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 - 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
AU - Registry, OTR-AIEOP
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.
KW - Cardiotoxicity
KW - Causes of death
KW - Childhood cancer
KW - Childhood cancer long-term survivors
KW - Late mortality
KW - Second malignant neoplasms
U2 - 10.1016/j.ejca.2018.12.021
DO - 10.1016/j.ejca.2018.12.021
M3 - Article
VL - 110
SP - 86
EP - 97
JO - European Journal of Cancer
JF - European Journal of Cancer
SN - 0959-8049
ER -