Francesca Bagnasco1, Silvia Caruso1, Anita Andreano2, Maria Grazia Valsecchi2, Momcilo Jankovic3, Andrea Biondi3, Lucia Miligi4, Claudia Casella5, Monica Terenziani6, Maura Massimino6, Carlotta Sacerdote7, Vera Morsellino1, Giovanni Erminio1, Alberto Garaventa8, Maura Faraci8, Concetta Micalizzi8, Maria Luisa Garrè8, Marta Pillon9, Giuseppe Basso9, Eleonora Biasin10, Franca Fagioli11, Roberto Rondelli11, Andrea Pession11, Franco Locatelli12, Nicola Santoro13, Paolo Indolfi14, Giovanna Palumbo15, Giovanna Russo16, Federico Verzegnassi17, Claudio Favre18, Marco Zecca19, Rossella Mura20, Paolo D'Angelo21, Carmen Cano22, Julianne Byrne23, Riccardo Haupt24. 1. Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy. 2. Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. 3. Pediatric Department, San Gerardo Hospital, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy. 4. Environmental and Occupational Epidemiology Branch, Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy. 5. Tumori Ligure, Unit of Clinical Epidemiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 6. Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. 7. Unit of Cancer Epidemiology, Città Della Salute e Della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy. 8. Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, IRCCS Istituto Giannina Gaslini, Genova, Italy. 9. Department of Child and Woman Health, Oncology Hematology Division, University-Hospital of Padua, Padua, Italy. 10. Pediatric Onco-Hematology and Stem Cell Transplant Division, City of Health and Science, Regina Margherita Children's Hospital, University of Turin, Turin, Italy. 11. Pediatric Oncology Hematology "Lalla Seragnoli", Policlinico S.Orsola-Malpighi, Bologna, Italy. 12. Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 13. Pediatric Hematology-Oncology Division, Department of Pediatrics, University of Bari, Bari, Italy. 14. Pediatric Oncology Service, Pediatric Department, Second University of Naples, Napoli, Italy. 15. Sezione Ematologia Dipartimento di Biotecnologie Cellulari Ed Ematologia - Università La Sapienza, Roma, Italy. 16. Haematology/Oncology Unit, Dept of Pediatrics, University of Catania- Catania, Italy. 17. Pediatric Hemato-Oncology Unit, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy. 18. Department of Hematology and Oncology, University Hospital AOU Meyer, Florence, Italy. 19. Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 20. Paediatric Haematology and Oncology Unit, Ospedale Pediatrico Microcitemico, Cagliari, Italy. 21. Pediatric Oncology Unit, G. Di Cristina Children's Hospital, Palermo, Italy. 22. Onco-hematology Paediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, Modena, Italy. 23. Boyne Research Institute, Drogheda, Ireland. 24. Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy. Electronic address: riccardohaupt@gaslini.org.
Abstract
INTRODUCTION: Advances in paediatric oncology led to the increase in long-term survival, revealing the burden of therapy-related long-term side effects. We evaluated overall and cause-specific mortality in a large cohort of Italian childhood cancer survivors (CCSs) and adolescent cancer survivors identified through the off-therapy registry. MATERIALS AND METHODS: CCSs alive 5 years after cancer diagnosis occurring between 1960 and 1999 were eligible; the last follow-up was between 2011 and 2014. Outcomes were reported as standardised mortality ratios (SMRs) and absolute excess risks (AERs). RESULTS: Among 12,214 CCSs, 1113 (9.1%) deaths occurred. Survival at 35 years since diagnosis was 87% (95% confidence interval [CI]: 86-88) and at 45 years was 81% (95% CI: 77-84). CCSs had an 11-fold increased risk of death (SMR 95% CI: 10.7-12), corresponding to an AER of 48 (95% CI: 45-51). Mortality decreased by 60% for survivors treated most recently (1990-1999). The most frequent causes of death were recurrence of the original cancer (56%), a subsequent neoplasm (19%) and cardiovascular diseases (5.8%). Among those who survived at least 15 years after diagnosis, a secondary malignancy was the leading cause of death. CONCLUSIONS: This study confirms the impact of recent advances in anticancer therapy in reducing mortality, mainly attributable to recurrence but also to other causes. However, overall mortality continues to be higher than in the general population. A long-term follow-up is needed to prevent late mortality due to secondary neoplasms and non-neoplastic causes in CCSs.
INTRODUCTION: Advances in paediatric oncology led to the increase in long-term survival, revealing the burden of therapy-related long-term side effects. We evaluated overall and cause-specific mortality in a large cohort of Italian childhood cancer survivors (CCSs) and adolescent cancer survivors identified through the off-therapy registry. MATERIALS AND METHODS: CCSs alive 5 years after cancer diagnosis occurring between 1960 and 1999 were eligible; the last follow-up was between 2011 and 2014. Outcomes were reported as standardised mortality ratios (SMRs) and absolute excess risks (AERs). RESULTS: Among 12,214 CCSs, 1113 (9.1%) deaths occurred. Survival at 35 years since diagnosis was 87% (95% confidence interval [CI]: 86-88) and at 45 years was 81% (95% CI: 77-84). CCSs had an 11-fold increased risk of death (SMR 95% CI: 10.7-12), corresponding to an AER of 48 (95% CI: 45-51). Mortality decreased by 60% for survivors treated most recently (1990-1999). The most frequent causes of death were recurrence of the original cancer (56%), a subsequent neoplasm (19%) and cardiovascular diseases (5.8%). Among those who survived at least 15 years after diagnosis, a secondary malignancy was the leading cause of death. CONCLUSIONS: This study confirms the impact of recent advances in anticancer therapy in reducing mortality, mainly attributable to recurrence but also to other causes. However, overall mortality continues to be higher than in the general population. A long-term follow-up is needed to prevent late mortality due to secondary neoplasms and non-neoplastic causes in CCSs.
Authors: Luciana P C Leitão; Darlen C de Carvalho; Juliana C G Rodrigues; Marianne R Fernandes; Alayde V Wanderley; Lui W M S Vinagre; Natasha M da Silva; Lucas F Pastana; Laura P A Gellen; Matheus C E Assunção; Sweny S M Fernandes; Esdras E B Pereira; André M Ribeiro-Dos-Santos; João F Guerreiro; Ândrea Ribeiro-Dos-Santos; Paulo P de Assumpção; Sidney E B Dos Santos; Ney P C Dos Santos Journal: J Pers Med Date: 2022-05-25
Authors: Margaret M Lubas; Belinda N Mandrell; Kirsten K Ness; Deo Kumar Srivastava; Matthew J Ehrhardt; Zhaoming Wang; Melissa M Hudson; Leslie L Robison; Kevin R Krull; Tara M Brinkman Journal: Pediatr Blood Cancer Date: 2021-04-06 Impact factor: 3.838
Authors: Laurence H Baker; Philip S Boonstra; Denise K Reinke; Erin J Peregrine Antalis; Bradley J Zebrack; Richard L Weinberg Journal: J Cancer Metastasis Treat Date: 2020-08-07
Authors: Vincent Pluimakers; Marta Fiocco; Jenneke van Atteveld; Monique Hobbelink; Dorine Bresters; Eline Van Dulmen-den Broeder; Margriet Van der Heiden-van der Loo; Geert O Janssens; Leontien Kremer; Jacqueline Loonen; Marloes Louwerens; Helena Van der Pal; Cécile Ronckers; Hanneke Van Santen; Birgitta Versluys; Andrica De Vries; Marry Van den Heuvel-Eibrink; Sebastian Neggers Journal: JMIR Res Protoc Date: 2021-01-27