Two studies of very large cohorts of survivors have reported more premature mortality compared with the general population. The most common causes of death were relapse of the primary cancer, second malignancy, and cardiac toxicity.[1,2] Despite high premature morbidity rates, overall mortality has decreased over time. This reduction is related to a decrease in deaths from the primary cancer without an associated increase in mortality from second cancers or treatment-related toxicities. The former reflects improvements in therapeutic efficacy, and the latter reflects changes in therapy made subsequent to studying the causes of late effects. The expectation that mortality rates in survivors will continue to exceed those in the general population is based on the long-term sequelae that are likely to increase with attained age. If patients treated on therapeutic protocols are followed for long periods into adulthood, it will be possible to evaluate the excess lifetime mortality in relation to specific therapeutic interventions.

References

1. Mertens AC, Yasui Y, Neglia JP, et al.: Late mortality experience in five-year survivors of childhood and adolescent cancer: the Childhood Cancer Survivor Study. J Clin Oncol 19 (13): 3163-72, 2001.  [PUBMED Abstract]
   
   
2. Möller TR, Garwicz S, Barlow L, et al.: Decreasing late mortality among five-year survivors of cancer in childhood and adolescence: a population-based study in the Nordic countries. J Clin Oncol 19 (13): 3173-81, 2001.  [PUBMED Abstract]
   
   

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