Does Cardiovascular Mortality Overtake Cancer Mortality During Cancer Survivorship?

Figures

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  Figure 1. Predicted Cause-Specific Mortality in Cancer Survivors 40 to 59 Years of Age at Diagnosis Predicted cause-specific mortality per 1,000 person-years (p-yrs) by time since diagnosis in cancer survivors 40 to 59 years of age at diagnosis. Predicted mortality was calculated using Poisson models incorporating categorical age at diagnosis and time since diagnosis. Cardiovascular mortality did not overtake cancer mortality during the observation period, except among survivors of uterine cancer. Blue line = cardiovascular disease mortality; red line = primary malignancy mortality; black line = all malignancy mortality. Ordering of cancer sites is by International Classification of Diseases code of the cancer site. Predicted mortality is predicted at the midpoint of each category of time since diagnosis. The number of people (N) contributing to the analysis at 1.5, 7.5, 12.5, and 20 years is provided. Graphs are truncated at the earliest time since diagnosis group where the width of the CI exceeds 50 to 1,000 patient-years.

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  Figure 2. Predicted Cause-Specific Mortality in Cancer Survivors 60 to 79 Years of Age at Diagnosis Predicted cause-specific mortality per 1,000 person-years (p-yrs) by time since diagnosis in cancer survivors 60 to 79 years of age at diagnosis. Predicted mortality was calculated using Poisson models incorporating categorical age at diagnosis and time since diagnosis. Mortality from cardiovascular causes overtook mortality due to the primary cancer in survivors of 7 of 9 cancer types. Cardiovascular mortality overtook all cancer mortality for malignant melanoma and uterine cancer over a longer time period. Blue line = cardiovascular disease mortality; red line = primary malignancy mortality; black line = all malignancy mortality. Ordering of cancer sites is by International Classification of Diseases code of the cancer site. Predicted mortality is predicted at the midpoint of each category of time since diagnosis. The number of people (N) contributing to the analysis at 1.5, 7.5, 12.5, and 20 years is provided. Graphs are truncated at the earliest time since diagnosis group where the width of the CI exceeds 50 to 1,000 patient-years.

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  Figure 3. Predicted Cause-Specific Mortality in Cancer Survivors ≥80 Years of Age at Diagnosis Predicted cause-specific mortality per 1,000 person-years (p-yrs) by time since diagnosis in cancer survivors ≥80 years of age at diagnosis. Predicted mortality was calculated using Poisson models incorporating categorical age at diagnosis and time since diagnosis. Mortality from cardiovascular causes overtook mortality due to the primary cancer in survivors of all 9 cancer types. Cardiovascular mortality overtook all cancer mortality for 6 cancer types over a longer time period. Blue line = cardiovascular disease mortality; red line = primary malignancy mortality; black line = all malignancy mortality. Ordering of cancer sites is by International Classification of Diseases code of the cancer site. Predicted mortality is predicted at the midpoint of each category of time since diagnosis. The number of people (N) contributing to the analysis at 1.5, 7.5, 12.5, and 20 years is provided. Graphs are truncated at the earliest time since diagnosis group where the width of the CI exceeds 50 to 1,000 patient-years.

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  Central Illustration. Does Cardiovascular Mortality Overtake Cancer Mortality During Cancer Survivorship? Tabulated crossover point (years, 95% CIs) at which the predicted cardiovascular disease mortality rate equals the predicted mortality rate from primary cancer for the 9 most common cancers, by age group at diagnosis. Predicted cardiovascular and cancer mortality rates over time were calculated using Poisson models including categorical age at diagnosis and time since diagnosis, and crossover points were calculated by interpolating between points at either side of the intersection; 95% CIs were estimated by taking the 2.5th and 97.5th percentile estimates from 200 bootstrap repetitions. Crossover points are not provided if the cardiovascular mortality rate did not equal the mortality rate from cancer within 20 years. An illustrative example is provided for colorectal cancer. In older survivors of 9 common cancers, cardiovascular mortality becomes dominant over mortality from the primary cancer as time passes since cancer diagnosis.