Young Adult Cancer Survivors Have Increased Mortality, Chronic Condition Risk

Young adult cancer survivors have an increased risk for mortality and severe and life-threatening chronic conditions compared with the general population, according to a study published in The Lancet Oncology.

Researchers used data from the retrospective cohort Childhood Cancer Survivor Study that included longitudinal follow-up of five-year cancer survivors diagnosed before the age of 21 years. Participants were diagnosed at 27 academic institutions in the United States and Canada between 1970 and 1999. Researchers evaluated outcomes among early adolescent and young adult cancer survivors (aged 15 to 20 years at diagnosis) and survivors diagnosed at age younger than 15 years by comparing both groups to siblings of the same age. Median follow-up was 20.6 years for early adolescent and young adult survivors and 21.1 years for childhood cancer survivors.

Six-fold greater risk of mortality among cancer survivors

Among 5,804 early adolescent and young adult survivors (median age, 42 years; range, 34-50 years) the standardized mortality ratio for all-cause mortality was 5.9 (95% CI, 5.5-6.2) compared with the general population—representing a nearly six-fold greater mortality risk for cancer survivors. Among 5,804 childhood cancer survivors (median age, 34 years; range, 27-42 years), the standardized mortality ratio was 6.2 (95% CI, 5.8-6.6) compared with the general population.

Early adolescent and young adult survivors had an increased risk of all-cause mortality lower standardized mortality ratios for death from health-related causes (i.e., conditions that exclude recurrence or progression of the primary cancer and external causes, but include the late effects of cancer therapy) than childhood cancer survivors (standardized mortality ratio, 4.8 vs. 6.8). This was most evident more than 20 years after cancer diagnosis.

Early adolescent (hazard ratio [HR], 4.2; 95% CI, 3.7-4.8) and young adult (HR, 5.6; 95% CI, 4.9-6.3) cancer survivors and childhood cancer survivors were both at greater risk of developing severe and disabling, life-threatening, or fatal conditions compared with siblings of the same age. Cancer survivors were at particularly increased risk of developing grade 3-5 cardiac, endocrine, and musculoskeletal conditions compared with siblings of the same age, although all these risks were lower for early adolescent and young adult survivors than for childhood cancer survivors.

“These results highlight the need for long-term screening of both childhood and early adolescent and young adult cancer survivors,” the researchers concluded.