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Late Mortality and Chronic Health Conditions in Long-Term Survivors of AYA Cancers


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A retrospective analysis from the Childhood Cancer Survivor Study, reported in The Lancet Oncology by Eugene Suh, MD, and colleagues, showed that as with survivors of childhood cancers, survivors of adolescent and young adult (AYA) cancers are at increased risk of earlier mortality and chronic health conditions compared with the general population or age-matched siblings.

Eugene Suh, MD

Eugene Suh, MD

The study involved an analysis of outcomes among 5-year survivors of early-adolescent and young adult cancers (aged 15–20 years at diagnosis) and 5-year survivors diagnosed at age < 15 years (childhood cancer survivors) matched for primary cancer diagnosis (including leukemia, lymphoma, central nervous system tumors, neuroblastoma, Wilms tumor, soft-tissue sarcomas, and bone cancer) by comparing both groups to the U.S. population and same-age siblings. Standardized mortality ratios were estimated using age-, sex-, and calendar year–specific U.S. rates.

Key Findings

Compared with the general population, the standardized mortality ratio was 5.9 (95% confidence interval [CI] = 5.5–6.2) among 5,804 early-adolescent and young adult survivors (median age = 42 years), numerically lower than the standardized mortality ratio of 6.2 (95% CI = 5.8–6.6) among 5,804 childhood cancer survivors (median age = 34 years; P = .22).

“Early-adolescent and young adult cancer survivors had higher risks of mortality and severe and life-threatening chronic health conditions than the general population. However, early-adolescent and young adult cancer survivors had lower nonrecurrent, health-related standardized mortality ratios and relative risks of developing grade 3–5 chronic health conditions than childhood cancer survivors, by comparison with siblings of the same age, which were most notable more than 20 years after their original cancer."
— Eugene Suh, MD, and colleagues

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Compared with the general population, the standardized mortality ratio for death from health-related causes (excluding recurrence or progression of primary cancer and external causes, but including late effects of cancer therapy) among early-adolescent and young adult survivors was 4.8 (95% CI = 4.4–5.1), significantly lower than the standardized mortality ratio of  6.8 among childhood cancer survivors (P < .0001); the difference was primarily evident > 20 years after cancer diagnosis.

Compared with 3,806 siblings of the same age, early-adolescent and young adult survivors (HR = 4.2, 95% CI = 3.7–4.8) and childhood survivors (HR = 5.6, 95% CI = 4.9–6.3) were at increased risk of severe and disabling, life-threatening, or fatal (grade 3–5) health conditions.

Compared with same-age siblings, both early-adolescent and young adult survivor and childhood survivor groups were at increased risk of developing grade 3 to 5 cardiac, endocrine, and musculoskeletal conditions; risks were numerically lower among early-adolescent and young adult survivors vs childhood cancer survivors.

The investigators concluded, “Early-adolescent and young adult cancer survivors had higher risks of mortality and severe and life-threatening chronic health conditions than the general population. However, early-adolescent and young adult cancer survivors had lower nonrecurrent, health-related standardized mortality ratios and relative risks of developing grade 3–5 chronic health conditions than childhood cancer survivors, by comparison with siblings of the same age, which were most notable more than 20 years after their original cancer. These results highlight the need for long-term screening of both childhood and early-adolescent and young adult cancer survivors.”

Tara O. Henderson, MD, of the University of Chicago Comer Children’s Hospital, is the corresponding author for The Lancet Oncology article.

Disclosure: The study was funded by the National Cancer Institute and American Lebanese-Syrian Associated Charities. For full disclosures of the study authors, visit thelancet.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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