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ROSWELL PARK RESEARCHERS STUDY 15-YEAR SURVIVORS OF CHILDHOOD CANCER

BUFFALO, NY - The first study to evaluate the impact of cardiac disease and second malignant neoplasms on late mortality and to identify risk factors for late mortality among 15-year survivors of cancer diagnosed during childhood or adolescence has concluded that survivors who relapsed during the 15-year period have excess mortality. The results of the study by Daniel M. Green, MD, Department of Pediatrics, and colleagues at Roswell Park Cancer Institute (RPCI), are published in the October issue of the Journal of Clinical Oncology.

"The down side is that these survivors have an increased relative risk of mortality compared to survivors who did not relapse and their peer population," according to Dr. Green. "However, risk factors identified may enable physicians to modify treatment planning and initiate prevention strategies to reduce this relative risk in these survivors."

The study evaluated 474 patients who survived 15 or more years after diagnosis culled from a total of 1,441 previously untreated patients referred to RPCI between January 1, 1960 and December 31, 1989. These survivors all were less than 20 years of age at diagnosis and were last contacted between 1993 and March 1999; 416 between March 1998 and March 1999. Mean follow-up was 24.13 years (plus or minus 6.13 years), with a range from 15.04 to 38.54 years, and a median of 23.39 years. Twenty-five of these patients had died. The actuarial survival percentage was 88% (plus or minus 2%) at 35 years after diagnosis.

Gender-specific all-cause and cause-specific (cardiac disease,
cancer) standardized mortality ratios were calculated to determine the
relationship of several demographic and treatment variables and late
mortality. "Patients who survived for 15 years after diagnosis had excess subsequent mortality rates from all-causes, including the primary cancer, second malignant neoplasms and cardiac disease," according to Dr. Green.

The study identified disease recurrence during the first 15 years after diagnosis, treatment with doxorubicin and the diagnosis of Hodgkin's disease as risk factors for late mortality for the 265 males; and treatment with radiation therapy or an alkylating agent and disease recurrence during the first 15 years as risk factors for the 209 females.

Of the 25 patients who have died, eight died of their primary
cancers 15.3 to 20.9 years after diagnosis; five died as a result of second malignant neoplasms 23.9 to 30.8 years after diagnosis; and five died from cardiac disease 20.9 to 27.6 years after diagnosis. The remaining seven patients died from various causes which may or may not be related to cancer.

"The results of this study are clear indications that we need more successful treatments for original cancers," concludes Dr. Green. "We also need to initiate strategies to decrease the frequency of exposures associated with increased risk of second malignant neoplasms, such as the adolescent breast to radiation therapy, strategies to decrease risk-taking behaviors, such as tobacco use, and strategies to reduce risk factors for ischemic heart disease, such as weight reduction, reduced saturated fat intake and increase exercise, which may decrease late mortality due to treatment-associated complications."

Roswell Park Cancer Institute, founded in 1898, is the nation's first and one of its largest cancer research, treatment and education centers and is the only National Cancer Institute-designated comprehensive cancer center in Western New York.

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