title: Late mortality among 5-year survivors of early onset cancer: a population-based register study.
abstract: To date, only few studies have been published documenting late mortality among early onset cancer survivors, especially regarding young adulthood (YA) malignancies. Our nation-wide population-based registry study provides information concerning cause-specific long-term mortality among 16,769 5-year survivors of early onset cancer (aged 0-34 years at diagnosis), with follow-up for death extending from 1971 through 2012. A sibling cohort and population data were used as reference. The overall standardized mortality ratio (SMR) of cancer patients was 4.6-fold, (95% CI 4.4-4.8). Highest SMRs were found for malignancies (12.8, 95% CI 12.3-13.3), infectious (4.8, 95%CI 2.9-6.7) and cardiovascular diseases (1.9, 95% CI 1.7-2.1). Malignancies and cardiovascular diseases accounted for the largest number of deaths. Childhood and YA cancer survivors with the same primary cancer site had a similarly elevated overall SMR with the exception of markedly higher SMRs after childhood Hodgkin lymphoma. The highest cumulative non-malignancy-related mortality was due to cardiovascular disease with a steady rise throughout the follow-up, but strongly dependent on the primary cancer site and age at diagnosis. In childhood cancer survivors, the cumulative cardiovascular mortality did not reduce over time. However, overall and malignancy-related mortality showed a declining tendency towards the most recent periods after both, childhood and YA cancer. Our findings on non-malignancy-related mortality stress the need to set up long-term individual follow-up with a focus on cardiovascular late effects for early onset cancer survivors, especially for YA cancer survivors still lacking those.
authors.affiliation: Department of Pediatrics, Turku University Hospital, Turku, Finland.
authors.forename: Andreina E
authors.initials: AE
authors.lastname: Kero
authors.forename: Liisa S
authors.initials: LS
authors.lastname: Järvelä
authors.forename: Mikko
authors.initials: M
authors.lastname: Arola
authors.forename: Nea
authors.initials: N
authors.lastname: Malila
authors.forename: Laura M
authors.initials: LM
authors.lastname: Madanat-Harjuoja
authors.forename: Jaakko
authors.initials: J
authors.lastname: Matomäki
authors.forename: Päivi M
authors.initials: PM
authors.lastname: Lähteenmäki
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D049673:History, 20th Century; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000266:history / Q000401:mortality; D011159:Population Surveillance; D012042:Registries; D035781:Siblings; D017741:Survivors; D055815:Young Adult
keywords: cancer survivors; cardiovascular; early onset cancer; mortality; nonmalignant; young adult cancer