According to a recent study published in JAMA Network Open, researchers have analyzed the relative burden of oncologic and nononcologic mortality among long-term survivors of cancer in the US. The study focused on patients who survived breast, prostate, colon, and rectal cancers, and aimed to provide quantitative risk estimates for both cancer-specific and non-cancer-specific outcomes.
Advances in early detection, treatment, and cancer outcomes have significantly improved the survival rates of cancer patients. However, this also increases their likelihood of dying from non-cancer-related conditions due to their increased lifespan. Therefore, risk-stratified care models have become crucial in allocating appropriate care between oncologists and primary care physicians. These models emphasize coordination and address the unique needs of cancer survivors.
The study used data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, focusing on patients diagnosed with breast, prostate, or colorectal cancer between 2003 and 2014. Only patients who received definitive treatment and survived at least five years after diagnosis were included in the study.
Researchers examined various factors including demographic information, tumor characteristics, and treatment details. They categorized the outcomes of interest based on the cause of death. The statistical analysis involved using the least absolute shrinkage and selection operator (LASSO) method to select factors associated with cancer-specific and non-cancer-specific mortality separately.
The study included a cohort of 627,702 patients diagnosed with breast, prostate, colon, or rectal cancer. Among these patients, the majority were women, and the mean age was 61.1 years. The results showed that the majority of cancer patients died due to non-cancer-related causes. In the breast cancer cohort, two-thirds of the patients died from causes unrelated to their primary cancer.
Heart disease was identified as the leading cause of non-cancer-specific deaths in all cancer cohorts, accounting for a significant portion of total deaths. Other common causes included Alzheimer’s disease, cerebrovascular diseases, and chronic obstructive pulmonary disease (COPD).
The study also found variations in factors associated with cancer-specific and non-cancer-specific mortality across different cancer types. For example, in breast cancer patients, higher stage and grade were associated with reduced median survival time for cancer-specific mortality. Similarly, in prostate cancer patients, higher prostate-specific antigen (PSA) levels and a Gleason score of 8 or higher were linked to decreased median survival time for cancer-specific mortality.
Cumulative mortality analysis by risk groups demonstrated substantial differences between cancer-specific and non-cancer-specific mortality. In low-risk groups of breast, prostate, colon, and rectal cancer patients, the incidence of non-cancer-specific mortality was significantly higher compared to cancer-specific mortality.
The findings of this study emphasize the importance of personalized, risk-stratified care for long-term cancer survivors. It underlines the need for improved coordination between oncologists and primary care physicians to provide comprehensive care beyond the initial cancer diagnosis.
It is important to note that the study had certain limitations, including limited clinical and treatment information, lack of data on comorbidities, and potential disparities in treatment and access to quality healthcare. Future studies should incorporate additional follow-up data on treatment and disease recurrence to gain a more comprehensive understanding.
The results of this study contribute to our understanding of the risk profiles of long-term cancer survivors and highlight the importance of addressing their specific healthcare needs. By providing insight into the relative burden of oncologic and nononcologic mortality, this research can support the development of effective care models for cancer survivors.
