Cancer Survival among World Trade Center Rescue and Recovery Workers: A Collaborative Cohort Study

Abstract

BACKGROUND AND AIM: World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated METHODS: This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) to WTC-exposed responders not enrolled (WTC-non-MMTP responders) and to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or 12/31/2016. RESULTS:From 1/1/2005-12/31/2016, there were: 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders; 564 cancer cases and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders; and, 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% CI=0.64-0.82), and all-cause mortality HR was 0.64 (95% CI=0.58-0.72). Comparing WTC-MMTP responders with WTC-non-MMTP responders, the cancer-specific mortality HR was 0.77 (95% CI=0.61-0.97), and all-cause mortality HR was 0.69 (95% CI=0.57-0.84). The cancer-specific HR was 0.94 (95% CI=0.78-1.14), and all-cause mortality HR was 0.93 (95% CI=0.79-1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population. CONCLUSIONS:WTC-MMTP responders had lower mortality compared with WTC-non-MMTP responders and with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care, which could have important implications for healthcare policy KEYWORDS: cancer survival, occupational epidemiology