Five-Year Survivors Of Cancer Research Articles

Age- and sex- specific rate of venous thromboembolism in cancer survivors: a nationwide cohort study

Abstract Background Patients with cancer have an increased risk of venous thromboembolism (VTE) initially, then to decrease over time. VTE might be potentially preventable with pharmacologic prophylaxis, particularly in high-risk patients. The long-term risk of VTE among cancer survivors, however, has not been reported. Purpose We investigated the rate of VTE in survivors of various cancers 5 years out from diagnosis, overall and according to age and sex. Methods Using Danish nationwide registries, five-year survivors of 20 cancers (diagnosed between 1994 and 2013; >15 years at diagnosis) were matched on age and sex with four non-cancer controls from the general population. Rates of VTE in the cancer and non-cancer groups were compared with Cox regression models, overall and according to age (i.e., 15-39, 40-64, and >65 years) and sex. Results In total, 197,702 five-year cancer survivors (median age at diagnosis 63 years [IQR: 53 – 71 years]; 38.5% men) were matched with 790,808 non-cancer controls. During a median follow-up of 6.2 years, cancer survivors overall had a higher associated rate of incident VTE than non-cancer controls (incidence rate per 1,000 person-years 5.6 [95% CI, 5.5-5.8] and 3.3 [3.3-3.4] for cancer survivors and non-cancer controls, respectively; adjusted hazard ratio [aHR] 1.77 [1.72-1.83]). The increased rate of VTE in cancer survivors, compared with matched controls, was statistically significant for all 20 cancer subtypes and was more pronounced in multiple myeloma and lung cancer [Figure 1]. The relatively higher rate of VTE in cancer survivors was more pronounced in women, and the younger patients (age group: 15-39 years) (PInteraction<0.01). Though, VTE was more prevalent in men (per 1,000 person-years 6.7 [95% CI, 6.4-6.9]) than in women (5.2 [95% CI, 5.0-5.3]), and in older patients (8.5 [95% CI, 8.2-8.7]) compared with younger patients (2.2 [95% CI, 1.9-2.4]) [Figure 2]. Conclusions Compared with the general population, five-year cancer survivors had higher associated rates of VTE, irrespective of age and sex. The increased relative rate of VTE was more pronounced in the younger individuals and women.Hazard ratios of venous thromboembolismVenous thromboembolism by age and sex

Polypharmacy risk among five-year cancer survivors.

11565 Background: Cancer survivors are increasing in the United States. Survivors often face cancer sequelae and side effects from treatment, which can arise during treatment or even months or years later. Survivors may therefore experience greater medication burden than the general population, increasing concerns for polypharmacy and risk of drug interactions and non-adherence. The objective of this study is to characterize prevalence of polypharmacy by cancer history in a nationally-representative sample of U.S. adults. Methods: Using National Health and Nutrition Examination Survey (NHANES) data from 2003-2014, we identified 32,330 individuals 20 years or older, 1,672 of whom had been diagnosed with cancer (excluding non-melanoma skin) at least five years before the survey. The association between cancer history and polypharmacy (5+ medications) was examined using Poisson regression models to calculate multivariable risk ratio (RRs) and 95% confidence intervals (CIs), adjusted for education, ethnicity, marital status, and age at survey. Results: Among five-year cancer survivors, 35% had a diagnosis within 5-9 years of the survey year, 26% within 10-14 years, 13% within 15-19 years, and 26% had a diagnosis 20 or more years before the survey year. Breast cancer was the most common type of cancer (23%), followed by cervical cancer (18%), prostate cancer (12%), and colon cancer (7%). Prevalence of polypharmacy was higher in cancer survivors (33.6%; 95% CI: 30.7-36.6%) than in those with no cancer history (13.0%, 95% CI: 12.4-13.7%) (RR: 1.32, 95% CI: 1.20, 1.45). Polypharmacy prevalence differed by age group (4.83% in 20-39 year olds; 40.37% in 40-64 year olds; 54.8% in 65 years and older), and within each age group, risk of polypharmacy was higher in cancer survivors than in those with no cancer history, with the most pronounced difference in cancer survivors 20-39 years old (RR: 2.93, 95% CI: 1.69-5.09), followed by 40-64 year olds (RR: 1.52, 95% CI 1.27-1.83) and those 65 years and older (RR: 1.17, 95% CI: 1.07-1.29). Conclusions: Cancer survivors are more likely to experience polypharmacy burden than those with no cancer history. Findings from this study can increase awareness about the unique challenges cancer survivors face and encourage medication reconciliation services.

Cardiac events in survivors of childhood cancer treated in more recent eras: A report from the Childhood Cancer Survivor Study.

10058 Background: Contemporary cancer protocols have incorporated modifications to minimize cardiotoxic exposures and preserve long-term health. We investigated the impact of these changes on late cardiac outcomes in a large cohort of adult survivors of childhood cancer. Methods: Congestive heart failure (CHF), myocardial infarction (MI), valvular disease, pericardial disease, and arrhythmias were graded by the National Cancer Institute’s Common Terminology Criteria for Adverse Events among 23,462 five-year cancer survivors [6,193 (26%) treated in the 1970s, 9,363 (40%) in the 1980s, and 7,906 (34%) in the 1990s] and 5,057 siblings. Cumulative incidence and 95% confidence intervals (95% CI) were estimated by treatment decade. Adjusted multivariable subdistribution hazard models were used to estimate hazard ratios (HR) and 95% CI for cardiac outcomes by decade. Mediation analysis examined risks with and without cardiotoxic exposures. Results: For survivors [median age 6 years (range: 0-21) at diagnosis, 28 years (8.2-58) at follow-up], cardiac radiation (RT) exposure declined from 77% of those treated in the 1970s to 55% and 40% in the 1980s and 1990s. Anthracycline exposure increased from 28% to 50% to 64%. The 20-year cumulative incidence of CHF (0.69% for those treated in 1970s, 0.74% in the 1980s, 0.54% in the 1990s) and MI (0.38%, 0.24%, 0.19%) declined in more recent treatment eras (p < 0.01). This change was not seen for valvular disease (0.06%, 0.06%, 0.05%), pericardial disease (0.04%, 0.02%, 0.03%) or arrhythmias (0.08%, 0.09%, 0.13%). Compared to survivors diagnosed in the 1970s, the risk of CHF, MI, and valvular disease decreased in the 1980s and 1990s, but only significantly for MI (HR 0.64 95% CI 0.47-0.89 and 0.52 95% CI 0.32-0.83). The overall MI risk was attenuated by adjustment for cardiac RT exposure (HR 0.94 95% CI 0.80-1.11), mostly among Hodgkin lymphoma (HL) survivors (HR 0.82 95% CI 0.69-0.98 [unadjusted for RT]; 1.03 95% CI 0.83-1.28 [adjusted for RT]). Conclusions: Reductions in exposure to cardiotoxic cancer therapies have resulted in declines in adverse cardiac outcomes, particularly for the RT-associated risk of myocardial infarction among HL survivors.

Prescribed medications in survivors of adult-onset cancer in Norway: A register-based study

Introduction Cancer patient's survival has improved steadily in Europe during the past decades, mainly due to major changes in diagnostic work-up, treatment and follow-up of patients. Hence, the population of cancer survivors has increased. Increasing use of multimodal curative therapies and novel treatment options for advanced cancers may cause adverse health effects. Prescribed medications provide a comprehensive assessment of long-term health-related issues among cancer survivors. We conducted a registry-based study to explore long-term adverse health effects, using prescribed medications as a proxy of disease, in adult cancer patients surviving at least five years after diagnosis. Methods The entire Norwegian population, born in 1990 or earlier, alive per January 1, 2005, approximately 3.8 million individuals were defined as our study cohort. The individuals were followed-up by linking compulsory national registers; the National Registry, the Cancer Registry of Norway (1953–2014), and the Norwegian Prescription Database (since 2004). Five-year cancer survivors were identified and the proportions of medication use in cancer survivors and cancer-free populations was calculated. The proportions were standardized for age per January 1, 2005; categorized as 0–19, 20–39, 49–59, 60–79, and over 80 years of age. Incidence rates of prescribed medication will be estimated using Cox proportional hazard models. Preliminary results A total of 299,326 cancer survivors, born during 1896-1990, were identified (47% males). The largest group of cancer survivors among males were those with cancer of the prostate (35%), skin (13%), bladder (8%), colon (7%), testis (5%) and rectum (5%). Among females, the largest group of survivors were those with cancer of the breast (32%), skin (14%), colon (8%), corpus uteri (7%), cervix uteri (5%), and rectum (3%). The study identified differences between cancer survivors and the cancer-free population in the use of medications (proportions presented as percentages) for the digestive tract and metabolism (22% versus 16%, respectively), blood and blood-forming organs (24% versus 17%), cardiovascular system (39% versus 28%), genito-urinary system and sex hormones (10% versus 16%), nervous system (39% versus 32%), systemic hormones other than sex hormones and insulin (12% versus 9%), musculo-skeletal system (23% versus 27%), and anti-neoplastic and immune-modulating agents (7% versus 2%). In contrast, similar medication use were found for antiparasitic products, insecticides and repellents (3% in each group), anti-infectives (for systemic use) (∼ 26%), dermatological (∼ 13%), sensory organs (∼ 13%), and for respiratory system (∼ 22%). Conclusions Our preliminary findings indicate a higher use of various prescribed medications among cancer survivors compared with the cancer-free population. This could suggest increased health challenges among the cancer survivors. Optimized follow-up of cancer survivors as well as primary and secondary prevention strategies of major comorbidities are recommended. More specific analyses, both regarding type of cancer and medications, will be performed.

Surveillance of hepatic late adverse effects in a large cohort of long-term survivors of childhood cancer: Prevalence and risk factors

BackgroundChildhood cancer survivors (CCS) are a growing group of young individuals with a high risk of morbidity and mortality. We evaluated the prevalence and risk factors of hepatic late adverse effects, defined as elevated liver enzymes, in a large cohort of CCS. MethodsThe cohort consisted of all five-year CCS treated in the EKZ/AMC between 1966 and 2003, without hepatitis virus infection and history of veno-occlusive disease (VOD). Liver enzyme tests included serum levels of alanine aminotransferase (ALT) for hepatocellular injury and gamma-glutamyltransferase (γGT) for biliary tract injury. We performed multivariable linear and logistic regression analyses. ResultsThe study population consisted of 1404 of 1795 eligible CCS, of whom 1362 performed liver enzyme tests at a median follow-up of 12years after diagnosis. In total, 118 (8.7%) of 1362 CCS had hepatic late adverse effects defined as ALT or γGT above the upper limit of normal. Abnormal ALT and γGT levels were found in 5.8% and 5.3%, respectively. In multivariable regression analyses treatment with radiotherapy involving the liver, higher body mass index, higher alcohol intake and longer follow-up time were significantly associated with elevated ALT and γGT levels; older age at diagnosis was only significantly associated with elevated γGT levels (all p<0.05). ConclusionOne in twelve CCS showed signs of hepatic late adverse effects after a median follow-up of 12years. Several risk factors have been identified. Future studies should focus on the course of long-term liver related outcomes and on the influence of radiotherapy and chemotherapy dose.

1400 ORAL Late mortality among five-year survivors of cancer in teenagers and young adults in England

1400 ORAL Late mortality among five-year survivors of cancer in teenagers and young adults in England

(709): Is there late-effect bidirectional influence of taste and pain among 5-year head and neck cancer survivors?

Second only to surviving, pain is of major concern to survivors of head and neck cancer. With improvements in treatment, larger numbers of cancer patients are living longer than before and experiencing the consequences of their life saving treatment. With time it has become apparent that not all of these consequences are positive and pain is one of the negative consequences. The purpose of this telephone survey was to assess the effects of head and neck cancer treatment among five-year cancer survivors (n=100) compared to matched controls.

Late mortality among five-year survivors of cancer in childhood and adolescenceDifferences between the Nordic Countries

The present study was aimed at assessing differences between the Nordic countries, if any, in late mortality among five-year survivors of childhood cancer. All cases diagnosed before the age of 20 years, between 1960 and 1989, were collected from all Nordic cancer registries. In total, 13 689 patients were identified as five-year survivors and during the extended follow-up 12.3% of them died. Mortality was analysed by decade of diagnosis, for all sites, and for leukaemia, Hodgkin's lymphoma, and central nervous system tumours separately. Analyses were done within a Cox proportional hazards regression framework with adjustments made for gender and age at diagnosis. Hazard ratios were calculated in relation to a weighted Nordic mean based on the proportion of five-year survivors in each country. Overall late mortality was significantly higher in Denmark and Finland than in Norway and Sweden. This could not be explained by inverse differences in five-year survival. The differences diminished over time and had disappeared in the last period. The pattern was similar for both genders. The disappearance of the differences was most probably the effect of a closer collaboration between Nordic paediatric oncologists with development and implementation of common protocols for treatment of childhood cancers in all countries.

Late Mortality in Childhood Cancer: Time to Count Our Chips

Late Mortality in Childhood Cancer: Time to Count Our Chips

Decreasing late mortality among five-year survivors of cancer in childhood and adolescence: a population-based study in the Nordic countries.

To assess the risk of death in patients who survive more than 5 years after diagnosis of childhood cancer and to evaluate causes of death in fatal cases. This was a population-based study in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) using data of the nationwide cancer registries and the cause-of-death registries. The study cohort included 13,711 patients who were diagnosed with cancer before the age of 20 years between 1960 and 1989 and who survived at least 5 years from diagnosis. By December 31, 1995, 1,422 patients had died, and death certificates were assessed in 1,402. Standardized mortality ratios (SMRs) for validated causes of death were calculated based on 156,046 patient-years at risk. The overall SMR was 10.8 (95% confidence interval [CI], 10.3 to 11.5), mainly due to high excess mortality from the primary cancer. SMR for second cancer was 4.9 (95% CI, 3.9 to 5.9) and was 3.1 (95% CI, 2.8 to 3.5) for noncancer death. The pattern of causes of death varied markedly between different groups of primary cancer diagnoses and was highly dependent on time passed since diagnosis. Overall late mortality was significantly lower in patients treated during the most recent period of time, 1980 to 1989, compared with those treated from 1960 to 1979 (hazard ratio, 0.61; 95% CI, 0.54 to 0.70), and there was no increase in rates of death due to cancer treatment. Long-term survivors of childhood cancer had an increased mortality rate, mainly dying from primary cancers. However, modern treatments have reduced late cancer mortality without increasing the rate of therapy-related deaths.