Public Release:  Nearly half of cancer survivors died from conditions other than cancer

American Association for Cancer Research

CHICAGO -- Although cancer recurrence may be the overriding fear for many survivors, nearly half of survivors from a recently presented study died from other conditions.

These results indicate survivors could potentially benefit from a more comprehensive, less cancer-focused approach to their health, according to lead researcher Yi Ning, M.D., Sc.D., assistant professor in the department of epidemiology and community health at Virginia Commonwealth University (VCU) and associate research member at VCU Massey Cancer Center in Richmond, Va. Ning presented the results at the AACR Annual Meeting 2012, held here March 31 - April 4.

"We realized that the mortality rates for some types of cancer, such as breast cancer, had declined," said Ning. "Cancer survivors live much longer than they did several decades ago. So with this large group of cancer survivors, we need to pay more attention to cancer survivors' overall health."

Ning and colleagues evaluated 1,807 cancer survivors who had participated in the National Health and Nutrition Examination Surveys (NHANES) study. The most common forms of cancer among the study group were breast, prostate, cervical, lung and colorectal.

When originally surveyed through NHANES, a large percentage of the study group suffered from conditions other than cancer, including cardiovascular conditions, hypertension and diabetes.

Researchers followed patients for more than 18 years. During the course of the study, 776 cancer survivors died. Fifty-one percent died from cancer and 49 percent died from other causes. Cardiovascular disease was the primary cause of noncancer deaths.

Researchers found that the longer patients survived after their initial cancer diagnosis, the more likely they were to die from another disease: 32.8 percent died from another condition within five years of diagnosis compared with 62.7 percent after 20 years.

With nearly half of cancer survivors dying from other causes, Ning said that physicians and patients must improve efforts to manage those risks.

"After the detection of cancer, clinicians and cancer survivors pay less attention to the prevention and treatment of other diseases and complications," said Ning. "We shouldn't neglect other aspects of health because we are focused on cancer and overlook other chronic conditions."

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Founded in 1907, the American Association for Cancer Research (AACR) is the world's first and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer. AACR's membership includes 34,000 laboratory, translational and clinical researchers; population scientists; other health care professionals; and cancer advocates residing in more than 90 countries. The AACR marshals the full spectrum of expertise of the cancer community to accelerate progress in the prevention, biology, diagnosis and treatment of cancer by annually convening more than 20 conferences and educational workshops, the largest of which is the AACR Annual Meeting with more than 18,000 attendees. In addition, the AACR publishes seven peer-reviewed scientific journals and a magazine for cancer survivors, patients and their caregivers. The AACR funds meritorious research directly as well as in cooperation with numerous cancer organizations. As the Scientific Partner of Stand Up To Cancer, the AACR provides expert peer review, grants administration and scientific oversight of individual and team science grants in cancer research that have the potential for patient benefit. The AACR actively communicates with legislators and policy makers about the value of cancer research and related biomedical science in saving lives from cancer.

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Presenter: Yi Ning, M.D., Sc.D.

Abstract Number: LB-339

Title: Cause of death in cancer survivors

Author Block: Yi Ning, Qin Shen, Kirsten Herrick, Ross Mikkelsen, Mitchell Anscher, Robert Houlihan, Kate Lapane. Virginia Commonwealth University, Richmond, VA

Background: Cancer, in general, is regarded as one of the most life threatening diseases. In the past decade, with the application of advanced scientific and medical technologies for cancer early detection, prevention, and treatment, cancer survivors are now living much longer and do not died directly from cancer, but from other diseases and complications, therefore, becomes increasingly important to understand major causes of death among cancer survivors to improve the quality of life and prolong life expectancy of cancer survivors. We conducted a study to investigate the cause of death among cancer survivors using data from national surveys. Methods: The analytical population consist of 1807 cancer survivors identified from the National Health and Nutrition Examination Survey (NHANES) III 1988-1994 and NHANES 1999- 2004. We excluded participants with age less than 18 years old and those with skin cancer. Cancer survivors were identified if they self-reported having ever been told by a doctor or other health professional that he/she had cancer or a malignancy of any kind. The cause of death was ascertained through the National Death Index (NDI). All participants were followed from the date of survey to the date of the survey to December 31, 2006 by linking NDI death certificate records.

Results: The Follow-up time ranged from 0 to 17.3 years. Total 776 participants died during the follow-up period. Underlying cause of death were recoded as 113 death causes in the National Death Index. We classified all death causes into 3 categories: related with cancer, indeterminate and not related with cancer. The causes of death were stratified by the duration since the diagnosis of cancer, which was calculated as follow-up time plus years between age at NHANES survey and age when being diagnosed with cancer. Commonly reported types of cancer were prostate (n=165), breast (n=141) and colorectal cancer (n=117) among 761 male and 1046 female participants. At time of the survey, there were 17.7% and 26.5% with diabetes, 63.2 and 66.9 with cardiovascular condition, and 58.7 and 62.9 had hypertension, and 61.3% and 70.5% with hypercholesterolemia in men and women, respectively. Among the deseeded cancer survivor, 41.8%, 9.3, and 48.9% were died from cancer, indeterminate, disease not related with cancer. The percentages were 43.4%, 6.2% and 50.4%, respectively in men and 40.4%, 12.1% and 47.6%, respectively in women. Noticeably, with the increase of the duration since diagnosis of cancer, higher percentage of cancer survivor died from disease not related to cancer, ranging from 23.3% within 5 years to 72.1% in more than 30 years (p value for trend <0.001). Conclusion: Although cancer is the major cause of death among cancer survivors, approximately half of participants died from other diseases and complications, such as cardiovascular and respiratory diseases. Clinicians and cancer survivors should pay attention to the prevention and treatment of other diseases and complications.

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