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      Causes of death among cancer patients in the era of cancer survivorship in Korea: Attention to the suicide and cardiovascular mortality

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          Abstract

          Background

          Improved cancer survival is expected to increase noncancer deaths; however, detailed causes of death have rarely been discussed. Changing landscapes in mortality patterns and noncancer mortality risks in patients with cancer require evaluation.

          Methods

          We identified cancer and noncancer‐related causes of death using data from the 2000‐2016 national cancer registry in Korea (n = 2 707 520), and we characterized the leading causes of death and proportionate mortalities over time. Risks of noncancer deaths relative to the general population were estimated using standardized mortality ratios (SMRs).

          Results

          Of 1 105 607 identified deaths, 87% were due to the primary cancer. Proportionate mortalities of primary cancer among overall deaths remained high in patients with liver (86%) and lung (70%) cancers and in female patients with breast cancer (77%), even 5 to 10 years following diagnosis, whereas proportionate mortalities reduced to ≤50% in patients with stomach (men, 39%; women, 48%), prostate (47%), and female thyroid (27%) cancers. Despite the predominance of index cancer deaths, the proportion of noncancer deaths among all deaths increased over time. There was a 20‐fold increase in cardiovascular disease deaths among patients with cancer from 2000 to 2016, and the risk of suicide among patients with cancer was higher than that among the general population (SMR: 1.68 [95% confidence interval (CI): 1.63‐1.74] in men, SMR: 1.42 [95% CI: 1.33‐1.55] in women).

          Conclusions

          Deaths from primary cancer remain a major concern; however, follow‐up is required for both cancer and noncancer‐related health issues in cancer survivors, especially concerning suicide and cardiovascular deaths.

          Abstract

          Death from primary cancer is still the major concern, but noncancer deaths are expected to become an important issue. Higher risks of suicide death and increasing number of cardiovascular disease deaths in cancer patients highlight the need for preventing suicide and cardiovascular disease in cancer patients.

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          Most cited references28

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          Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage.

          Soonman Kwon (2009)
          South Korea introduced mandatory social health insurance for industrial workers in large corporations in 1977, and extended it incrementally to the self-employed until it covered the entire population in 1989. Thirty years of national health insurance in Korea can provide valuable lessons on key issues in health care financing policy which now face many low- and middle-income countries aiming to achieve universal health care coverage, such as: tax versus social health insurance; population and benefit coverage; single scheme versus multiple schemes; purchasing and provider payment method; and the role of politics and political commitment. National health insurance in Korea has been successful in mobilizing resources for health care, rapidly extending population coverage, effectively pooling public and private resources to purchase health care for the entire population, and containing health care expenditure. However, there are also challenges posed by the dominance of private providers paid by fee-for-service, the rapid aging of the population, and the public-private mix related to private health insurance.
          Article 0 comments Cited 217 times – based on 0 reviews     Review now
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            Incidence of suicide in persons with cancer.

            Tomoko Misono, Mary Redman, Jesse Fann … (2008)
            The purpose of this study was to characterize suicide rates among patients with cancer in the United States and identify patient and disease characteristics associated with higher suicide rates. Prior studies, mostly in Europe, have suggested that patients with cancer may be at increased risk for suicide, but large cohort studies comparing patients with cancer with the general population have not been performed in the United States. Patients in the study were residents of geographic areas served by the Surveillance, Epidemiology, and End Results (SEER) program who were diagnosed with cancer from 1973 to 2002. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. This was a retrospective cohort study of suicide in persons with cancer. Among 3,594,750 SEER registry patients observed for 18,604,308 person-years, 5,838 suicides were identified, for an age-, sex-, and race-adjusted rate of 31.4/100,000 person-years. In contrast, the suicide rate in the general US population was 16.7/100,000 person-years. Higher suicide rates were associated with male sex, white race, and older age at diagnosis. The highest suicide risks were observed in patients with cancers of the lung and bronchus (standardized mortality ratio [SMR] = 5.74; 95% CI, 5.30 to 6.22), stomach (SMR = 4.68; 95% CI, 3.81 to 5.70), oral cavity and pharynx (SMR = 3.66; 95% CI, 3.16 to 4.22), and larynx (SMR = 2.83; 95% CI, 2.31 to 3.44). SMRs were highest in the first 5 years after diagnosis with cancer. Patients with cancer in the United States have nearly twice the incidence of suicide of the general population, and suicide rates vary among patients with cancers of different anatomic sites. Further examination of the psychological experience of patients with cancer, particularly that of patients with certain types of cancer, is warranted.
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              Improved estimates of cancer-specific survival rates from population-based data.

              Nadia Howlader, A Mariotto, Marsha Reichman … (2010)
              Accurate estimates of cancer survival are important for assessing optimal patient care and prognosis. Evaluation of these estimates via relative survival (a ratio of observed and expected survival rates) requires a population life table that is matched to the cancer population by age, sex, race and/or ethnicity, socioeconomic status, and ideally risk factors for the cancer under examination. Because life tables for all subgroups in a study may be unavailable, we investigated whether cause-specific survival could be used as an alternative for relative survival. We used data from the Surveillance, Epidemiology, and End Results Program for 2,330,905 cancer patients from January 1, 1992, through December 31, 2004. We defined cancer-specific deaths according to the following variables: cause of death, only one tumor or the first of multiple tumors, site of the original cancer diagnosis, and comorbidities. Estimates of relative survival and cause-specific survival that were derived by use of an actuarial method were compared. Among breast cancer patients who were white, black, or of Asian or Pacific Islander descent and who were older than 65 years, estimates of 5-year relative survival (107.5%, 106.6%, and 103.0%, respectively) were higher than estimates of 5-year cause-specific survival (98.6%, 95% confidence interval [CI] = 98.4% to 98.8%; 97.4%, 95% CI = 96.2% to 98.2%; and 99.2%, 95% CI = 98.4%, 99.6%, respectively). Relative survival methods likely underestimated rates for cancers of the oral cavity and pharynx (eg, for white cancer patients aged ≥65 years, relative survival = 54.2%, 95% CI = 53.1% to 55.3%, and cause-specific survival = 60.1%, 95% CI = 59.1% to 60.9%) and the lung and bronchus (eg, for black cancer patients aged ≥65 years, relative survival = 10.5%, 95% CI = 9.9% to 11.2%, and cause-specific survival = 11.9%, 95% CI = 11.2 % to 12.6%), largely because of mismatches between the population with these diseases and the population used to derive the life table. Socioeconomic differences between groups with low and high status in relative survival estimates appeared to be inflated (eg, corpus and uterus socioeconomic status gradient was 13.3% by relative survival methods and 8.8% by cause-specific survival methods). Although accuracy of the cause of death on a death certificate can be problematic for cause-specific survival estimates, cause-specific survival methods may be an alternative to relative survival methods when suitable life tables are not available.
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                Author and article information

                Contributors
                Hyunsoon Cho:
                ORCID: https://orcid.org/0000-0002-3261-3114
                hscho@ncc.re.kr
                Journal
                Journal ID (nlm-ta): Cancer Med
                Journal ID (iso-abbrev): Cancer Med
                Journal ID (doi): 10.1002/(ISSN)2045-7634
                Journal ID (publisher-id): CAM4
                Title: Cancer Medicine
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2045-7634
                Publication date (Electronic): 20 January 2020
                Publication date Collection: March 2020
                Volume: 9
                Issue: 5 ( doiID: 10.1002/cam4.v9.5 )
                Pages: 1741-1752
                Affiliations
                [ 1 ] Department of Preventive Medicine School of Medicine Kyung Hee University Seoul Republic of Korea
                [ 2 ] Department of Cancer Control and Population Health Graduate School of Cancer Science and Policy National Cancer Center Goyang Republic of Korea
                [ 3 ] Division of Cancer Registration and Surveillance National Cancer Control Institute National Cancer Center Goyang Republic of Korea
                [ 4 ] Vital Statistics Division Statistics Korea Daejeon Republic of Korea
                Author notes
                [*] [* ] Correspondence

                Hyunsoon Cho, Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan‐ro, Ilsandong‐gu, Goyang‐si, Gyeonggi‐do 10408, Republic of Korea (South Korea).

                Email: hscho@ 123456ncc.re.kr

                Author information
                https://orcid.org/0000-0001-9861-6740
                https://orcid.org/0000-0002-4389-9701
                https://orcid.org/0000-0002-3261-3114
                Article
                Publisher ID: CAM42813
                DOI: 10.1002/cam4.2813
                PMC ID: 7050076
                PubMed ID: 31960609
                SO-VID: a3680361-1e54-46cb-9692-71483f4eda93
                Copyright © © 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 October 2019
                Date revision received : 15 December 2019
                Date accepted : 16 December 2019
                Page count
                Figures: 3, Tables: 4, Pages: 12, Words: 8727
                Funding
                Funded by: National Cancer Center , open-funder-registry 10.13039/501100003645;
                Award ID: NCC‐1710300‐3
                Funded by: National Research Foundation of Korea , open-funder-registry 10.13039/501100003725;
                Award ID: NRF‐2019R1H1A1079981
                Categories
                Subject: Original Research
                Subject: Clinical Cancer Research
                Subject: Original Research
                Custom metadata
                source-schema-version-number 2.0
                cover-date March 2020
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.6.1 mode:remove_FC converted:02.03.2020

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: cancer survivorship,cardiovascular diseases,cause of death,neoplasms,noncancer mortality,suicide
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: cancer survivorship, cardiovascular diseases, cause of death, neoplasms, noncancer mortality, suicide

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