Abstract
Late mortality of European 5-year survivors of childhood or adolescent cancer has dropped over the last 60 years, but excess mortality persists. There is little information concerning secular trends in cause-specific mortality among older European survivors. PanCareSurFup pooled data from 12 cancer registries and clinics in 11 European countries from 77 423 five-year survivors of cancer diagnosed before age 21 between 1940 and 2008 followed for an average age of 21 years and a total of 1.27 million person-years to determine their risk of death using cumulative mortality, standardized mortality ratios (SMR), absolute excess risks (AER), and multivariable proportional hazards regression analyses. At the end of follow-up 9166 survivors (11.8%) had died compared to 927 expected (SMR 9.89, 95% confidence interval [95% CI] 9.69-10.09), AER 6.47 per 1000 person-years, (95% CI 6.32-6.62). At 60 to 68 years of attained age all-cause mortality was still higher than expected (SMR = 2.41, 95% CI 1.90-3.02). Overall cumulative mortality at 25 years from diagnosis dropped from 18.4% (95% CI 16.5-20.4) to 7.3% (95% CI 6.7-8.0) over the observation period. Compared to the diagnosis period 1960 to 1969, the mortality hazard ratio declined for first neoplasms (P for trend <.0001) and for infections (P <.0001); declines in relative mortality from second neoplasms and cardiovascular causes were less pronounced (P =.1105 and P =.0829, respectively). PanCareSurFup is the largest study with the longest follow-up of late mortality among European childhood and adolescent cancer 5-year survivors, and documents significant mortality declines among European survivors into modern eras. However, continuing excess mortality highlights survivors' long-term care needs.
Original language | English |
---|---|
Pages (from-to) | 406-419 |
Number of pages | 14 |
Journal | International journal of cancer. Journal international du cancer |
Volume | 150 |
Issue number | 3 |
Early online date | 2021 |
DOIs | |
Publication status | Published - 1 Feb 2022 |
Keywords
- European
- cardiovascular
- causes of death
- late mortality
- second malignant neoplasms
- survivors of childhood cancer
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In: International journal of cancer. Journal international du cancer, Vol. 150, No. 3, 01.02.2022, p. 406-419.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Impact of era of diagnosis on cause-specific late mortality among 77 423 five-year European survivors of childhood and adolescent cancer
T2 - The PanCareSurFup consortium
AU - Byrne, Julianne
AU - Schmidtmann, Irene
AU - Rashid, Humayra
AU - Hagberg, Oskar
AU - Bagnasco, Francesca
AU - Bardi, Edit
AU - de Vathaire, Florent
AU - Essiaf, Samira
AU - Winther, Jeanette Falck
AU - Frey, Eva
AU - Gudmundsdottir, Thorgerdur
AU - Haupt, Riccardo
AU - Hawkins, Michael M.
AU - Jakab, Zsuzsanna
AU - Jankovic, Momcilo
AU - Kaatsch, Peter
AU - Kremer, Leontien C. M.
AU - Kuehni, Claudia E.
AU - Harila-Saari, Arja
AU - Levitt, Gill
AU - Reulen, Raoul
AU - Ronckers, C. cile M.
AU - Maule, Milena
AU - Skinner, Roderick
AU - Steliarova-Foucher, Eva
AU - Terenziani, Monica
AU - Zaletel, Lorna Zadravec
AU - Hjorth, Lars
AU - Garwicz, Stanislaw
AU - Grabow, Desiree
N1 - Funding Information: Barncancerfonden; Compagnia San Paolo; European Commission, Grant/Award Number: 257505; Fondation Pfizer pour la Sante de L'enfant et de L'Adolescent; Fondo Chiara Rama ONLUS; French Agence Nationale Pour la Recherche Scientifique; Institut National Du Cancer; Italian Ministry of Health Ricerca Corrente; Javna Agencija za Raziskovalno Dejavnost RS; KWF Kankerbestrijding, Grant/Award Number: UVA 2012‐5517; La Ligue Nationale Contre le Cancer; Schweizerischer Nationalfonds zur Forderung der Wissenschaftlichen Forschung, Grant/Award Number: PDFMP3_141775; Swiss Cancer League, Grant/Award Number: KLS‐3412‐02‐2014; Swiss Cancer Research Foundation, Grant/Award Numbers: KFS‐02783‐02‐2011, KFS‐4157‐02‐2017; Swiss Paediatric Oncology Group; The Italian Association for Cancer Research Funding information Funding Information: We are grateful to all the survivors who allowed their personal information to be used for research and in PanCareSurFup. We thank all those involved in the data collection, and data management, including Tina ?agar from the Slovenian Cancer Registry; Klaus Bjerregaard and Bo Midberg, Regional Cancer Centre South, Lund, Sweden; Melanie Kaiser and staff of the German Childhood Cancer Registry; the Italian Association of Cancer Registries (AIRTUM), the Italian Registry of Off-Therapy (OTR) of the Italian Association of Pediatric Hematology and Oncology (AIEOP). This project has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no 257505 (PanCareSurFup). The material presented and views expressed here are the responsibility of the authors only. The EU Commission takes no responsibility for any use made of the information set out. Additional financial support was received from: The Swedish Childhood Cancer Fund (Lund University); The Italian Association for Cancer Research and the Compagnia San Paolo (University of Turin); the Italian Ministry of Health Ricerca Corrente (Istituto Giannina Gaslini, University of Turin); The Fondo Chiara Rama ONLUS (Istituto Giannina Gaslini); La Ligue Nationale Contre le Cancer (Universit? Paris-Sud, Orsay; The French Agence Nationale Pour la Recherche Scientifique (Hope-Epi project; Universit? Paris-Sud Orsay); the Institut National du Cancer (Universit? Paris-Sud Orsay); Fondation Pfizer pour la sant? de l'enfant et de l'adolescent (Universit? Paris-Sud Orsay); Slovenian Research Agency (Institute of Oncology); the Swiss Pediatric Oncology Group (University of Bern); The Swiss Cancer League (KLS-3412-02-2014; University of Bern); The Swiss Cancer Research Foundation (KFS-02783-02-2011 and KFS-4157-02-2017; University of Bern); The Swiss National Science Foundation Grant Number (PDFMP3_141775 and KFS-4157-02-2017; University of Bern); Dutch Cancer Society (UVA 2012-5517; Academic Medical Center, Amsterdam, the Netherlands). The material presented and views expressed here are the responsibility of the authors only. Neither the EU Commission nor any other funder takes responsibility for any use made of the information set out. Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization. Funding Information: We are grateful to all the survivors who allowed their personal information to be used for research and in PanCareSurFup. We thank all those involved in the data collection, and data management, including Tina Žagar from the Slovenian Cancer Registry; Klaus Bjerregaard and Bo Midberg, Regional Cancer Centre South, Lund, Sweden; Melanie Kaiser and staff of the German Childhood Cancer Registry; the Italian Association of Cancer Registries (AIRTUM), the Italian Registry of Off‐Therapy (OTR) of the Italian Association of Pediatric Hematology and Oncology (AIEOP). This project has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no 257505 (PanCareSurFup). The material presented and views expressed here are the responsibility of the authors only. The EU Commission takes no responsibility for any use made of the information set out. Additional financial support was received from: The Swedish Childhood Cancer Fund (Lund University); The Italian Association for Cancer Research and the Compagnia San Paolo (University of Turin); the Italian Ministry of Health Ricerca Corrente (Istituto Giannina Gaslini, University of Turin); The Fondo Chiara Rama ONLUS (Istituto Giannina Gaslini); La Ligue Nationale Contre le Cancer (Université Paris‐Sud, Orsay; The French Agence Nationale Pour la Recherche Scientifique (Hope‐Epi project; Université Paris‐Sud Orsay); the Institut National du Cancer (Université Paris‐Sud Orsay); Fondation Pfizer pour la santé de l'enfant et de l'adolescent (Université Paris‐Sud Orsay); Slovenian Research Agency (Institute of Oncology); the Swiss Pediatric Oncology Group (University of Bern); The Swiss Cancer League (KLS‐3412‐02‐2014; University of Bern); The Swiss Cancer Research Foundation (KFS‐02783‐02‐2011 and KFS‐4157‐02‐2017; University of Bern); The Swiss National Science Foundation Grant Number (PDFMP3_141775 and KFS‐4157‐02‐2017; University of Bern); Dutch Cancer Society (UVA 2012‐5517; Academic Medical Center, Amsterdam, the Netherlands). The material presented and views expressed here are the responsibility of the authors only. Neither the EU Commission nor any other funder takes responsibility for any use made of the information set out. Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization. Publisher Copyright: © 2021 UICC.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - Late mortality of European 5-year survivors of childhood or adolescent cancer has dropped over the last 60 years, but excess mortality persists. There is little information concerning secular trends in cause-specific mortality among older European survivors. PanCareSurFup pooled data from 12 cancer registries and clinics in 11 European countries from 77 423 five-year survivors of cancer diagnosed before age 21 between 1940 and 2008 followed for an average age of 21 years and a total of 1.27 million person-years to determine their risk of death using cumulative mortality, standardized mortality ratios (SMR), absolute excess risks (AER), and multivariable proportional hazards regression analyses. At the end of follow-up 9166 survivors (11.8%) had died compared to 927 expected (SMR 9.89, 95% confidence interval [95% CI] 9.69-10.09), AER 6.47 per 1000 person-years, (95% CI 6.32-6.62). At 60 to 68 years of attained age all-cause mortality was still higher than expected (SMR = 2.41, 95% CI 1.90-3.02). Overall cumulative mortality at 25 years from diagnosis dropped from 18.4% (95% CI 16.5-20.4) to 7.3% (95% CI 6.7-8.0) over the observation period. Compared to the diagnosis period 1960 to 1969, the mortality hazard ratio declined for first neoplasms (P for trend <.0001) and for infections (P <.0001); declines in relative mortality from second neoplasms and cardiovascular causes were less pronounced (P =.1105 and P =.0829, respectively). PanCareSurFup is the largest study with the longest follow-up of late mortality among European childhood and adolescent cancer 5-year survivors, and documents significant mortality declines among European survivors into modern eras. However, continuing excess mortality highlights survivors' long-term care needs.
AB - Late mortality of European 5-year survivors of childhood or adolescent cancer has dropped over the last 60 years, but excess mortality persists. There is little information concerning secular trends in cause-specific mortality among older European survivors. PanCareSurFup pooled data from 12 cancer registries and clinics in 11 European countries from 77 423 five-year survivors of cancer diagnosed before age 21 between 1940 and 2008 followed for an average age of 21 years and a total of 1.27 million person-years to determine their risk of death using cumulative mortality, standardized mortality ratios (SMR), absolute excess risks (AER), and multivariable proportional hazards regression analyses. At the end of follow-up 9166 survivors (11.8%) had died compared to 927 expected (SMR 9.89, 95% confidence interval [95% CI] 9.69-10.09), AER 6.47 per 1000 person-years, (95% CI 6.32-6.62). At 60 to 68 years of attained age all-cause mortality was still higher than expected (SMR = 2.41, 95% CI 1.90-3.02). Overall cumulative mortality at 25 years from diagnosis dropped from 18.4% (95% CI 16.5-20.4) to 7.3% (95% CI 6.7-8.0) over the observation period. Compared to the diagnosis period 1960 to 1969, the mortality hazard ratio declined for first neoplasms (P for trend <.0001) and for infections (P <.0001); declines in relative mortality from second neoplasms and cardiovascular causes were less pronounced (P =.1105 and P =.0829, respectively). PanCareSurFup is the largest study with the longest follow-up of late mortality among European childhood and adolescent cancer 5-year survivors, and documents significant mortality declines among European survivors into modern eras. However, continuing excess mortality highlights survivors' long-term care needs.
KW - European
KW - cardiovascular
KW - causes of death
KW - late mortality
KW - second malignant neoplasms
KW - survivors of childhood cancer
UR - http://www.scopus.com/inward/record.url?scp=85117439375&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ijc.33817
DO - https://doi.org/10.1002/ijc.33817
M3 - Article
C2 - 34551126
SN - 0020-7136
VL - 150
SP - 406
EP - 419
JO - International journal of cancer. Journal international du cancer
JF - International journal of cancer. Journal international du cancer
IS - 3
ER -