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Long term cause specific mortality among 34489 five year survivors of childhood cancer in Great Britain: population based cohort study

Lookup NU author(s): Professor Roderick Skinner



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


OBJECTIVETo determine whether modern treatments for cancer are associated with a net increased or decreased risk of death from neoplastic and non-neoplastic causes among survivors of childhood cancer.DESIGNPopulation based cohort study.SETTINGBritish Childhood Cancer Survivor Study.PARTICIPANTSNationwide population based cohort of 34489 five year survivors of childhood cancer with a diagnosis from 1940 to 2006 and followed up until 28 February 2014.MAIN OUTCOME MEASURESCause specific standardised mortality ratios and absolute excess risks are reported. Multivariable Poisson regression models were utilised to evaluate the simultaneous effect of risk factors. Likelihood ratio tests were used to test for heterogeneity or trend.RESULTSOverall, 4475 deaths were observed, which was 9.1 (95% confidence interval 8.9 to 9.4) times that expected in the general population, corresponding to 64.2 (95% confidence interval 62.1 to 66.3) excess deaths per 10 000 person years. The number of excess deaths from all causes declined among those treated more recently; those treated during 1990-2006 experienced 30% of the excess number of deaths experienced by those treated before 1970. The corresponding percentages for the decline in excess deaths from recurrence or progression and nonneoplastic causes were 30% and 60%, respectively. Among survivors aged 50-59 years, 41% and 22% of excess deaths were attributable to subsequent primary neoplasms and circulatory conditions, respectively, whereas the corresponding percentages among those aged 60 years or more were 31% and 37%.CONCLUSIONSThe net effects of changes in cancer treatments, and surveillance and management for late effects, over the period 1940 to 2006 was to reduce the excess number of deaths from both recurrence or progression and non-neoplastic causes among those treated more recently. Among survivors aged 60 years or more, the excess number of deaths from circulatory causes exceeds the excess number of deaths from subsequent primary neoplasms. The important message for the evidence based surveillance aimed at preventing excess mortality and morbidity in survivors aged 60 years or more is that circulatory disease overtakes subsequent primary neoplasms as the leading cause of excess mortality.

Publication metadata

Author(s): Fidler MM, Reulen RC, Winter DL, Kelly J, Jenkinson HC, Skinner R, Frobisher C, Hawkins MM, British Childhood Canc Survivor

Publication type: Article

Publication status: Published

Journal: BMJ

Year: 2016

Volume: 354

Print publication date: 01/01/2016

Online publication date: 01/09/2016

Acceptance date: 29/07/2016

Date deposited: 18/10/2016

ISSN (electronic): 1756-1833

Publisher: BMJ Group


DOI: 10.1136/bmj.i4351


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