Mortality in survivors of adolescent and young adult cancer: progress and opportunities

Abstract

Survivors of adolescent and young adult (AYA) cancer (ie, those aged 15 to 39 years at diagnosis) are a large and growing population. There are more than 2 million survivors of AYA cancer in the USA alone,¹ and efforts targeted at reducing late morbidity and mortality are urgently needed. In The Lancet Public Health, Taylor Hughes and colleagues² evaluate the risk of mortality after a diagnosis of cancer as an AYA over a median of 9 years from diagnosis. Including 24 459 individuals with primary AYA cancer in the Alberta AYA Cancer Survivor Study, they found that all-cause cumulative morality was 35·6% (95% CI 34·6–36·7) at 30 years from diagnosis. This translated to an 11-fold increased risk of mortality in the overall cohort and a 4-fold increased risk of mortality among those who reached 5 years of survival compared with expected mortality in the general population. Cancer recurrence or progression was the main driver of excess mortality, whereas beyond 10-years from diagnosis, subsequent primary neoplasms (SPN) and non-cancer causes of death became more prevalent. Encouragingly, the authors found reductions in mortality for AYAs diagnosed with cancer in more recent decades, largely the result of decreased deaths due to cancer recurrence or progression. These results are similar to those of previous population-based survival analyses using data from the Surveillance, Epidemiology, and End Results database and California Cancer Registry, which found improvements in primary cancer mortality over time, as well as persistently elevated long-term risks of non-cancer and SPN mortality among survivors of AYA cancer.3, 4, 5