LATE MORTALITY OF LONG-TERM SURVIVORS OF CHILDHOOD-CANCER

Purpose: To determine the frequency and patterns of lore mortality amo ng long-term survivors of childhood cancer. Materials and Methods: Med ical records of patients who survived at least 5 years after the diagn osis of childhood cancer were reviewed to determine the causes of subs equent deaths. Estimated 15-year survival and standardized mortality r atios for deaths from nonneoplastic treatment complications were compa red with adjusted United States population estimates, The study includ ed 2,053 patients who had survived greater than or equal to 5 years, g rouped by treatment eras that reflected increased intensity of therapy and significantly improved survival (early era, 1962 to 1970; recent era, 1971 to 1983). Results: There have been 258 subsequent deaths in the 2,053 childhood cancer survivors; 169 occurred 5 to 10 years postd iagnosis and 89 greater than or equal to 10 years post diagnosis. For the study period as a whole, deaths were attributed to recurrent prima ry malignancy in 61% of cases, second malignancy in 20%, nonneoplastic treatment complication in 10%, and unintentional injury/suicide in 8% . Late death from recurrent disease decreased significantly for surviv ors treated in the recent era (P < .0001), while the risk of death fro m second malignancies increased, although not statistically significan tly (P = .10). Projected 15-year survival estimates for all greater th an or equal to 5-year survivors in both treatment ems was greater than 90%, but differed from expected rates, Conclusion: Late mortality fro m recurrence after treatment for childhood cancer decreases with more effective initial therapy. Prolonged disease-free status is associated with an expected survival that approaches that of the general populat ion for patients treated from 1971 through 1983. The impact of more re cent intensified and novel therapies for high-risk patients remains to be determined. (C) 1997 by American Society of Clinical Oncology.