• Jennifer M Yeh, Larissa Nekhlyudov, Sue J Goldie, Ann C Mertens, and Lisa Diller.
• Harvard School of Public Health, Harvard Medical School/Harvard Pilgrim Health Care Institute and Harvard Vanguard Medical Associates, Dana-Farber Cancer Institute and Children's Hospital, Boston, Massachusetts, and Emory University, Atlanta, Georgia, USA. jyeh@hsph.harvard
• Ann. Intern. Med. 2010 Apr 6; 152 (7): 409-17, W131-8.

BackgroundAlthough childhood cancer survival rates have dramatically increased, survivors face elevated risk for life-threatening late effects, including secondary cancer.ObjectiveTo estimate the cumulative effect of disease- and treatment-related mortality risks on survivor life expectancy.DesignState-transition model to simulate the lifetime clinical course of childhood cancer survivors.SettingChildhood Cancer Survivor Study.PatientsFive-year survivors of childhood cancer.MeasurementsProbabilities of risk for death from the original cancer diagnosis, excess mortality from subsequent cancer and cardiac, pulmonary, external, and other complications, and background mortality (age-specific mortality rates for the general population) were estimated over the lifetime of survivors of childhood cancer.ResultsFor a cohort of 5-year survivors aged 15 years who received a diagnosis of cancer at age 10 years, the average lifetime probability was 0.10 for late-recurrence mortality; 0.15 for treatment-related subsequent cancer and death from cardiac, pulmonary, and external causes; and 0.05 for death from other excess risks. Life expectancy for the cohort of persons aged 15 years was 50.6 years, a loss of 10.4 years (17.1%) compared with the general population. Reduction in life expectancy varied by diagnosis, ranging from 4.0 years (6.0%) for kidney tumor survivors to more than 17.8 years (> or =28.0%) for brain and bone tumor survivors, and was sensitive to late-recurrence mortality risk and duration of excess mortality risk.LimitationEstimates are based on data for survivors who received treatment 20 to 40 years ago; patients who received treatment more recently may have more favorable outcomes.ConclusionChildhood cancer survivors face considerable mortality during adulthood, with excess risks reducing life expectancy by as much as 28%. Monitoring the health of current survivors and carefully evaluating therapies with known late toxicities in patients with newly diagnosed cancer are needed.

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