Causes of death among cancer patients.
The purpose of our study was to characterize the causes of death among cancer patients as a function of objectives: (i) calendar year, (ii) patient age, and (iii) time after diagnosis.



US death certificate data in Surveillance, Epidemiology, and End Results Stat 8.2.1 were used to categorize cancer patient death as being due to index-cancer, nonindex-cancer, and noncancer cause from 1973 to 2012. In addition, data were characterized with standardized mortality ratios (SMRs), which provide the relative risk of death compared with all persons.



The greatest relative decrease in index-cancer death (generally from > 60% to < 30%) was among those with cancers of the testis, kidney, bladder, endometrium, breast, cervix, prostate, ovary, anus, colorectum, melanoma, and lymphoma. Index-cancer deaths were stable (typically >40%) among patients with cancers of the liver, pancreas, esophagus, and lung, and brain. Noncancer causes of death were highest in patients with cancers of the colorectum, bladder, kidney, endometrium, breast, prostate, testis; >40% of deaths from heart disease. The highest SMRs were from nonbacterial infections, particularly among <50-year olds (e.g. SMR >1,000 for lymphomas, P < 0.001). The highest SMRs were typically within the first year after cancer diagnosis (SMRs 10-10,000, P < 0.001). Prostate cancer patients had increasing SMRs from Alzheimer's disease, as did testicular patients from suicide.



The risk of death from index- and nonindex-cancers varies widely among primary sites. Risk of noncancer deaths now surpasses that of cancer deaths, particularly for young patients in the year after diagnosis.
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
N G
NG
Zaorsky
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
T M
TM
Churilla
Biostatistics, Fox Chase Cancer Center, Philadelphia, USA.
B L
BL
Egleston
Department of Clinical Sciences, Temple University School of Medicine, Philadelphia, USA.
S G
SG
Fisher
Surgical Oncology, Fox Chase Cancer Center, Philadelphia, USA.
J A
JA
Ridge
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
E M
EM
Horwitz
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
J E
JE
Meyer
D002423:Cause of Death; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D009369:Neoplasms / Q000401:mortality*; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D014481:United States / Q000453:epidemiology
SEER; United States; cancer; clinical trials; comorbidity; competing events; epidemiology; heart disease; mortality; non-cancer death; second cancer