Trends in late mortality among adolescent and young adult (AYA) cancer survivors
Menée à partir des données des registres américains des cancers portant sur 282 969 adolescents et jeunes adultes (âge : 15-39 ans) ayant survécu 5 ans ou plus à un cancer diagnostiqué entre 1975 et 2011, cette étude analyse l'évolution de la mortalité toutes causes confondues et de la mortalité par cancer
Background : Over the past several decades, treatment of cancer in adolescents and young adults (AYAs) has evolved substantially, leading to steady improvements in estimated five-year survival at diagnosis. However, the impact on late mortality in this population is largely unexamined. We investigated temporal trends in mortality among five-year AYA cancer survivors.
Methods : The Surveillance, Epidemiology, and End Results database was used to identify AYAs (age 15-39) diagnosed with cancer during 1975-2011 who survived ≥5 years beyond diagnosis. Survival months were accrued from five years post-diagnosis until death or end of 2016. Cumulative mortality from all causes, the primary cancer, other cancers, and noncancer/nonexternal causes (i.e. excluding accidents, suicide, homicide) were estimated according to diagnosis era.
Results : Among 282,969 five-year AYA cancer survivors, five-year mortality (i.e. from 5 through 10 years post-diagnosis) from all causes decreased from 8.3% (95% CI: 8.0%-8.6%) among those diagnosed in 1975-1984 to 5.4% (95% CI: 5.3%-5.6%) among those diagnosed in 2005-2011. This was largely explained by decreases in mortality from the primary cancer (6.8% to 4.2%) between these periods. However, for specific cancer types, including colorectal, bone, sarcomas, cervical/uterine, and bladder, cumulative mortality curves demonstrated little improvement in primary cancer-mortality over time. Some reduction in late mortality from noncancer/nonexternal causes was apparent for Hodgkin lymphoma, leukemia, kidney cancer, head and neck cancers, and trachea, lung, and bronchus cancers.
Conclusion : Over the past four decades, all-cause and cancer-specific mortality have decreased among five-year AYA cancer survivors overall, but several cancer types have not shared in these improvements.
Journal of the National Cancer Institute , résumé, 2019