Long term survivors of childhood cancer

At the beginning of Lucina’s career, 5 year survival rates for many childhood cancers were not great, but over the last few decades this has improved significantly with overall survival rates at 5 years being over 85%. What happens after 5 years (known as late mortality)? Dixon SB et al (Lancet 2023; 401:10386:1447–1457. https://doi.org/10.1016/S0140-6736(22)02471-0) have looked at specific causes of late mortality and risk reduction through modifiable lifestyle and cardiovascular risk factors. This retrospective cohort study was from 31 US and Canadian cancer hospital based institutions and included, 34, 230 5 year survivors of childhood cancer with a median follow-up from diagnosis of 29 years (range 5–48) in the Childhood Cancer Survivor Study. The 40 year cumulative all-cause mortality was 23·3% (95% CI 22·7–24·0), with 3061 (51·2%) of 5916 deaths from health-related causes. Survivors 40 years or more from diagnosis experienced 131 excess health-related deaths per 10 000 person-years (95% CI 111 to 163), including those due to the top three causes of health-related death in the general population: cancer, heart disease and cerebrovascular disease. Healthy lifestyle and absence of hypertension and diabetes were each associated with a 20–30% reduction in health-related mortality independent of other factors (all p values≤0·002). Children who survive …