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Cited by 776Childhood Cancer Survivors' Quality of LifeMultiple and Secondary Primary CancersCancer survivorship and care

Late Mortality Among 5-Year Survivors of Childhood Cancer: A Summary From the Childhood Cancer Survivor Study

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Armstrong, Gregory T., Liu, Qi, Yasui, Yutaka, Neglia, Joseph P., Leisenring, Wendy, Robison, Leslie L., Mertens, Ann C.·2009·Journal of Clinical Oncology
DOI 10.1200/jco.2008.21.1425PMC PMC2677921
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Abstract

The Childhood Cancer Survivor Study (CCSS) has assembled the largest cohort to date for assessment of late mortality. Vital status and cause of death of all patients eligible for participation in CCSS was determined using the National Death Index and death certificates to characterize the mortality experience of 20,483 survivors, representing 337,334 person-years of observation. A total of 2,821 deaths have occurred as of December 31, 2002. The overall cumulative mortality is 18.1% (95% CI, 17.3 to 18.9) at 30 years from diagnosis. With time, while all-cause mortality rates have been stable, the pattern of late death is changing. Mortality attributable to recurrence or progression of primary disease is decreasing, with increases in rates of mortality attributable to subsequent neoplasms (standardized mortality ratios [SMR], 15.2; 95% CI, 13.9 to 16.6), cardiac death (SMR, 7.0; 95% CI, 5.9 to 8.2), and pulmonary death (SMR, 8.8; 95% CI, 6.8 to 11.2) largely due to treatment-related causes. In addition, the CCSS has identified specific treatment-related risk factors for late mortality. Radiotherapy (relative risk [RR], 2.9; 95% CI, 2.1 to 4.2), alkylating agents (RR, 2.2; 95% CI, 1.6 to 3.0), and epipodophyllotoxins (RR, 2.3; 95% CI, 1.2 to 4.5) increase the risk of death due to subsequent malignancy. Cardiac radiation exposure (RR, 3.3; 95% CI, 2.0 to 5.5) and high dose of anthracycline exposure (RR, 3.1; 95% CI, 1.6 to 5.8) are associated with late cardiac death. By continued longitudinal follow-up of the cohort and expansion of the cohort to include patients diagnosed between 1987 and 1999, the CCSS will remain a primary resource for assessment of late mortality of survivors of childhood cancers.

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  • Anthracycline-induced severe cardiomyopathy is a common, potentially fatal late effect of chemotherapy, with ~2% of non-relapse-related deaths among childhood cancer survivors attributed to cardiomyopathy or heart failure.

    “Anthracycline-induced, severe cardiomyopathy is another common, potentially fatal late effect of chemotherapy, with ~2% of non-relapse-related deaths among childhood cancer survivors attributed to cardiomyopathy or heart failure 160 .”

    From Osteosarcoma (2022) · cites this paper as [160]

  • In trials for relapsed/refractory osteosarcoma, MTKIs were effective in reducing PFS and became mainstay.

    “In these trials, MTKIs were effective in reducing PFS, becoming the mainstay of treatments for patients with relapsed disease.”

    From Osteosarcoma (2022) · cites this paper as [160]

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Authors
Armstrong, G. T., Liu, Q., Yasui, Y., Neglia, J. P., Leisenring, W., Robison, L. L., & Mertens, A. C.
Affiliations
University of Minnesota (US)
ORCID
Venue
Journal of Clinical Oncology
Publisher
American Society of Clinical Oncology (ASCO)
Published
2009-05-10
Volume
27
Issue
14
Pages
2328-2338
ISSN
  • 0732-183X (ISSN-L)
  • 1527-7755
DOI
10.1200/jco.2008.21.1425
PMC
PMC2677921
OpenAlex
W1988228415
Cited by
776
References
34
Citations by year
2026: 26 · 2025: 40 · 2024: 53 · 2023: 57 · 2022: 46 · 2021: 61 · 2020: 56 · 2019: 58 · 2018: 43 · 2017: 40 · 2016: 60 · 2015: 51 · 2014: 40 · 2013: 41 · 2012: 34
FWCI
4.60
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Oncology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Cancer Institute (U24CA055727)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
  • Health Sciences › Medicine › Epidemiology › Multiple and Secondary Primary Cancers
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords
childhood cancer survivors, late mortality, Childhood Cancer Survivor Study, secondary malignancies, cardiovascular mortality, radiotherapy, alkylating agents, epipodophyllotoxins, anthracyclines, cumulative mortality
MeSH terms
Adolescent, Adult, Age Factors, Cardiovascular Diseases, Cause of Death, Child, Female, Follow-Up Studies, Humans, Male, Neoplasm Recurrence, Local, Neoplasms, Pregnancy, Pregnancy Complications, Neoplastic, Quality of Life, Retrospective Studies, Sex Factors, United States, Cohort Studies, Multicenter Studies as Topic, Comorbidity, Incidence, Survival Rate, Treatment Outcome, Cost of Illness, Sex Distribution, Survivors, Risk Assessment, National Cancer Institute (U.S.), Young Adult

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