Dr. Ehrhardt on Factors Associated with Late Mortality in Survivors of Childhood Cancer

Matthew J. Ehrhardt, MD, MS, pediatric hematologist-oncologist, St. Jude Children's Research Hospital, discusses the link between modifiable chronic health conditions and social determinants of health with late mortality for survivors of childhood cancer.

Findings from a study published in JAMA Network Open showed that in a cohort analysis of survivors of childhood cancer, living in a high area deprivation index (ADI) and having modifiable chronic health conditions were independently associated with an increased risk of late death in these survivors. Investigators concluded that these findings emphazied the need to improve outcomes for these patients by developing risk-stratification strategies in order to optimize care delivery.

The study included 9440 eligible individuals who survived 5 or more years after a diagnosis of childhood cancer, and data showed that survivors were at 7-fold increased risk of all-cause and health-related death. Additionally, 3407 survivors had 10 or more chronic health conditions of grade 1 to 4, or 3 or more chronic health conditions of grade 3 to 4 at baseline. These patients were at the highest risk of mortality.

Modifiable chronic health conditions can include high blood pressure, obesity, or dyslipidemia, and these were found to have an association with an increased risk of mortality in survivors of childhood cancer, Ehrhardt explains. Moreover, frailty was also found to be linked to an increase in mortality, Ehrhardt adds. Aging, low lean-muscle mass, self-reported exhaustion, low energy expenditure, slowness, and weakness can all be signs of frailty.

ADI is a well-established marker that measures neighborhood-level socioeconomic disadvantage, and it accounts for education level, employment status, housing quality, and poverty measures at the census block level, Ehrhardt explains. The association between a high ADI and increased late mortality was noted during the study, even when adjusting for other factors such as chronic health conditions and treatment exposures. This confirmed that the ADI was associated with an increased risk of death in survivors of childhood cancer, Ehrhardt concludes.