Frequency, timing and causes of late mortality in survivors of childhood malignancy


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Raoul Reulen1
1University of Birmingham, Birmingham, UK

Abstract

Due to marked advances in curative therapy for childhood cancer - mainly the introduction of modern chemotherapy in the 1960s - the five-year survival rate after childhood cancer has substantially improved over the last few decades from less than 30% in the 1960s to currently over 80%. As a result of these improved survival rates, a large and ever growing number of childhood cancer survivors have reached adulthood. A major concern following treatment of childhood cancer is the increased risk of late mortality due to common chronic diseases of mature adulthood observed in the general population. This presentation will provide an overview of the evidence from current large-scale cohort studies investigating cause-specific mortality after treatment for childhood cancer. It will describe the frequency of overall mortality and the risk of mortality due to specific causes of death. Particular attention will be given to the extent to which cause-specific mortality varies by type of childhood cancer and to what extent mortality patterns vary by attained age and time since childhood cancer diagnosis. More survivors are now reaching an age at which, in the general population, the risk of common diseases of mature adulthood increases. This implies that even a small increased risk of mortality relative to that observed in the general population could lead to a substantial excess number of survivors of childhood cancer dying prematurely. Recent large-scale cohort studies with extended follow-up are now starting to report cause-specific mortality risks beyond 40 years of follow-up, i.e. into middle age, and it is becoming evident that the majority of the excess late mortality is attributable to deaths due to second primary cancer and cardiovascular disease. Understanding the long-term risks of mortality is crucial because it provides a basis for counselling long-term survivors, planning future clinical follow-up and deciding on new treatment protocols with the ultimate aim of reducing late mortality without compromising the currently achieved five-year survival rates.