Disparities in mortality from noncancer causes among adolescents and young adults with cancer
Menée à partir des données des registres américains des cancers portant sur 242 940 femmes et 158 347 hommes ayant survécu à un cancer diagnostiqué entre l'âge de 15 ans et de 39 ans sur la période 1985-2015, cette étude analyse les disparités dans le risque de décès lié à une autre cause que le cancer
Background: Few studies have examined noncancer outcomes among patients diagnosed with cancer as adolescents and young adults (AYAs). We examined risk of mortality from noncancer causes after an AYA cancer diagnosis, and investigated disparities according to race/ethnicity and other characteristics. Methods: Patients with a first primary cancer at ages 15-39 years diagnosed during 1985-2015 were identified in the Surveillance, Epidemiology and End Results database (N=242,940 women, 158,347 men). Survival months were accrued from diagnosis until death or December 2015. Multivariable-adjusted hazard ratios (HR) were used to examine disparities in mortality from all noncancer causes, cardiovascular diseases (CVD), and infectious diseases (ID) according to race/ethnicity, geographic region, and county-level characteristics. Results: For all cancer types combined, the 10-year cumulative incidence of noncancer death after AYA cancer was 2% and 5% among women and men, respectively. With adjustment for cancer type, all noncancer mortality was increased among non-Hispanic Black AYAs (HR vs non-Hispanic White: HRWomen=2.31; 95%CI: 2.16-2.47; HRMen=2.17; 95%CI: 2.05-2.30) and those in the South (HR vs. Northeast: HRWomen=1.18; 95%CI: 1.07-1.29; HRMen=1.42; 95%CI: 1.31-1.55) or in rural counties (HR vs metro: HRWomen=1.74; 95%CI: 1.47-2.07; HRMen=1.57; 95%CI: 1.33-1.86). Mortality from CVD and ID was also elevated among non-Hispanic Black AYAs. Conclusions: Results of the current study suggest that noncancer mortality after AYA cancer is highest among survivors who are non-Hispanic Black or live in the South or in rural counties. Impact: Our analyses highlight disparities among AYAs with cancer, and identify subgroups that may be targeted for increased medical surveillance or behavioral interventions.