The purpose of our study was to characterize the causes of death among cancer patients as a function of objectives: (I) calendar year, (II) patient age, and (III) time after diagnosis.
US death certificate data in SEER Stat 8. 2.1 were used to categorize cancer patient death as being due to index-cancer, non-index-cancer, and non-cancer cause from 1973 to 2012. In addition, data were characterized with standardized mortality ratios (SMRs), which provide the relative risk of death compared to all persons.
The greatest relative decrease in index-cancer death (generally from > 60% to < 30%) was among those with cancers of the testis, kidney, bladder, endometrium, breast, cervix, prostate, ovary, anus, colorectum, melanoma, and lymphoma. Index-cancer deaths were stable (typically > 40%) among patients with cancers of the liver, pancreas, esophagus, and lung, and brain. Non-cancer causes of death were highest in patients with cancers of the colorectum, bladder, kidney, endometrium, breast, prostate, testis; > 40% of deaths from heart disease. The highest SMRs were from non-bacterial infections, particularly among < 50 year olds (e.g. SMR > 1,000 for lymphomas, p < 0.001). The highest SMRs were typically within the first year after cancer diagnosis (SMRs 10 - 10,000, p < 0.001). Prostate cancer patients had increasing SMRs from Alzheimer's disease, as did testicular patients from suicide.
The risk of death from index- and non-index-cancers varies widely among primary sites. Risk of non-cancer deaths now surpasses that of cancer deaths, particularly for young patients in the year after diagnosis.
Annals of oncology : official journal of the European Society for Medical Oncology. 2016 Nov 09 [Epub ahead of print]
N G Zaorsky, T M Churilla, B L Egleston, S G Fisher, J A Ridge, E M Horwitz, Je Meyer Md
(1) Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia PA, United States. ., (1) Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia PA, United States., (2) Department of Biostatistics, Fox Chase Cancer Center, Philadelphia PA, United States., (3) Temple University School of Medicine, Philadelphia PA United States., (4) Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia PA, United States.