Modifiable chronic health conditions linked to late mortality in pediatric cancer survivors
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Pediatric cancer survivors appeared at increased risk for late mortality associated with modifiable chronic health conditions, according to study results published in JAMA Network Open.
Researchers also observed an increased mortality risk among those residing in areas with a lack of available resources.
Rationale and methodology
For nearly a decade it has been known that potentially modifiable risk factors can dramatically increase the risk for specific health conditions among cancer survivors, Matthew J. Ehrhardt, MD, MS, pediatric hematologist-oncologist in the department of oncology at St. Jude Children’s Research Hospital, told Healio.
“In addition, population level measures of deprivation, such as the Area Deprivation Index, have been shown to be associated with an increased risk for adverse health events and mortality in the general population, but not yet specifically evaluated in childhood cancer survivors,” he said. “We suspected these factors would be associated with an increased risk for mortality among childhood cancer survivors as well and believed that identification of these types of associations may help investigators target key events for future intervention studies seeking to reduce mortality risk.”
Ehrhardt and colleagues pooled data on 3,407 childhood cancer survivors (median age, 35.4 years; 52.5% male; 81.7% white) included in the St. Jude Lifetime Cohort (SJLIFE) study who survived 5 or more years after a childhood cancer diagnosis and completed an on-campus risk factor assessment.
Researchers used National Death Index causes of death and 95% CIs calculated based on U.S. mortality rates to estimate late mortality ratios. They also used multivariable piecewise exponential regression analysis to assess rate ratios and 95% CIs for all-cause and cause-specific late mortality.
Median follow-up was 27.3 years.
Findings
Results showed that factors associated with a significant increased risk for late all-cause mortality included one modifiable grade 2 or higher chronic health condition (RR = 2.2; 95% CI, 1.2-4), two modifiable grade 2 or higher chronic health conditions (RR = 2.6; 95% CI, 1.4-4.9) or three modifiable grade 2 or higher chronic health conditions (RR = 3.6; 95% CI, 1.8-7.1).
In addition, cancer survivors who resided in a U.S. Census block with an Area Deprivation Index in either the 51st to 80th percentile (RR = 5.5; 95% CI, 1.3-23.5), 81st to 100th percentile (RR = 8.7; 95% CI, 2-37.6) or an unassigned Area Deprivation Index score (RR = 15.7; 95% CI, 3.5-70.3). as well as those who had frailty (RR = 2.3; 95% CI, 1.3-3.9), appeared at significant increased risk for late all-cause mortality.
Researchers additionally observed an association between increased risk for late mortality and those with one modifiable grade 2 or higher chronic health condition (RR = 2.2; 95% CI, 1.1-4.4), two modifiable grade 2 or higher chronic health conditions (RR = 2.5; 95% CI, 1.2-5.2) or three modifiable grade 2 or higher chronic health conditions (RR = 4; 95% CI, 1.9-8.4).
They observed the same increased risk for late mortality among those with an Area Deprivation Index in either the 51st to 80th percentile (RR = 9.2; 95% CI, 1.2-69.7), 81st to 100th percentile (RR = 16.2; 95% CI, 2.1-123.7) or an unassigned Area Deprivation Index score (RR = 27.3; 95% CI, 3.5-213.6), and among those having frailty (RR = 2.3; 95% CI, 1.2-4.1).
Study limitations included certain causes of death occurring too infrequently to include in the analysis, researchers not being able to assign a census block to all individuals, and many patients dying before they could participate in the study and, thus, not included in risk factor analyses.
Implications
“It is important to take the time to understand where our patients are coming from and what available resources they may or may not have to achieve goals that we work together to set for them,” Ehrhardt told Healio.
“For example, if addressing hypertension is an important goal, then understanding what access to exercise and healthy food sources survivors have may help to strategize a more effective treatment approach,” he said. “In reality, this can be extraordinarily difficult as the pressures of packed clinic templates can put significant constraints on the available time providers may have to spend with individual patients. When available, we need to work closely with comprehensive care team members such as social workers in order to identify and maximize utilization of resources available to cancer survivors.”
Future research should assess whether interventions for modifiable chronic health conditions and social determinants of health can reduce mortality risk among cancer survivors, Ehrhardt added.
“This requires development and testing of comprehensive intervention studies and will likely benefit from inclusion of survivors and a multidisciplinary team of providers in the development of these approaches,” he said. “For example, an intervention for hypertension may include not only antihypertensive medications, but also robust assessment and optimization of access to healthy foods, green space for exercise and education level.”
References:
- Access matters: Lack of resources is associated with increased mortality in childhood cancer survivors (press release). Available at: www.stjude.org/media-resources/news-releases/2023-medicine-science-news/lack-of-resources-associated-with-increased-mortality-in-childhood-cancer-survivors.html. Published Feb. 10, 2023. Accessed Feb. 10, 2023.
- Ehrhardt MJ, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2022.55395.
For more information:
Matthew J. Ehrhardt, MD, MS, can be reached at matt.ehrhardt@stjude.org.
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