Abstract
BackgroundReceiving a cancer diagnosis may trigger immediate fatal non-cancer health outcomes in addition to dying of cancer itself. We aim to investigate the full pattern of non-cancer deaths in patients within a year of a cancer diagnosis.MethodsPatients diagnosed with cancer between 1990 and 2016 were identified from the SEER program. Standardized mortality ratios (SMRs) were calculated to characterize the relative risks of non-cancer deaths compared with the general population.ResultsAmong 7,366,229 patients, 241,575 non-cancer deaths (15.9%) were recorded in the first year following a cancer diagnosis. The relative risk of non-cancer deaths was 2.34-fold (95% confidence interval (CI): 2.33–2.35) that of the general population. The majority of non-cancer deaths were caused by cardiovascular diseases (21.8%), followed by infectious diseases (7.2%). Significant elevations in mortality risks were observed for nearly all non-cancer causes, particularly in infectious diseases (SMR: 5.08; 95% CI: 5.03–5.13). Patients with liver cancer (SMR: 12.29; 95% CI: 12.06–12.53) were at the highest risk of early non-cancer deaths. The risks of non-cancer deaths were highest within the first month after diagnosis, and decreased rapidly thereafter.ConclusionsRisks of non-cancer deaths vary by the types of causes and anatomic sites of cancer. Our data underscore the importance of close observation and early multidisciplinary care for noncancer conditions in patients who have recently received a cancer diagnosis.
Highlights
As recent progress in cancer prevention, diagnosis, and treatment has prolonged survival of patients with cancer, risk of non-cancer deaths is becoming a great threat to the health of cancer survivors [1]
Compared with the general population, the relative risk of non-cancer deaths in patients with a cancer diagnosis was 2.34 within the first year after diagnosis
Compared with the general population, non-cancer death risks within the first year after diagnosis were higher among those with an age of 20 to 39 years (SMR: 19.88; 95% Cofidence Interval (CI): 19.43–20.34), of Asian or Pacific Islander ethnicity (SMR: 3.82; 95% CI: 3.62–4.03), unmarried (SMR: 2.92; 95% CI: 2.90–2.93), with distant metastases (SMR: 4.13; 95% CI: 4.10–4.17), not treated with surgery (SMR: 3.57; 95% CI: 3.55–3.59), and not treated with radiotherapy (SMR: 2.60; 95% CI: 2.59– 2.61)
Summary
As recent progress in cancer prevention, diagnosis, and treatment has prolonged survival of patients with cancer, risk of non-cancer deaths is becoming a great threat to the health of cancer survivors [1]. As cancer is largely a disease of elder persons, cancer survivorship and treatment occur in the context of comorbidities. Risks of deaths from other non-cancer causes remain unclear. This study intended to comprehensively assess all the non-cancer causes of death within the first year immediately after a cancer diagnosis. It aimed to identify the subgroups at particular risk of early death from non-cancer causes. Receiving a cancer diagnosis may trigger immediate fatal non-cancer health outcomes in addition to dying of cancer itself. We aim to investigate the full pattern of non-cancer deaths in patients within a year of a cancer diagnosis
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