully translated to an observed decline in late mortality among 5-year survivors of childhood cancer.

Adult Survivors of Childhood Cancer Have Poor Adherence to Dietary Guidelines

“…3 Weight status was defined as underweight if BMI (kg/m 2 ) ,18.5, normal weight if BMI = 18.5-24.9, overweight if BMI = 25-29.9, and obese if BMI $30. 4 Height was assessed by SDS. Raw height was converted to SDS by comparing the height of the survivors with the mean height of a reference population (i.e., the 2000 CDC growth chart).…”

“…However, after successful treatment, childhood cancer survivors experience a substantially higher risk of premature mortality and serious morbidity at a young age (2)(3)(4). Nutrition is among the few modifiable factors that can prevent or delay the early onset of chronic diseases.…”

Risk factors for subsequent endocrine-related cancer in childhood cancer survivors

“…Over the past decades, childhood cancer treatment protocols have been modified, aiming to reduce the occurrence and severity of long-term treatment-related complications. Recently, Armstrong and coworkers demonstrated that these efforts resulted in improved long-term survival (Armstrong et al 2016).…”

“…After 25 years of follow-up since primary cancer diagnosis, secondary malignant neoplasms even become the most important cause of death in survivors of childhood cancer (Mertens et al 2008, Reulen et al 2010. Although mortality attributable to secondary malignancies in childhood cancer survivors declined over the past treatment eras (Armstrong et al 2016), the risk for developing a solid secondary malignant neoplasm did not (Schaapveld et al 2015). Endocrine-related cancers are among the most common secondary malignancies in childhood cancer survivors (Inskip & Curtis 2007, Olsen et al 2009, Friedman et al 2010, Reulen et al 2011.…”

Late effects in children who underwent hematopoietic stem cell transplantation (review)

“…Развитие осложнений ТГСК в посттрансплан-тационном периоде (ПТП) может быть связано с характеристиками заболевания и преморбидными факторами, особенностями пациента (возраст, пол, генетические особенности), осложнениями, приобре-тенными на фоне терапии (химио-(ХТ) и иммуноте-рапия, хирургическое лечение, облучение), и после-дующей ТГСК, а также с посттрансплантационными иммуноопосредованными изменениями [8,9].…”