Noncancer-related mortality risks in adult survivors of pediatric malignancies: the childhood cancer survivor study

• Type of Material: Article
• Authors: Cheryl L. Cox, St. Jude Children’s Research Hospital; Vikki G. Nolan, University of Memphis; Wendy Leisenring, Fred Hutchinson Cancer Research Center; Yutaka Yasui, University of Alberta; Susan W. Ogg, St. Jude Children’s Research Hospital; Ann Mertens, Emory University; Joseph P. Neglia, University of Minnesota; Kirsten K. Ness, St. Jude Children’s Research Hospital; Gregory T. Armstrong, St. Jude Children’s Research Hospital; Les L. Robison, St. Jude Children’s Research Hospital
• Language: English
• Date: 2014-09-01
• Publisher: Springer (part of Springer Nature): Springer Open Choice Hybrid Journals
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 Springer Science+Business Media New York.
• Final Published Version (URL): http://dx.doi.org/10.1007/s11764-014-0353-7
• Title of Journal or Parent Work: Journal of Cancer Survivorship
• ISSN: 1932-2259
• Volume: 8
• Issue: 3
• Start Page: 460
• End Page: 471
• Grant/Funding Information: National Institute of Health grants U24 CA55727 (LL Robison, PI) and P30 CA21765 (R Gilbertson, PI); and the American Lebanese Syrian Associated Charities (ALSAC).
• Keywords: Cancer survivorship; WOMEN; CARDIOVASCULAR-DISEASE; PROSPECTIVE COHORT; Surveillance; NEOPLASMS; ALCOHOL-CONSUMPTION; REGRESSION; Social Sciences, Biomedical; METAANALYSIS; Biomedical Social Sciences; Life Sciences & Biomedicine; Science & Technology; SELF-RATED HEALTH; Social Sciences; Oncology; Childhood cancer; 5-YEAR SURVIVORS; Mortality risk
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Health Sciences, Oncology

Abstract

Purpose: We sought to identify factors, other than cancer-related treatment and presence/severity of chronic health conditions, which may be associated with late mortality risk among adult survivors of pediatric malignancies. Methods: Using the Childhood Cancer Survivor Study cohort and a case-control design, 445 participants who died from causes other than cancer recurrence/progression or non-health-related events were compared with 7,162 surviving participants matched for primary diagnosis, age at baseline questionnaire, time from diagnosis to baseline questionnaire, and time at-risk. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for overall/cause-specific mortality. Independent measures included number/severity of chronic conditions, medical care, health-related behaviors, and health perceptions/concerns. Results: Adjusting for education, income, chemotherapy/radiation exposures, and number/severity of chronic health conditions, an increased risk for all-cause mortality was associated with exercising fewer than 3 days/week (OR = 1.72, CI 1.27-2.34), being underweight (OR = 2.58, CI 1.55-4.28), increased medical care utilization (P < 0.001), and self-reported fair to poor health (P < 0.001). Physical activity was associated with a higher risk of death among males (OR = 3.26, CI 1.90-5.61) reporting no exercise compared to those who exercised ≥3 times per week. Ever consuming alcohol was associated with a reduced risk of all-cause (OR = 0.61, CI 0.41-0.89) and other nonexternal causes of death (OR = 0.40, CI 0.20-0.79). Concerns/worries about future health (OR = 1.54, CI 1.10-2.71) were associated with increased all-cause mortality. Conclusions: Factors independent of cancer treatment and chronic health conditions modify the risk of death among adult survivors of pediatric cancer. Implications for Cancer Survivors: Continued cohort observation may inform interventions to reduce mortality.