Causes of death among cancer survivors in the NIH-AARP Diet and Health Study

Background: The long-term causes of death among cancer survivors of all cancer sites have not been examined.

Objective: To evaluate the cause-specific mortality among cancer survivors in a large, prospective cohort.

Methods: In the National Institutes of Health-AARP Diet and Health Study, 73,703 cancer cases were identified through linkage to state cancer registries from 1995-2006. Cause of death was ascertained by linkage to the National Death Index (1995-2008). Cause of death among cancer survivors and non-cancer controls (n=409,228) during the first 5-years and after 5-years of follow-up were examined. Age-adjusted mortality rates were calculated.

Results: During the first 5-years of follow-up, 23,102 and 12,161 deaths were occurred among cancer survivors and non-cancer controls, respectively, whereas 4,581 and 31,028 deaths were identified among cancer survivors and non-cancer controls, respectively, after 5-years of follow-up. During the first five-years of follow-up among cancer survivors, cancer was the leading cause of death (men:81%, women:87%) followed by cardiovascular disease (men:9%, women:6%) and respiratory disease (men:2%, women:2%). After five-years of follow-up, the proportion of death from cancer decreased (men:53%, women:62%), but cardiovascular disease death (men:23%, women:16%) and respiratory disease death (men:6%, women:7%) increased among cancer survivors. After 5-years of follow-up, the cardiovascular death rate among cancer survivors (65 and 44 per 10,000 person-years in men and women, respectively) was similar to that of non-cancer controls (65 and 38 per 100,000 person-years).

Conclusion: Among cancer survivors, the probability of dying from cancer decreased with time while the probability of dying from cardiovascular disease increased.