“Survival”

Presentation1

When my first child was born I was 30 years and 9 months of age.

If my son can somehow managed to live the impossibly long time of THIRTY YEARS – after being diagnosed with cancer – he would be 30 years and 7 months of age.

Survival stats for cancer are based on 5 years worth of survival.

Can you think of  a more preposterous benchmark to use to determine ‘survival’ when you are talking about infants and toddlers than 5 years?

My son is closing in on 8 years worth of treatment for childhood cancer and tomorrow he begins his 110th cycle of tumor directed therapy.  If his tumor magically disappeared tomorrow -for the first time ever – and he stopped all therapy the odds of him surviving the TREATMENT until the age of 30 are incredibly grim.

How grim?

Take a read of this extraordinarily well done piece by our friends over at People Against Childhood Cancer to see for yourself just what survival looks like in childhood cancer.

Then take a read of this article and perhaps you’ll realize that childhood cancer does not end with the word ‘remission’.  In fact – many times that is just the beginning of the journey where all roads  take their own way but eventually lead to the same destination of a another death thanks to a childhood cancer diagnosis.

 

Cause-Specific Late Mortality Among 5-Year Survivors of Childhood Cancer: The Childhood Cancer Survivor Study

  1. Yutaka Yasui

Author Affiliations


  1. Affiliations of authors: Department of Pediatrics, Emory University, Atlanta, GA (ACM, KW); Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada (QL, YY); Department of Pediatrics, University of Minnesota, Minneapolis, MN (JPN); Clinical Statistics and Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA (WL); Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, TN (GTA, LLR)

 

Background The 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.

Methods A 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.

Results Among 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.

Conclusion Our 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 modi

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