You are here

Article Text

Article menu

Download PDFPDF

Respiratory epidemiology
Original article
Respiratory mortality of childhood, adolescent and young adult cancer survivors
  1. Miranda M Fidler1,2,
  2. Raoul C Reulen1,
  3. Chloe J Bright1,
  4. Katherine E Henson1,3,
  5. Julie S Kelly1,
  6. Meriel Jenney4,
  7. Antony Ng5,
  8. Jeremy Whelan6,
  9. David L Winter1,
  10. Clare Frobisher1,
  11. Michael M Hawkins1
  12. On behalf of the British Childhood Cancer Survivor Study (BCCSS) Steering Group
    1. 1 Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
    2. 2 Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
    3. 3 Clinical Trial Service Unite, University of Oxford, Oxford, UK
    4. 4 Department of Paediatric Oncology, Children’s Hospital for Wales, Cardiff, UK
    5. 5 Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, UK
    6. 6 Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
    1. Correspondence to Professor Michael M Hawkins, Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Universityof Birmingham, Birmingham B15 2TY, UK; m.m.hawkins{at}bham.ac.uk

    Abstract

    Background Exposure to radiation and/or chemotherapy during cancer treatment can compromise respiratory function. We investigated the risk of long-term respiratory mortality among 5-year cancer survivors diagnosed before age 40 years using the British Childhood Cancer Survivor Study (BCCSS) and Teenage and Young Adult Cancer Survivor Study (TYACSS).

    Methods The BCCSS comprises 34 489 cancer survivors diagnosed before 15 years from 1940 to 2006 in Great Britain. The TYACSS includes 200 945 cancer survivors diagnosed between 15 years and 39 years from 1971 to 2006 in England and Wales. Standardised mortality ratios and absolute excess risks were used.

    Findings Overall, 164 and 1079 respiratory deaths were observed in the BCCSS and TYACSS cohorts respectively, which was 6.8 (95% CI 5.8 to 7.9) and 1.7 (95% CI 1.6 to 1.8) times that expected, but the risks varied substantially by type of respiratory death. Greatest excess numbers of deaths were experienced after central nervous system (CNS) tumours in the BCCSS and after lung cancer, leukaemia, head and neck cancer and CNS tumours in the TYACSS. The excess number of respiratory deaths increased with increasing attained age, with seven (95% CI 2.4 to 11.3) excess deaths observed among those aged 50+ years in the BCCSS and three (95% CI 1.4 to 4.2) excess deaths observed among those aged 60+ years in the TYACSS. It was reassuring to see a decline in the excess number of respiratory deaths among those diagnosed more recently in both cohorts.

    Conclusions Prior to this study, there was almost nothing known about the risks of respiratory death after cancer diagnosed in young adulthood, and this study addresses this gap. These new findings will be useful for both survivors and those involved in their clinical management and follow-up.

    • clinical epidemiology
    • copd epidemiology
    • paediatric interstitial lung disease
    • pneumonia

    This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

    https://doi.org/10.1136/thoraxjnl-2017-210683

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      View Full Text

      Footnotes

      • Contributors Study design: MMF and MMH. Data collection: MMF, MMH, DLW, JSK, CJB, KEH, RCR and CF. Data analysis and interpretation: MMF, CJB, KEH and RCR. Drafting of the article: MMF and MMH. Critical revision: all authors. Final decision to submit: MMF and MMH.

      • Funding This work was supported by grant number C386/A10422 from Cancer Research UK and PanCareSurFup, which was funded by the European Commission 7th Framework Programme. Some of the work completed in this manuscript was undertaken while MMF was a postdoctoral fellow at the International Agency for Research on Cancer, which was partially funded by the European Commission’s 7th Framework Programme Marie Curie Actions-People-COFUND. No funder had a role in the study design, collection/analysis/interpretation of the data, writing of the report or in the decision to submit the article for publication.

      • Disclaimer The views expressed in this publication are those of the authors and not necessarily represent those of the funders or collaborators.

      • Competing interests None declared.

      • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

      • Ethics approval The National Research Ethics Committee and Confidentiality Advisory Group gave national ethical and legal consents for the BCCSS and TYACSS cohorts to proceed.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement The data are not publicly available due to them containing semi-identifiable information that could compromise research participant privacy. Nonetheless, additional summary tables of count data or person-years are available from the corresponding author upon request.

      • Collaborators The British Childhood Cancer Survivor Study (BCCSS) is a national collaborative undertaking guided by a steering group that comprises Douglas Easton (chair), Michael Hawkins, Helen Jenkinson, Meriel Jenney, Raoul Reulen, Kathryn Pritchard-Jones, Elaine Sugden, Charles Stiller, Andrew Toogood and Hamish Wallace.