Cause of mortality in 5‐year survivors of childhood cancer

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Abstract
Survivors of childhood and adolescent cancer are at risk for long‐term effects of disease and treatment. The Childhood Cancer Survivor Study assessed overall and cause‐specific mortality in a retrospective cohort of 20,690 5‐year survivors. Eligible subjects were individuals diagnosed with cancer (from 1970 to 1986) before the age of 21 who had survived 5 years from diagnosis. Underlying cause of death was obtained from death certificates and other sources, then and coded and categorized as recurrent disease, sequel of cancer treatment, or non‐cancer‐related. Age and sex standardized mortality ratios (SMRs) were calculated using United States population mortality data. The cohort demonstrated an 8.2‐fold excess in overall mortality (95% confidence interval, 7.9 to 8.5). Recurrence of the original cancer was the leading cause of death among 5‐year survivors, accounting for 57% of deaths. Statistically significant excess mortality rates were seen due to subsequent malignancies (SMR = 15.0), along with cardiac (SMR = 6.9), and pulmonary (SMR = 8.7). There was no increase seen for automotive accidents (SMR = 1.0), other accidents (SMR = 1.3), or suicide (SMR = 1.0). While recurrent disease remains a major contributor to late mortality in 5‐year survivors of childhood cancer, significant excesses in mortality risk associated with treatment‐related complications exist up to 25 years after the initial cancer diagnosis. Pediatr Blood Cancer 2007;48:723–726.