Cancer patients with the highest risk of index and nonindex cancer death and medical comorbidity death are identified; certain patient groups may be targeted with interventions.
Nicholas G. Zaorsky, MD, Thomas M. Churilla, MD, Brian Egleston, PhD, Elizabeth Handorf, PhD, Eric M. Horwitz, MD, Joshua E. Meyer, MD; Fox Chase Cancer Center
BACKGROUND: Causes of mortality among cancer patients are not well characterized.
PURPOSE: To characterize the causes of death among cancer patients after diagnosis (1) as a function of calendar year and (2) compared with the general population.
METHODS: Surveillance, Epidemiology, and End Results Stat 8.2.1 was used to create a rate session, from 1973 to 2012. Data were characterized by raw count and percentages. Death was characterized as due to index cancer, non–index cancer, and noncancer medical comorbidity. Further, data were characterized using standardized incidence ratio (SIR) vs time after diagnosis (time binned), which provides the relative risk of death as compared with patients who do not have cancer in the US, from 2007 to 2012. At least 1,000 person-years at risk (PYARs) were necessary for analysis.
RESULTS: For the calendar year session, there were 1,857,363 mortalities. The greatest decrease in index cancer death (generally from > 60% to < 30% of patients) was among patients with cancer of the larynx, gallbladder, stomach, bladder, endometrium, breast, and testis; melanoma; non-Hodgkin lymphoma (NHL); and Hodgkin lymphoma. Index cancer deaths (typically > 40%) have been stable or rising among patients with cancer of the liver, pancreas, lung and bronchus, soft tissue, and nasopharynx. Noncancer causes of death are highest (vs index or nonindex cancer) in patients with cancers of the rectum, bladder, kidney, endometrium, breast, prostate, and testis. The highest SIRs (range: 2–200) were typically within the first year after diagnosis of any cancer. The highest SIRs were from other infections (eg, SIR > 100 for lymphomas), chronic liver disease (SIRs > 20 for cervix, lung, and oral cavity cancers), and suicide (SIR > 15 for testis, lung, oral cavity, and NHL), followed by heart disease, diabetes, and accidents.
CONCLUSION: Cancer patients with the highest risk of index and nonindex cancer death and medical comorbidity death are identified; certain patient groups may be targeted with interventions.
Proceedings of the 98th Annual Meeting of the American Radium Society -americanradiumsociety.org