Survivors of childhood cancer had a fourfold higher risk of mortality decades after their diagnosis, typically from the same leading causes of death afflicting the general U.S. population, a report from the Childhood Cancer Survivor Study (CCSS) showed.

The 40-year all-cause mortality rate was 23.3% among the more than 34,000 pediatric cancer patients who had survived at least 5 years from the time of their diagnosis, compared with the under 5% rate expected in the general population, reported Stephanie Dixon, MD, of St. Jude Children’s Research Hospital in Memphis, Tennessee, and colleagues in The Lancet.

By 40 years from the time of diagnosis, survivors experienced 138 excess deaths per 10,000 person-years, of which 131 were attributable to health-related causes, including those due to the top three causes of mortality:

• Cancer: 54 excess deaths per 10,000 person-years
• Heart disease: 27 excess deaths per 10,000 person-years
• Cerebrovascular disease: 10 excess deaths per 10,000 person-years

Although 5-year survival after childhood cancer has improved dramatically over the past 50 years, “it is well known that cancer and cancer treatment contribute to an increased risk of late morbidity and mortality among long-term survivors,” Dixon and her colleagues wrote. They observed that while this study showed that many of the causes of death experienced in late survivors are the same as the major causes of death in the general U.S. population, “survivors are dying at a younger and higher rate.”

However, the researchers found that when survivors were stratified by lifestyle score and cardiovascular risk factors, the excess risk of health-related death was lowest in the survivors with a healthy lifestyle.

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