Late mortality from other diseases following childhood cancer in Australia and the impact of intensity of treatment
File version
Accepted Manuscript (AM)
Author(s)
Walwyn, Thomas S
Cohn, Richard J
Harden, Hazel E
Pole, Jason D
Aitken, Joanne F
Griffith University Author(s)
Primary Supervisor
Other Supervisors
Editor(s)
Date
Size
File type(s)
Location
License
Abstract
BACKGROUND: People who receive treatment for cancer during childhood often experience subsequent complications of therapy, known as late effects, which can lead to an increased risk of death. PROCEDURE: Using deidentified population-based data from the Australian Childhood Cancer Registry for children aged 0-14 diagnosed with cancer during the period 1983-2011 and who survived for a minimum of 5 years, we examined disease-related deaths (other than cancer recurrence or second primary cancers) that occurred up to 31 December 2016. Risk of death relative to the general population was approximated using standardised mortality ratios (SMRs). Treatment received was stratified according to the intensity of treatment rating, version 3 (ITR-3). RESULTS: During the study period, 82 noncancer disease-related deaths were recorded among 13 432 childhood cancer survivors, four times higher than expected (SMR = 4.43, 95% CI = 3.57-5.50). A clear link to treatment intensity was observed, with the relative risk of noncancer disease-related mortality being twice as high for children who underwent 'most intensive' treatment (SMR = 5.94, 95% CI = 3.69-9.55) compared to the 'least intensive' treatment group (SMR = 2.98, 95% CI = 1.42-6.24; Ptrend = .01). Thirty-year cumulative mortality from noncancer disease-related deaths was estimated at 1.4% (95% CI = 1.1-1.9) after adjusting for competing causes of death such as cancer, accidents, or injuries. CONCLUSIONS: Although childhood cancer survivors are at increased relative risk of death from noncancer diseases, particularly those who undergo more intensive treatment, the cumulative mortality within 30 years of diagnosis remains small. Knowledge of late effects can guide surveillance of survivors and treatment modification, without wanting to compromise the high rates of survival.
Journal Title
Pediatric Blood & Cancer
Conference Title
Book Title
Edition
Volume
68
Issue
5
Thesis Type
Degree Program
School
Publisher link
Patent number
Funder(s)
Grant identifier(s)
Rights Statement
Rights Statement
© 2020 Wiley Periodicals Inc. This is the peer reviewed version of the following article: Late mortality from other diseases following childhood cancer in Australia and the impact of intensity of treatment, Pediatric Blood & Cancer, 2021, 68 (5), pp. e28835, which has been published in final form at https://doi.org/10.1002/pbc.28835. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Item Access Status
Note
Access the data
Related item(s)
Subject
Clinical sciences
Oncology and carcinogenesis
childhood cancer
late effects
mortality
survivorship
treatment intensity
Persistent link to this record
Citation
Youlden, DR; Walwyn, TS; Cohn, RJ; Harden, HE; Pole, JD; Aitken, JF, Late mortality from other diseases following childhood cancer in Australia and the impact of intensity of treatment, Pediatric Blood & Cancer, 2021, 68 (5), pp. e28835