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

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Journal of Cancer Survivorship Aims and scope Submit manuscript

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.

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Acknowledgments

Special thanks to the support from the National Institute of Health grants U24 CA55727 (LL Robison, PI) and P30 CA21765 (R Gilbertson, PI), and the American Lebanese Syrian Associated Charities (ALSAC). Podium presentation at the American Public Health Association Annual Meeting, November 5, 2013, Boston, MA. Cox CL, Nolan V, Leisenring W, Yasui Y, Ogg S, Neglia J, Ness K, Robison LL. Health perceptions, behavior, and medical care utilization: Links to mortality in adult survivors of childhood cancer.

Conflict of interest

The authors have no conflict of interest, financial or otherwise. There are no disclosures of any nature.

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Authors and Affiliations

  1. Department of Epidemiology/Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA

    Cheryl L. Cox, Susan W. Ogg, Kirsten K. Ness, Gregory T. Armstrong & Les L. Robison

  2. School of Public Health, University of Memphis, Memphis, TN, USA

    Vikki G. Nolan

  3. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Wendy Leisenring

  4. Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada

    Yutaka Yasui

  5. Department of Pediatrics, Emory University, Atlanta, GA, USA

    Ann C. Mertens

  6. Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    Joseph P. Neglia

Authors
  1. Cheryl L. Cox
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  2. Vikki G. Nolan
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  3. Wendy Leisenring
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  4. Yutaka Yasui
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  5. Susan W. Ogg
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  6. Ann C. Mertens
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  7. Joseph P. Neglia
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  8. Kirsten K. Ness
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  9. Gregory T. Armstrong
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  10. Les L. Robison
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Corresponding author

Correspondence to Cheryl L. Cox.

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Cox, C.L., Nolan, V.G., Leisenring, W. et al. Noncancer-related mortality risks in adult survivors of pediatric malignancies: the childhood cancer survivor study. J Cancer Surviv 8, 460–471 (2014). https://doi.org/10.1007/s11764-014-0353-7

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  • DOI: https://doi.org/10.1007/s11764-014-0353-7

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