Isn’t it evident? Of course, from cancer! Not necessarily. While cancer accounts for a significant portion of deaths worldwide, it still is second to heart disease as the most common cause of death.1 As long-term cancer survival continues to improve, it is important to identify risk for dying from cancer and other causes.2 This could inform future research into screening, prevention, and long-term follow-up.
A recent study sought to characterize the causes of death among American cancer patients and to determine yearly trends, patient age, and time since diagnosis, as critical variables.3
Using death certificate data in the Surveillance, Epidemiology, and End Results (SEER) database (which is representative of 28% of the US population), standardized mortality ratios (SMRs) were used to depict the relative risk of death as compared with all persons. Deaths were coded in the following manner: “Index-cancer” refers to the cancer originally diagnosed in the patient; “Nonindex-cancer” connotes a second primary; and, “Noncancer death”, indicates death from any medical cause not coded as cancer. The timeframe of 1973 to 2012 formed the basis of the data analysis. The following four key findings were revealed:
The greatest relative decrease in index-cancer death (from >60% to < 30%) was among patients with malignancies of the testis, kidney, bladder, endometrium, breast, cervix, prostate, ovary, anus, colorectum, melanoma, and lymphoma.
Noncancer causes of death were highest in patients with cancers of the colorectum, bladder, kidney, endometrium, breast, prostate and testis; more than 40% of these deaths were from heart disease.
The highest SMRs were usually within the first year following diagnosis; most common was from non-bacterial infections, particularly in patients over age 50 years and patients with lymphoma.
Increasing SMRs from Alzheimer’s disease were noted in patients with prostate cancer and suicide in patients with testicular cancer.
The study authors summarized that patients with prostate, breast, and testis cancer are least likely to die from their cancer while those with lung, pancreas, and brain primary tumors are most likely to die of their cancer. Patients with cancers of the oropharynx, larynx, and Hodgkin lymphoma would most benefit from screening for second cancers. Finally, patients with breast and prostate cancer are at highest risk to die from a noncancer cause of death, the most prominent cause of such being heart disease.
These findings suggest the need for an increasing role in screening following cancer diagnosis and treatment especially for cancers with known risk for a second primary. Additionally, concomitant education about the dangers of smoking that is associated with heart disease is also indicated. There are opportunities to learn from and integrate our cardiology nurse colleagues into this realm of practice. In the absence of more effective approaches to screen for and treat lung, pancreas, and brain malignancies, early introduction of palliative care should be a priority—not a possibility.
Keeping appraised of findings such as what has been reported here, helps oncology nurses plan effectively for both new clinical practice innovations and approaches, and also for offering commentary on cancer program development.
GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Jan 10;385(9963):117-71.
Masters GA, Krilov L, Bailey HH, et al. Clinical cancer advances 2015: Annual report on progress against cancer from the American Society of Clinical Oncology. J Clin Oncol. 2015 Mar 1;33(7):786-809.
Zaorsky NG, Churilla TM, Egleston BL, et al. Causes of death among cancer patients. Annals Oncol. 2017 28(2): 400-407.
FDA Approves Onivyde for Advanced Pancreatic Cancer Marijke Vroomen Durning, RN, 10/27/2015 3 On October 22, 2015, the US Food and Drug Administration (FDA) approved Onivyde (irinotecan liposome injection, Merrimack Pharmaceuticals, Inc.), in combination with fluorouracil ...