Noncancer-related mortality risks in adult survivors of pediatric malignancies: The childhood cancer survivor study

Cheryl L. Cox, Vikki G. Nolan, Wendy Leisenring, Yutaka Yasui, Susan W. Ogg, Ann C. Mertens, Joseph P. Neglia, Kirsten K. Ness, Gregory T. Armstrong, Les L. Robison

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21 Scopus citations


Purpose: We sought to identify factors, other than cancer-related treatment and presence/severity of chronic health conditions, which may be associated with late mortality risk among adult survivors of pediatric malignancies. Methods: Using the Childhood Cancer Survivor Study cohort and a case-control design, 445 participants who died from causes other than cancer recurrence/progression or non-health-related events were compared with 7,162 surviving participants matched for primary diagnosis, age at baseline questionnaire, time from diagnosis to baseline questionnaire, and time at-risk. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for overall/cause-specific mortality. Independent measures included number/severity of chronic conditions, medical care, health-related behaviors, and health perceptions/concerns. Results: Adjusting for education, income, chemotherapy/radiation exposures, and number/severity of chronic health conditions, an increased risk for all-cause mortality was associated with exercising fewer than 3 days/week (OR = 1.72, CI 1.27-2.34), being underweight (OR = 2.58, CI 1.55-4.28), increased medical care utilization (P < 0.001), and self-reported fair to poor health (P < 0.001). Physical activity was associated with a higher risk of death among males (OR = 3.26, CI 1.90-5.61) reporting no exercise compared to those who exercised ≥3 times per week. Ever consuming alcohol was associated with a reduced risk of all-cause (OR = 0.61, CI 0.41-0.89) and other nonexternal causes of death (OR = 0.40, CI 0.20-0.79). Concerns/worries about future health (OR = 1.54, CI 1.10-2.71) were associated with increased all-cause mortality. Conclusions: Factors independent of cancer treatment and chronic health conditions modify the risk of death among adult survivors of pediatric cancer. Implications for Cancer Survivors: Continued cohort observation may inform interventions to reduce mortality.

Original languageEnglish (US)
Pages (from-to)460-471
Number of pages12
JournalJournal of Cancer Survivorship
Issue number3
StatePublished - Sep 2014

Bibliographical note

Funding Information:
Acknowledgments Special thanks to the support from the National Institute of Health grants U24 CA55727 (LL Robison, PI) and P30 CA21765 (R Gilbertson, PI), and the American Lebanese Syrian Associated Charities (ALSAC). Podium presentation at the American Public Health Association Annual Meeting, November 5, 2013, Boston, MA. Cox CL, Nolan V, Leisenring W, Yasui Y, Ogg S, Neglia J, Ness K, Robison LL. Health perceptions, behavior, and medical care utilization: Links to mortality in adult survivors of childhood cancer.


  • Cancer survivorship
  • Childhood cancer
  • Mortality risk
  • Surveillance


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