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

Cheryl L. Cox; Vikki G. Nolan; Wendy Leisenring; Yutaka Yasui; Susan W. Ogg; Ann C. Mertens; Joseph P. Neglia; Kirsten K. Ness; Gregory T. Armstrong; Les L. Robison

doi:10.1007/s11764-014-0353-7

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

Cheryl L. Cox, Vikki G. Nolan, Wendy Leisenring, Yutaka Yasui, Susan W. Ogg, Ann C. Mertens, Joseph P. Neglia, Kirsten K. Ness, Gregory T. Armstrong, Les L. Robison

Pediatrics - Hematology

Research output: Contribution to journal › Article › peer-review

20 Scopus citations

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.

Original language	English (US)
Pages (from-to)	460-471
Number of pages	12
Journal	Journal of Cancer Survivorship
Volume	8
Issue number	3
DOIs	https://doi.org/10.1007/s11764-014-0353-7
State	Published - Sep 2014

Bibliographical note

Funding Information:
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.

Keywords

Cancer survivorship
Childhood cancer
Mortality risk
Surveillance

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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title = "Noncancer-related mortality risks in adult survivors of pediatric malignancies: The childhood cancer survivor study",

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.",

keywords = "Cancer survivorship, Childhood cancer, Mortality risk, Surveillance",

author = "Cox, {Cheryl L.} and Nolan, {Vikki G.} and Wendy Leisenring and Yutaka Yasui and Ogg, {Susan W.} and Mertens, {Ann C.} and Neglia, {Joseph P.} and Ness, {Kirsten K.} and Armstrong, {Gregory T.} and Robison, {Les L.}",

note = "Funding Information: 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.",

year = "2014",

month = sep,

doi = "10.1007/s11764-014-0353-7",

language = "English (US)",

volume = "8",

pages = "460--471",

journal = "Journal of Cancer Survivorship",

issn = "1932-2259",

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T1 - Noncancer-related mortality risks in adult survivors of pediatric malignancies

T2 - The childhood cancer survivor study

AU - Cox, Cheryl L.

AU - Nolan, Vikki G.

AU - Leisenring, Wendy

AU - Yasui, Yutaka

AU - Ogg, Susan W.

AU - Mertens, Ann C.

AU - Neglia, Joseph P.

AU - Ness, Kirsten K.

AU - Armstrong, Gregory T.

AU - Robison, Les L.

N1 - Funding Information: 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.

PY - 2014/9

Y1 - 2014/9

N2 - 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.

AB - 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.

KW - Cancer survivorship

KW - Childhood cancer

KW - Mortality risk

KW - Surveillance

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

Abstract

Bibliographical note

Keywords

UN SDGs

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