Dataset Information

Declining childhood and adolescent cancer mortality.

ABSTRACT: BACKGROUND:To evaluate whether progress continues in identifying more effective treatments for children and adolescents with cancer, the authors examined both overall and disease-specific childhood cancer mortality rates for the United States, focusing on data from 2000 to 2010. METHODS:Age-adjusted US mortality trends from 1975 to 2010 were estimated using joinpoint regression analysis. Analyses of annual percentage change (APC) were performed on the same diagnostic groupings for the period restricted to 2000 through 2010 for groupings ages <20 years, <15 years, and 15 to 19 years. RESULTS:After a plateau in mortality rates during 1998 to 2002 (APC, 0.3%), the annual decline in childhood cancer mortality from 2002 to 2010 (APC, -2.4%) was similar to that observed from 1975 to 1998 (APC, -2.7%). Statistically significant declines in mortality rates from 2000 to 2010 were noted for acute lymphoblastic leukemia, acute myeloid leukemia, non-Hodgkin lymphoma, Hodgkin lymphoma, neuroblastoma, central nervous system cancers, and gonadal cancers. From 2000 to 2010, the rates of decline in mortality for the group ages 15 to 19 years generally were equal to or greater than the rates of decline for the group ages birth to 14 years. Improvements in treatment since 1975 resulted >45,000 cancer deaths averted through 2010. CONCLUSIONS:Cancer mortality for both children and adolescents declined from 2000 to 2010, with significant declines observed for multiple cancer types. However, greater than 1900 cancer deaths still occur each year among children and adolescents in the United States, and many survivors experience long-term effects that limit their quality of life. Continued research directed toward identifying more effective treatments that produce fewer long-term sequelae is critical to address these remaining challenges.

SUBMITTER: Smith MA

PROVIDER: S-EPMC4136455 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Declining childhood and adolescent cancer mortality.

Smith Malcolm A MA Altekruse Sean F SF Adamson Peter C PC Reaman Gregory H GH Seibel Nita L NL

Cancer 20140522 16

<h4>Background</h4>To evaluate whether progress continues in identifying more effective treatments for children and adolescents with cancer, the authors examined both overall and disease-specific childhood cancer mortality rates for the United States, focusing on data from 2000 to 2010.<h4>Methods</h4>Age-adjusted US mortality trends from 1975 to 2010 were estimated using joinpoint regression analysis. Analyses of annual percentage change (APC) were performed on the same diagnostic groupings for ...[more]

PMID: 24853691

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Project description:Incidence and mortality data, stage of disease and treatment information for female breast cancer were obtained for the years 1975-1999 for the former Yorkshire Regional Health Authority area, from the Northern and Yorkshire Cancer Registry and Information Service. Deaths by age group and 3-year calendar period were separated into those occurring among cases diagnosed 0-2 and 3-4 years preceding death (short- and medium-term survivors, respectively), and among longer-term survivors and age-adjusted rates were calculated separately by survival time. The 3-year survival of cases incident in 1991-1999 and in 1982-1990 were compared, adjusting for stage and treatment. Breast cancer mortality in Yorkshire stopped increasing around 1983 and has since consistently declined, primarily among short- and medium-term survivors. The 3-year survival was significantly improved in cases diagnosed in 1991-1999, compared with 1982-1990, in all age groups (hazard ratio (HR)=0.75, 95% c.l. 0.71-0.78). The improvement was least in the 65+ years age group (HR=0.83, 95% c.l. 0.79-0.88), intermediate in the youngest (<50 years) cases (HR=0.71, 95% c.l. 0.63-0.80) and greatest in the age group 50-64 years, offered routine screening after 1988 (HR=0.51, 95% c.l. 0.47-0.57). The benefit for cases diagnosed in the 1990s persisted, but was reduced after adjustment for stage in cases <65 years, while it disappeared in older cases (HR=1.01). Below age 65 years, the use of systemic therapy increased substantially, but did not explain the residual improvements in short-term prognosis. A greater decline in breast cancer mortality in Yorkshire from 1982 to 1984 was observed among short- and medium-term, than in longer-term, survivors. Much of the improvement in survival in cases <65 years could be attributed to a more favourable stage at diagnosis, whereas this accounted for nearly all the improvement in survival among older cases. Systemic therapy had little or no impact on 3-year survival. Continuing declines in mortality can be expected in the current decade, as a result of the long-term effects of both mammography screening and increased use of systemic therapy.

Project description:Some studies have analyzed the association of health care systems variables, such as health service resources or expenditures, with amenable mortality, but the association of types of health care systems with the decline of amenable mortality has yet to be studied. The present study examines whether specific health care system types are associated with different time trend declines in amenable mortality from 2000 to 2014 in 22 European OECD countries.A time trend analysis was performed. Using Nolte and McKee's list, age-standardized amenable mortality rates (SDRs) were calculated as the annual number of deaths over the population aged 0-74 years per 100,000 inhabitants. We classified health care systems according to a deductively generated classification by Böhm. This classification identifies three dimensions that are not entirely independent of each other but follow a clear order: the regulation dimension is first, followed by the financing dimension and finally service provision. We performed a hierarchical semi-log polynomial regression analysis on the annual SDRs to determine whether specific health care systems were associated with different SDR trajectories over time.The results showed a clear decline in SDRs in all 22 health care systems between 2000 and 2014 although at different annual changes (slopes). Regression analysis showed that there was a significant difference among the slopes according to provision dimension. Health care systems with a private provision exhibited a slowdown in the decline of amenable mortality over time. It therefore seems that ownership is the most relevant dimension in determining a different pattern of decline in mortality.All countries experienced decreases in amenable mortality between 2000 and 2014; this decline seems to be partially a reflection of health care systems, especially when affected by the provision dimension. If the private ownership is maintained or promoted by health systems, these findings might be considered when thinking about regulation policies to control factors that might influence health care performance.

Project description:BackgroundThe proportion of pediatric and adolescent cancer patients surviving 5 years has increased during the past four decades. This growing population of survivors remains at risk for disease- and treatment-associated late mortality.MethodsA total of 20 483 five-year survivors of childhood and adolescent cancer diagnosed between January 1, 1970, and December 31, 1986, and enrolled in the Childhood Cancer Survivor Study (CCSS) were included in a National Death Index search for deaths occurring between January 1, 1979, and December 31, 2002. Treatment information was abstracted from primary medical records. Survival probabilities, standardized mortality ratios (SMRs), and absolute excess risks were calculated for overall and cause-specific deaths. Diagnosis- and sex-specific survival probabilities were estimated by the product-limit method. All statistical tests were two-sided.ResultsAmong the CCSS cohort, 2821 (13.8%) 5-year survivors had died by the end of the follow-up period. The cause of death was obtained for 2534 individuals, with 57.5% of deaths attributed to recurrent disease. Estimated probability of survival 30 years from diagnosis was 82%. When compared with the US population, the absolute excess risk of death from any cause was 7.36 deaths per 1000 person-years. The overall SMR was 8.4 (95% confidence interval [CI] = 8.0 to 8.7). Increases in cause-specific mortality were seen for deaths due to subsequent malignancy (SMR = 15.2, 95% CI = 13.9 to 16.6) and cardiac (SMR = 7.0, 95% CI = 5.9 to 8.2), pulmonary (SMR = 8.8, 95% CI = 6.8 to 11.2), and other medical (SMR = 2.6, 95% CI = 2.3 to 3.0) causes. At 20 years of follow-up (25 years after first cancer diagnosis), the death rate due to a subsequent malignancy exceeded that due to all other causes.ConclusionOur extended follow-up of 5-year survivors of pediatric and adolescent cancer indicates that excess mortality persists long after diagnosis. Continued observation is needed to further define lifetime risk and to determine the potential contribution of chronic health conditions and modifiable health behaviors.

Dataset Information

Declining childhood and adolescent cancer mortality.

Publications

Declining childhood and adolescent cancer mortality.

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