A model-based estimate of cumulative excess mortality in survivors of childhood cancer.
BACKGROUND
Although childhood cancer survival rates have dramatically increased, survivors face elevated risk for life-threatening late effects, including secondary cancer.


OBJECTIVE
To estimate the cumulative effect of disease- and treatment-related mortality risks on survivor life expectancy.


METHODS
State-transition model to simulate the lifetime clinical course of childhood cancer survivors.


METHODS
Childhood Cancer Survivor Study.


METHODS
Five-year survivors of childhood cancer.


METHODS
Probabilities of risk for death from the original cancer diagnosis, excess mortality from subsequent cancer and cardiac, pulmonary, external, and other complications, and background mortality (age-specific mortality rates for the general population) were estimated over the lifetime of survivors of childhood cancer.


RESULTS
For a cohort of 5-year survivors aged 15 years who received a diagnosis of cancer at age 10 years, the average lifetime probability was 0.10 for late-recurrence mortality; 0.15 for treatment-related subsequent cancer and death from cardiac, pulmonary, and external causes; and 0.05 for death from other excess risks. Life expectancy for the cohort of persons aged 15 years was 50.6 years, a loss of 10.4 years (17.1%) compared with the general population. Reduction in life expectancy varied by diagnosis, ranging from 4.0 years (6.0%) for kidney tumor survivors to more than 17.8 years (> or =28.0%) for brain and bone tumor survivors, and was sensitive to late-recurrence mortality risk and duration of excess mortality risk.


CONCLUSIONS
Estimates are based on data for survivors who received treatment 20 to 40 years ago; patients who received treatment more recently may have more favorable outcomes.


CONCLUSIONS
Childhood cancer survivors face considerable mortality during adulthood, with excess risks reducing life expectancy by as much as 28%. Monitoring the health of current survivors and carefully evaluating therapies with known late toxicities in patients with newly diagnosed cancer are needed.
Yeh
Jennifer M
JM
Harvard School of Public Health, Harvard Medical School/Harvard Pilgrim Health Care Institute and Harvard Vanguard Medical Associates, Dana-Farber Cancer Institute and Children's Hospital, Boston, Massachusetts, and Emory University, Atlanta, Georgia, USA. jyeh@hsph.harvard
Nekhlyudov
Larissa
L
Goldie
Sue J
SJ
Mertens
Ann C
AC
Diller
Lisa
L
D000293:Adolescent; D002423:Cause of Death; D002648:Child; D003198:Computer Simulation; D006801:Humans; D008017:Life Expectancy; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011336:Probability; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017741:Survivors