ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Epidemiology and Prevention
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1580953
Excess mortality in young cancer survivors compared with the general population in Italy: a retrospective study from the Italian populationbased cohort of adolescents and young adult cancer survivors
Provisionally accepted
Paolo Giorgi Rossi1*
Francesco Marinelli1
Pamela Mancuso2
Lucia Mangone2Massimo Vicentini2
Isabella Bisceglia2
Alice Bernasconi3
Laura Botta3Annalisa Trama3- 1Epidemiology Unit, AUSL-IRCCS di Reggio Emilia, 42122, Reggio Emilia, Italy, Reggio Emilia, Italy
- 2EPIDEMIOLOGY UNIT, AUSL-IRCCS REGGIO EMILIA, Reggio Emilia, Italy
- 3Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, Milano, Italy
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BackgroundAdolescents and young adults (AYA) cancer survivors experience increased morbidity and mortality from second cancers, cardiovascular, infectious, kidney, and other chronic diseases. We aim to calculate all-causes cancer and non-cancer excess mortality of young cancer survivors compared to the general population. MethodsThe AYA cohort includes cancer patients diagnosed between 1976 and 2013 and alive at 5 years after diagnosis in 30 population-based cancer registries and followed up until 31 December 2019. The standardised mortality ratios (SMRs) and absolute excess risks (AERs) per 100,000 for person-years were calculated. Results58,387 5-year survivors were followed up for 427,130 person-years; the median follow-up time was 5.7 years beyond the 5th year after diagnosis. During this time, 4,194 (7.2%) had died by the end of 2019, and only 1.6% were lost to follow-up. Compared with the general population, AYA survivors had higher mortality, overall, the SMR for all-cause mortality was 7.0 (95%CI: 6.8-7.2). The excess of mortality was higher in the first period after diagnosis (5-10 years), SMR 12.8 (95%CI 12.3-13.3), then it decreased, reaching an SMR of 2.2 (95%CI 1.6-3.2) after 30 years. ConclusionsThe excess mortality is mostly due to the malignancy of the primary tumour, but an about 2-fold excess of mortality is also appreciable for non-cancer causes. Young adult cancer survivors face a sevenfold increase in all-cause mortality compared to the general population, with a notable rise in both cancer-related and non-cancer deaths. Thirty years post-diagnosis, the excess risk from cancer and non-cancer causes becomes nearly equal.
Keywords: Survivors, Adolescent and young adults, Cancer, cohort study, Mortality
Received: 21 Feb 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Giorgi Rossi, Marinelli, Mancuso, Mangone, Vicentini, Bisceglia, Bernasconi, Botta and Trama. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Paolo Giorgi Rossi, Epidemiology Unit, AUSL-IRCCS di Reggio Emilia, 42122, Reggio Emilia, Italy, Reggio Emilia, Italy
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