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Long-term non-cancer mortality in pediatric and young adult cancer survivors in Finland

Authors

  • Pinki K. Prasad MD, MPH,

    Corresponding author
    1. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
    2. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
    • Vanderbilt-Ingram Cancer Center, 397 Preston Research Building, 2220 Pierce Avenue, Nashville, TN 37232.
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  • Lisa B. Signorello ScD,

    1. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
    2. Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
    3. International Epidemiology Institute, Rockville, Maryland
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  • Debra L. Friedman MD, MS,

    1. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
    2. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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  • John D. Boice Jr. ScD,

    1. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
    2. Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
    3. International Epidemiology Institute, Rockville, Maryland
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  • Eero Pukkala PhD

    1. School of Public Health, University of Tampere, Tampere, Finland
    2. Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
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  • Conflict of interest: The authors of this paper do not have any financial interest in the subject matter discussed. This includes ownership of stock, membership on a standing advisory council or committee, a seat on the board of directors, or being publicly associated with a company or its products.

Abstract

Background

Excess late mortality has been reported among pediatric cancer survivors, but there is a need to further establish risk profiles for non-cancer death and to examine cause-specific mortality among survivors of young adult cancers.

Procedures

In a nationwide record linkage study in Finland, we identified 9,245 5-year cancer survivors diagnosed before age 35 and treated between 1966 and 1999, and followed them for mortality endpoints from 1971 to 2008. Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were calculated to compare the observed number of deaths with those expected in the general Finnish population. Primary endpoints included death from cardiovascular and respiratory diseases; death from malignant diseases was excluded.

Results

Non-malignant disease mortality in the cohort was 90% higher (SMR = 1.9, 95% CI: 1.7–2.2) than expected, with SMRs for circulatory and respiratory disease similarly elevated (SMR = 1.9, 95% CI: 1.5–2.3 and SMR = 2.3, 95% CI: 1.3–3.8, respectively). Important differences were noted amongst patient subgroups, with risk greatest for survivors of central nervous system (CNS) cancer, Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL). The SMR's for circulatory disease were 6.6 (95% CI: 4.8–8.9) for HL and 4.8 (95% CI: 2.6–8.1) for NHL for the entire population; but these risks remained elevated for survivors diagnosed between 15 and 34 years of age.

Conclusions

Previous studies have shown that there is an elevated risk of non-cancer mortality in childhood cancer survivors; this is one of the first studies that show an increase in cardiovascular and respiratory mortality in long-term survivors of adolescent and young adult cancers. Pediatr Blood Cancer 2012; 58: 421–427. © 2011 Wiley Periodicals, Inc.

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