Jennifer M. Yeh, PhD; Larissa Nekhlyudov, MD, MPH; Sue J. Goldie, MD, MPH; Ann C. Mertens, PhD; Lisa Diller, MD
Acknowledgment: The authors thank Drs. Qi Liu and Yutaka Yasui for providing additional CCSS data, and Dr. Karen Kuntz for her methodological expertise.
Grant Support: By the National Cancer Institute (R25-CA057711; Dr. Yeh).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-2014.
Reproducible Research Statement:Study protocol: Available from Dr. Yeh (e-mail, firstname.lastname@example.org). Statistical code and data set: Not available.
Requests for Single Reprints: Jennifer M. Yeh, PhD, Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, Second Floor, Boston, MA 02115; e-mail, email@example.com.
Current Author Addresses: Drs. Yeh and Goldie: Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, Second Floor, Boston, MA 02115.
Dr. Nekhlyudov: Department of Population Medicine, Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02115.
Dr. Mertens: Emory University, Emory-Children's Center, 2015 Uppergate Drive, Atlanta, GA 30322.
Dr. Diller: Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.
Author Contributions: Conception and design: J.M. Yeh, L. Nekhlyudov, S.J. Goldie, L. Diller.
Analysis and interpretation of the data: J.M. Yeh, L. Nekhlyudov, S.J. Goldie, A.C. Mertens, L. Diller.
Drafting of the article: J.M. Yeh, S.J. Goldie, L. Diller.
Critical revision of the article for important intellectual content: J.M. Yeh, L. Nekhlyudov, S.J. Goldie, L. Diller.
Final approval of the article: J.M. Yeh, L. Nekhlyudov, S.J. Goldie, A.C. Mertens, L. Diller.
Provision of study materials or patients: L. Diller.
Statistical expertise: J.M. Yeh, L. Diller.
Obtaining of funding: J.M. Yeh, L. Diller.
Administrative, technical, or logistic support: J.M. Yeh, S.J. Goldie, L. Diller.
Collection and assembly of data: J.M. Yeh, A.C. Mertens, L. Diller.
Yeh J., Nekhlyudov L., Goldie S., Mertens A., Diller L.; A Model-Based Estimate of Cumulative Excess Mortality in Survivors of Childhood Cancer. Ann Intern Med. 2010;152:409-417. doi: 10.7326/0003-4819-152-7-201004060-00005
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Published: Ann Intern Med. 2010;152(7):409-417.
Although childhood cancer survival rates have dramatically increased, survivors face elevated risk for life-threatening late effects, including secondary cancer.
To estimate the cumulative effect of disease- and treatment-related mortality risks on survivor life expectancy.
State-transition model to simulate the lifetime clinical course of childhood cancer survivors.
Childhood Cancer Survivor Study.
Five-year survivors of childhood cancer.
Probabilities of risk for death from the original cancer diagnosis, excess mortality from subsequent cancer and cardiac, pulmonary, external, and other complications, and background mortality (age-specific mortality rates for the general population) were estimated over the lifetime of survivors of childhood cancer.
For a cohort of 5-year survivors aged 15 years who received a diagnosis of cancer at age 10 years, the average lifetime probability was 0.10 for late-recurrence mortality; 0.15 for treatment-related subsequent cancer and death from cardiac, pulmonary, and external causes; and 0.05 for death from other excess risks. Life expectancy for the cohort of persons aged 15 years was 50.6 years, a loss of 10.4 years (17.1%) compared with the general population. Reduction in life expectancy varied by diagnosis, ranging from 4.0 years (6.0%) for kidney tumor survivors to more than 17.8 years (â‰¥28.0%) for brain and bone tumor survivors, and was sensitive to late-recurrence mortality risk and duration of excess mortality risk.
Estimates are based on data for survivors who received treatment 20 to 40 years ago; patients who received treatment more recently may have more favorable outcomes.
Childhood cancer survivors face considerable mortality during adulthood, with excess risks reducing life expectancy by as much as 28%. Monitoring the health of current survivors and carefully evaluating therapies with known late toxicities in patients with newly diagnosed cancer are needed.
National Cancer Institute.
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Hematology/Oncology, Cancer Survivorship.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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