Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
Department of Mathematics and Statistics, Elon University, Elon, North Carolina.
Cancer Epidemiol Biomarkers Prev. 2019 Sep;28(9):1417-1426. doi: 10.1158/1055-9965.EPI-18-1384. Epub 2019 Jun 17.
Few studies have examined noncancer outcomes among patients diagnosed with cancer as adolescents and young adults (AYA). We examined risk of mortality from noncancer causes after an AYA cancer diagnosis and investigated disparities according to race/ethnicity and other characteristics.
Patients with a first primary cancer at ages 15 to 39 years diagnosed during 1987 to 2015 were identified in the Surveillance, Epidemiology, and End Results database ( = 242,940 women, 158,347 men). Survival months were accrued from diagnosis until death or December 2015. Multivariable-adjusted HRs were used to examine disparities in mortality from all noncancer causes, cardiovascular diseases (CVD), and infectious diseases (ID) according to race/ethnicity, geographic region, and county-level characteristics.
For all cancer types combined, the 10-year cumulative incidence of noncancer-related death after AYA cancer was 2% and 5% among women and men, respectively. With adjustment for cancer type, all noncancer mortality was increased among non-Hispanic Black AYAs [HR vs. non-Hispanic White: HR = 2.31; 95% confidence interval (CI): 2.16-2.47; HR = 2.17; 95% CI: 2.05-2.30] and those in the South (HR vs. Northeast: HR = 1.18; 95% CI: 1.07-1.29; HR = 1.42; 95% CI: 1.31-1.55) or in rural counties (HR vs. metro: HR = 1.74; 95% CI: 1.47-2.07; HR = 1.57; 95% CI: 1.33-1.86). Mortality from CVD and ID was also elevated among non-Hispanic Black AYAs.
Results of this study suggest that noncancer mortality after AYA cancer is highest among survivors who are non-Hispanic Black or live in the South or in rural counties.
Our analyses highlight disparities among AYAs with cancer and identify subgroups that may be targeted for increased medical surveillance or behavioral interventions.
鲜有研究调查过青少年和年轻成人（AYA）癌症患者的非癌症相关结局。我们研究了 AYA 癌症诊断后非癌症相关原因导致的死亡率，并根据种族/族裔和其他特征调查了差异。
我们从监测、流行病学和最终结果数据库中确定了 1987 年至 2015 年期间诊断为 15 至 39 岁的首例原发性癌症患者（女性 242940 人，男性 158347 人）。从诊断到死亡或 2015 年 12 月，计算生存月数。使用多变量调整的 HR 来检查非癌症相关死亡率的差异，包括所有非癌症病因、心血管疾病（CVD）和传染病（ID），根据种族/族裔、地理位置和县级特征进行分层。
对于所有癌症类型，女性和男性在 AYA 癌症后 10 年的非癌症相关死亡累积发生率分别为 2%和 5%。在调整癌症类型后，非裔美国人的所有非癌症死亡率均升高（非裔美国人与非裔美国人的 HR：HR = 2.31；95%置信区间（CI）：2.16-2.47；HR = 2.17；95% CI：2.05-2.30），南部地区（与东北部地区相比的 HR：HR = 1.18；95% CI：1.07-1.29；HR = 1.42；95% CI：1.31-1.55）或农村县（与大都市相比的 HR：HR = 1.74；95% CI：1.47-2.07；HR = 1.57；95% CI：1.33-1.86）。非裔美国人 CVD 和 ID 的死亡率也较高。
本研究结果表明，AYA 癌症幸存者中，非裔美国人或生活在南部或农村县的幸存者的非癌症死亡率最高。
我们的分析强调了 AYA 癌症患者之间的差异，并确定了可能需要加强医疗监测或行为干预的亚组。
