Late mortality and causes of death among 5-year survivors of childhood cancer diagnosed in the period 1960-1999 and registered in the Italian Off-Therapy Registry

OTR-AIEOP Registry

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: Advances in paediatric oncology led to the increase in long-term survival, revealing the burden of therapy-related long-term side effects. We evaluated overall and cause-specific mortality in a large cohort of Italian childhood cancer survivors (CCSs) and adolescent cancer survivors identified through the off-therapy registry.

MATERIALS AND METHODS: CCSs alive 5 years after cancer diagnosis occurring between 1960 and 1999 were eligible; the last follow-up was between 2011 and 2014. Outcomes were reported as standardised mortality ratios (SMRs) and absolute excess risks (AERs).

RESULTS: Among 12,214 CCSs, 1113 (9.1%) deaths occurred. Survival at 35 years since diagnosis was 87% (95% confidence interval [CI]: 86-88) and at 45 years was 81% (95% CI: 77-84). CCSs had an 11-fold increased risk of death (SMR 95% CI: 10.7-12), corresponding to an AER of 48 (95% CI: 45-51). Mortality decreased by 60% for survivors treated most recently (1990-1999). The most frequent causes of death were recurrence of the original cancer (56%), a subsequent neoplasm (19%) and cardiovascular diseases (5.8%). Among those who survived at least 15 years after diagnosis, a secondary malignancy was the leading cause of death.

CONCLUSIONS: This study confirms the impact of recent advances in anticancer therapy in reducing mortality, mainly attributable to recurrence but also to other causes. However, overall mortality continues to be higher than in the general population. A long-term follow-up is needed to prevent late mortality due to secondary neoplasms and non-neoplastic causes in CCSs.

Original languageEnglish
Pages (from-to)86-97
Number of pages12
JournalEuropean Journal of Cancer
Volume110
DOIs
Publication statusPublished - Mar 2019

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Survivors
Registries
Cause of Death
Mortality
Neoplasms
Therapeutics
Confidence Intervals
Recurrence
Survival
Cardiovascular Diseases
Pediatrics

Cite this

@article{e03900c92b0e4fee8ba758b7a0391528,
title = "Late mortality and causes of death among 5-year survivors of childhood cancer diagnosed in the period 1960-1999 and registered in the Italian Off-Therapy Registry",
abstract = "INTRODUCTION: Advances in paediatric oncology led to the increase in long-term survival, revealing the burden of therapy-related long-term side effects. We evaluated overall and cause-specific mortality in a large cohort of Italian childhood cancer survivors (CCSs) and adolescent cancer survivors identified through the off-therapy registry.MATERIALS AND METHODS: CCSs alive 5 years after cancer diagnosis occurring between 1960 and 1999 were eligible; the last follow-up was between 2011 and 2014. Outcomes were reported as standardised mortality ratios (SMRs) and absolute excess risks (AERs).RESULTS: Among 12,214 CCSs, 1113 (9.1{\%}) deaths occurred. Survival at 35 years since diagnosis was 87{\%} (95{\%} confidence interval [CI]: 86-88) and at 45 years was 81{\%} (95{\%} CI: 77-84). CCSs had an 11-fold increased risk of death (SMR 95{\%} CI: 10.7-12), corresponding to an AER of 48 (95{\%} CI: 45-51). Mortality decreased by 60{\%} for survivors treated most recently (1990-1999). The most frequent causes of death were recurrence of the original cancer (56{\%}), a subsequent neoplasm (19{\%}) and cardiovascular diseases (5.8{\%}). Among those who survived at least 15 years after diagnosis, a secondary malignancy was the leading cause of death.CONCLUSIONS: This study confirms the impact of recent advances in anticancer therapy in reducing mortality, mainly attributable to recurrence but also to other causes. However, overall mortality continues to be higher than in the general population. A long-term follow-up is needed to prevent late mortality due to secondary neoplasms and non-neoplastic causes in CCSs.",
author = "{OTR-AIEOP Registry} and Francesca Bagnasco and Silvia Caruso and Anita Andreano and Valsecchi, {Maria Grazia} and Momcilo Jankovic and Andrea Biondi and Lucia Miligi and Claudia Casella and Monica Terenziani and Maura Massimino and Carlotta Sacerdote and Vera Morsellino and Giovanni Erminio and Alberto Garaventa and Maura Faraci and Concetta Micalizzi and Garr{\`e}, {Maria Luisa} and Marta Pillon and Giuseppe Basso and Eleonora Biasin and Franca Fagioli and Roberto Rondelli and Andrea Pession and Franco Locatelli and Nicola Santoro and Paolo Indolfi and Giovanna Palumbo and Giovanna Russo and Federico Verzegnassi and Claudio Favre and Marco Zecca and Rossella Mura and Paolo D'Angelo and Carmen Cano and Julianne Byrne and Riccardo Haupt",
note = "Copyright {\circledC} 2019 Elsevier Ltd. All rights reserved.",
year = "2019",
month = "3",
doi = "10.1016/j.ejca.2018.12.021",
language = "English",
volume = "110",
pages = "86--97",
journal = "European Journal of Cancer",
issn = "0959-8049",
publisher = "Elsevier Ltd",

}

TY - JOUR

T1 - Late mortality and causes of death among 5-year survivors of childhood cancer diagnosed in the period 1960-1999 and registered in the Italian Off-Therapy Registry

AU - OTR-AIEOP Registry

AU - Bagnasco, Francesca

AU - Caruso, Silvia

AU - Andreano, Anita

AU - Valsecchi, Maria Grazia

AU - Jankovic, Momcilo

AU - Biondi, Andrea

AU - Miligi, Lucia

AU - Casella, Claudia

AU - Terenziani, Monica

AU - Massimino, Maura

AU - Sacerdote, Carlotta

AU - Morsellino, Vera

AU - Erminio, Giovanni

AU - Garaventa, Alberto

AU - Faraci, Maura

AU - Micalizzi, Concetta

AU - Garrè, Maria Luisa

AU - Pillon, Marta

AU - Basso, Giuseppe

AU - Biasin, Eleonora

AU - Fagioli, Franca

AU - Rondelli, Roberto

AU - Pession, Andrea

AU - Locatelli, Franco

AU - Santoro, Nicola

AU - Indolfi, Paolo

AU - Palumbo, Giovanna

AU - Russo, Giovanna

AU - Verzegnassi, Federico

AU - Favre, Claudio

AU - Zecca, Marco

AU - Mura, Rossella

AU - D'Angelo, Paolo

AU - Cano, Carmen

AU - Byrne, Julianne

AU - Haupt, Riccardo

N1 - Copyright © 2019 Elsevier Ltd. All rights reserved.

PY - 2019/3

Y1 - 2019/3

N2 - INTRODUCTION: Advances in paediatric oncology led to the increase in long-term survival, revealing the burden of therapy-related long-term side effects. We evaluated overall and cause-specific mortality in a large cohort of Italian childhood cancer survivors (CCSs) and adolescent cancer survivors identified through the off-therapy registry.MATERIALS AND METHODS: CCSs alive 5 years after cancer diagnosis occurring between 1960 and 1999 were eligible; the last follow-up was between 2011 and 2014. Outcomes were reported as standardised mortality ratios (SMRs) and absolute excess risks (AERs).RESULTS: Among 12,214 CCSs, 1113 (9.1%) deaths occurred. Survival at 35 years since diagnosis was 87% (95% confidence interval [CI]: 86-88) and at 45 years was 81% (95% CI: 77-84). CCSs had an 11-fold increased risk of death (SMR 95% CI: 10.7-12), corresponding to an AER of 48 (95% CI: 45-51). Mortality decreased by 60% for survivors treated most recently (1990-1999). The most frequent causes of death were recurrence of the original cancer (56%), a subsequent neoplasm (19%) and cardiovascular diseases (5.8%). Among those who survived at least 15 years after diagnosis, a secondary malignancy was the leading cause of death.CONCLUSIONS: This study confirms the impact of recent advances in anticancer therapy in reducing mortality, mainly attributable to recurrence but also to other causes. However, overall mortality continues to be higher than in the general population. A long-term follow-up is needed to prevent late mortality due to secondary neoplasms and non-neoplastic causes in CCSs.

AB - INTRODUCTION: Advances in paediatric oncology led to the increase in long-term survival, revealing the burden of therapy-related long-term side effects. We evaluated overall and cause-specific mortality in a large cohort of Italian childhood cancer survivors (CCSs) and adolescent cancer survivors identified through the off-therapy registry.MATERIALS AND METHODS: CCSs alive 5 years after cancer diagnosis occurring between 1960 and 1999 were eligible; the last follow-up was between 2011 and 2014. Outcomes were reported as standardised mortality ratios (SMRs) and absolute excess risks (AERs).RESULTS: Among 12,214 CCSs, 1113 (9.1%) deaths occurred. Survival at 35 years since diagnosis was 87% (95% confidence interval [CI]: 86-88) and at 45 years was 81% (95% CI: 77-84). CCSs had an 11-fold increased risk of death (SMR 95% CI: 10.7-12), corresponding to an AER of 48 (95% CI: 45-51). Mortality decreased by 60% for survivors treated most recently (1990-1999). The most frequent causes of death were recurrence of the original cancer (56%), a subsequent neoplasm (19%) and cardiovascular diseases (5.8%). Among those who survived at least 15 years after diagnosis, a secondary malignancy was the leading cause of death.CONCLUSIONS: This study confirms the impact of recent advances in anticancer therapy in reducing mortality, mainly attributable to recurrence but also to other causes. However, overall mortality continues to be higher than in the general population. A long-term follow-up is needed to prevent late mortality due to secondary neoplasms and non-neoplastic causes in CCSs.

U2 - 10.1016/j.ejca.2018.12.021

DO - 10.1016/j.ejca.2018.12.021

M3 - Article

C2 - 30772657

VL - 110

SP - 86

EP - 97

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

ER -