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Younger age linked to poorer survival from second cancers
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Younger age at the time of a second primary malignant neoplasm diagnosis appeared linked to worse survival outcomes among cancer survivors, according to a retrospective study published in JAMA Oncology.
“Although the increase of incidence in second cancers is well known among cancer survivors, less is known about outcomes of these cancers or the influence of age,” Theresa H.M. Keegan, PhD, cancer epidemiologist at UC Davis Comprehensive Cancer Center, said in a press release.
Pediatric cancer survivors are at a higher risk for developing second primary malignant neoplasms than cancer survivors aged 40 years or older; however, adolescent and young adult (AYA) survivors — or those aged 15 to 39 years — have the highest absolute risk for second primary malignant neoplasms among all age groups.
Keegan and colleagues analyzed SEER data to compare survival impact of second primary malignant neoplasms in AYAs with children and adults to determine whether age contributed to differences in survival.
The population-based cohort comprised 15,954 pediatric (younger than 15 years), 125,750 AYA, and 873,370 older patients (40 years or older) diagnosed with a first primary malignant neoplasm or second primary malignant neoplasm between 1992 and 2008. Researchers followed the cohort through 2013 and performed data analysis between June 2016 and January 2017.
Five-year relative survival overall and for each cancer as a primary or second primary malignancy served as the primary study outcomes.
Overall, children and AYAs had an 80% 5-year survival rate after a diagnosis of a first cancer, but this rate decreased to 47% for children and 60% for AYAs when the same cancer occurred as a second primary malignancy. In comparison, 5-year survival among adults was 70% for a first cancer and 61% for a second cancer.
These data equated to 5-year survival rates from a second primary malignancy that were 33.1% lower for children, 20.2% lower for AYAs and 8.3% lower for adults compared with the same cancer as a first primary malignancy.
Among the most common second primary malignant neoplasms in AYAs, the absolute difference in 5-year survival was 42% lower for secondary non-Hodgkin lymphoma, 19% lower for secondary breast carcinoma, 15% lower for secondary thyroid carcinoma and 13% lower for secondary soft-tissue carcinoma.
The researchers are the first to their knowledge to report such large differences in 5-year survival after a second breast cancer or thyroid cancer by age. This difference may be due to different aggressiveness of a second malignancy, the increased probability that younger patients harbor a genetic syndrome and different distributions of first malignancies in younger patients.
Children with acute lymphoid leukemia (HR = 4.51; 95% CI, 2.16-9.41), acute myeloid leukemia (HR = 2.96; 95% CI, 1.92-4.57) and central nervous system cancers (HR = 3.26; 95% CI, 1.75-6.07) as a second malignancy had a significantly greater risk for cancer death than that of the same first malignancy.
In AYAs, almost every second malignancy had a higher risk for death compared with that cancer as a first malignancy.
Notably, AYAs with a second malignancy of Hodgkin lymphoma (HR = 3.5; 95% CI, 1.7-7.1), soft-tissue sarcoma (HR = 2.8; 95% CI, 2.1-3.9), breast carcinoma (HR = 2.1; 95% CI, 1.8-2.4), AML (HR = 1.9; 95% CI, 1.5-2.4) and CNS cancer (HR = 1.8; 95% CI, 1.2-2.8) experienced worse survival than AYAs with the same first primary malignant neoplasms.
“For almost every type of cancer, the AYA population did worse with a secondary cancer,” Melanie Goldfarb, MD, McS, FACS, FACE, endocrine surgeon at John Wayne Cancer Institute, said in a press release. “What struck us was that the second cancer caused such an increased risk [for] death.”
The researchers are the first to report a large difference in survival for first and second primary Hodgkin lymphoma and non-Hodgkin lymphoma, particularly among children and AYAs.
“Treatment for any first primary malignant neoplasm may have affected potential treatment options for a non-Hodgkin lymphoma second primary malignant neoplasms owing to cumulative toxic effects, thus having an impact on prognosis,” Keegan and colleagues wrote.
Societal issues may also play a role in diminishing survivor rates in children, adolescents and young adults, Goldfarb said.
“These younger people don’t have all the support or resources they need,” she said. “They may not have adequate insurance or they may get lost in the system. They may suffer from depression, which can contribute to their overall health and worsen their cancer outcome.”– by Chuck Gormley
Disclosure: The researchers report no relevant financial disclosures.
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