Noncancer-related mortality risks in adult survivors of pediatric malignancies: the childhood cancer survivor study
- Cheryl L. CoxAffiliated withDepartment of Epidemiology/Cancer Control, St. Jude Children’s Research Hospital Email author
- , Vikki G. NolanAffiliated withSchool of Public Health, University of Memphis
- , Wendy LeisenringAffiliated withClinical Research Division, Fred Hutchinson Cancer Research Center
- , Yutaka YasuiAffiliated withDepartment of Public Health Sciences, University of Alberta
- , Susan W. OggAffiliated withDepartment of Epidemiology/Cancer Control, St. Jude Children’s Research Hospital
- , Ann C. MertensAffiliated withDepartment of Pediatrics, Emory University
- , Joseph P. NegliaAffiliated withDepartment of Pediatrics, University of Minnesota
- , Kirsten K. NessAffiliated withDepartment of Epidemiology/Cancer Control, St. Jude Children’s Research Hospital
- , Gregory T. ArmstrongAffiliated withDepartment of Epidemiology/Cancer Control, St. Jude Children’s Research Hospital
- and 1 more
- , Les L. RobisonAffiliated withDepartment of Epidemiology/Cancer Control, St. Jude Children’s Research Hospital
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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.
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.
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.
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.
KeywordsMortality risk Childhood cancer Surveillance Cancer survivorship
- Noncancer-related mortality risks in adult survivors of pediatric malignancies: the childhood cancer survivor study
Journal of Cancer Survivorship
Volume 8, Issue 3 , pp 460-471
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Mortality risk
- Childhood cancer
- Cancer survivorship
- Industry Sectors
- Author Affiliations
- 1. Department of Epidemiology/Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA
- 2. School of Public Health, University of Memphis, Memphis, TN, USA
- 3. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- 4. Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada
- 5. Department of Pediatrics, Emory University, Atlanta, GA, USA
- 6. Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA