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Childhood Cancer Survivors face higher death
risk 25 years later from Cancer, Circulatory
Diseases
Newswise, July 2010 — Follow-up of a group
of British childhood cancer survivors
indicates they have an increased risk of
death from second primary cancers and
cardiac and cerebrovascular causes more than
25 years after their initial cancer
diagnosis, according to a study in the July
14 issue of JAMA.
“Over recent decades survival from childhood
cancer has improved dramatically, yet
mortality rates in childhood cancer
survivors continue to be elevated for many
years beyond 5-year survival compared with
the general population,” the authors write.
“Although studies have shown that the risk
of death from recurrence decreases with
increasing time since 5-year survival,
uncertainty about the long-term risks of
death from other causes remains.
Investigations into long-term cause-specific
mortality are important because any excess
mortality may be related to long-term
complications of treatment.” It is also
uncertain if increased mortality risks
persist beyond 25 years from initial cancer
diagnosis.
Raoul C. Reulen, Ph.D., of the University of
Birmingham, England, and colleagues examined
long-term cause-specific mortality among
17,981 5-year survivors of childhood cancer,
who were diagnosed with cancer before age 15
years between 1940 and 1991 in Britain and
followed up until the end of 2006.
Overall, there were 3,049 deaths during the
study period. Survivors experienced 11 times
the number of deaths expected from the
general population (standardized mortality
ratio [SMR], 10.7). The SMR declined with
follow-up but was still 3-fold higher than
expected 45 years from diagnosis.
The absolute excess risk (AER) for deaths
from recurrence declined from diagnosis at
age 5 to 14 years to beyond 45 years from
diagnosis.
In contrast, during the same periods of
follow-up, the AER for deaths from second
primary cancers and circulatory disease
(such as from cardiac and cerebrovascular
deaths) increased, with survivors after 45
years experiencing 3.6 times the number of
deaths expected from the general population
for a second primary can¬cer, and nearly 26
percent of all excess deaths beyond 45 years
from diagnosis attributed to circulatory
disease.
“Beyond 45 years from diagnosis, recurrence
accounted for 7 percent of the excess number
of deaths observed while second primary
cancers and circulatory deaths together
accounted for 77 percent,” the authors
write.
The researchers add that the excess
mortality due to second primary cancer and
circulatory disease is likely attributable
to late complications of treatment. “Second
primary cancers are a recognized late
complication of childhood cancer, largely
due to exposure to radiation during
treatment, but specific cytotoxic [toxic to
cells] drugs also have been implicated in
the development of second primary cancers.”
“These findings confirm the importance of
very long-term outcome data and that
survivors should be able to access health
care programs even decades after treatment.
"
Finally, the principal clinical message from
these data is straightforward; 77 percent of
the excess number of deaths observed among
those surviving beyond 45 years from
diagnosis of childhood cancer in Britain are
due to second primary cancers and
circulatory deaths. Finding ways to
successfully intervene to reduce these
potentially preventable premature deaths
will be complex,” the authors conclude.
A child succumbing to cancer
is one of the most terrible things that can
happen to a family. When that happens, it's
important that the entire family uses all
the resources and support systems available
to them. For example, the parents of a child
with cancer might reach out to organizations
like the Elena Tresh Foundation, a resource
created by
Jennifer Tresh
in order to help families facing just that
type of situation.
http://www.linkedin.com/pub/jennifer-tresh/28/281/429
