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Adult survivors of childhood cancer have decreased life expectancy
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Survivors of childhood cancer are at increased risk for mortality during adulthood when compared with healthy individuals. Depending on type of cancer diagnosed, age at diagnosis and treatment era, life expectancy may be reduced by as many as four to 18 years, according to new findings from the Childhood Cancer Survivor Study.
Researchers estimated the overall effect of cancer and the risk for treatment-related mortality on life expectancy among five-year survivors of childhood cancer, aged 15 years; who were diagnosed with cancer at the age of 10 years.
A computer-based model assessed the probability of mortality risk associated with original cancer diagnosis, excess mortality from subsequent cancer and cardiac, pulmonary, external and other complications, as well as background mortality.
The average lifetime cause-specific probability for late-recurrence mortality was 0.1. It was 0.2 for nonrecurrence excess mortality, including 0.1 for treatment-related subsequent cancer, 0.03 for cardiac, 0.02 for pulmonary, 0.05 for death from other risks, and < .001 for external causes.
Conditional life expectancy was projected at 50.6 years — this accounted for a loss of 10.4 years compared with the general population; however, it varied depending on age at diagnosis, treatment era and cancer type.
The decrease in life expectancy varied by diagnosis, ranging from four years for survivors of kidney tumors to longer than 17 years for survivors of brain tumors and Ewing sarcoma.
“These data are based upon estimates for survivors who received treatment 20 to 40 years ago. Therefore, patients who received treatment more recently may have more favorable outcomes,” the researchers wrote.
In an accompanying editorial, Patricia A. Ganz, MD, and Anne Coscarelli, MD, both of the Jonsson Comprehensive Cancer Center, and Jacqueline N. Casillas, MD, of the David Geffen School of Medicine at the University of California, wrote, “The mortality rates reported by Yeh and colleagues are just the tip of the iceberg for these survivors, who live with serious health problems. The psychosocial burden and effect on quality of life is not accounted for either. … These survivors also face arrests in social and educational development, psychosexual and body image disturbances, difficulties in maintaining social relationships and disruptions in work and careers.
“Increasingly, we hope that childhood cancer survivors transition into adult health care system with treatment summaries and survivorship care plans that outline late effects.”
For more information:
- Yeh JM. Ann Intern Med. 2010;152:409-417.