Treatment-related mortality in children with cancer: Prevalence and risk factors

Erik A. H. Loeffen*, Rutger R. G. Knops, Joren Boerhof, E. A. M. (Lieke) Feijen, Johannes H. M. Merks, Ardine M. J. Reedijk, Jan A. Lieverst, Rob Pieters, H. Marike Boezen, Leontien C. M. Kremer, Wim J. E. Tissing

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Aim: Intensive treatment regimens have contributed to a marked increase in childhood cancer survival rates. Death due to treatment-related adverse effects becomes an increasingly important area to further improve overall survival. In this study, we examined 5-year survival in children with cancer to identify risk factors for treatment-related mortality (TRM).

Methods: All children (aged

Results: A total of 1764 patients were included; overall 5-year survival was 78.6%. Of all 378 deaths, 81 (21.4%) were treatment-related, with infection being responsible for more than half of these deaths. Forty percent of TRM occurred in the first three months after initial diagnosis. Factors associated with TRM in the multivariable competing risks analysis were diagnosis of a haematological malignancy, age at diagnosis

Conclusion: Over one in five deaths in children with cancer death was related to treatment, mostly due to infection. In children suffering from a haematological malignancy, more children died due to their treatment than due to progression of their disease. To further increase overall survival, clinical and research focus should be placed on lowering TRM rates without compromising anti-tumour efficacy. The findings presented in this study might help identifying areas for improvement. (C) 2019 The Authors. Published by Elsevier Ltd.

Original languageEnglish
Pages (from-to)113-122
Number of pages10
JournalEuropean Journal of Cancer
Publication statusPublished - Nov-2019


  • Child
  • Cancer
  • Mortality
  • Treatment-related mortality

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