Long-Term Major Respiratory Mortality Among 5-Year Survivors of Adolescent and Young Adult Cancer.

Abstract

Adolescent and young adults (AYAs) diagnosed with cancer are at risk of experiencing pulmonary dysfunction years or even decades following completion of treatment. Is the risk of major respiratory mortality higher in long-term survivors of AYA cancers compared with the general population? This study analyzed data from the Surveillance, Epidemiology, and End Results (SEER) 8 database, covering 1975 to 2021. Standardized mortality ratios (SMRs) and absolute excess risks were calculated, stratified according to demographic and clinical characteristics. A total of 125,051 five-year AYA cancer survivors (aged 15-39 years at diagnosis) were included. Overall, 443 major respiratory deaths occurred, which was 1.1-fold (95% CI, 1.01-1.21) that expected in the general population, corresponding to 0.25 (95% CI, 0.01-0.50) excess respiratory deaths per 10,000 person-years. Hodgkin lymphoma was associated with the highest SMR for pneumonia deaths, whereas lung cancer had the highest SMR for chronic lower respiratory disease deaths. The absolute excess risk for pneumonia deaths was more than twice as high in male individuals as in female individuals (0.7 vs 0.3). In addition, Black survivors faced a 54% increased risk of death from chronic lower respiratory disease. This investigation highlights the heterogeneity in the risk of mortality due to respiratory diseases among long-term AYA cancer survivors in the United States. This risk varies across different cancer types, age demographic characteristics, and ethnicities. These findings provide useful insights for the development of personalized guidelines aimed at long-term monitoring of pulmonary dysfunction in this expanding population.