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Temporal trends in competing mortality from second and subsequent primary cancers, 1980-2014: An Australian population-based study

Ye, Y ORCID: 0000-0003-0025-8434, Otahal, P ORCID: 0000-0003-4042-1769, Wills, KE ORCID: 0000-0003-3897-2908, Neil, AL ORCID: 0000-0002-1344-6672 and Venn, AJ ORCID: 0000-0001-7090-1398 2018 , 'Temporal trends in competing mortality from second and subsequent primary cancers, 1980-2014: An Australian population-based study' , Cancer Epidemiology, vol. 55 , pp. 61-67 , doi: 10.1016/j.canep.2018.05.005.

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Background: Subsequent primary cancers (SPCs) compete with first cancers and non-cancer events as the primary cause of death among cancer patients. We aimed to assess temporal trends in SPC mortality since 1980 among adult-onset cancer patients in competing risk models.Methods: Patients registered with a first cancer in the population-based Tasmanian Cancer Registry, Australia, between 1980-2009 were followed up to December 2014. Cumulative incidence function (CIF) was used to estimate the cumulative incidence of cause-specific deaths in the presence of competing risks. The hazard ratios of SPC-specific deaths were assessed in two regression models: subdistribution hazard ratios from competing risk models (SHRs) and hazard ratios from Cox models (CHRs).Results: Overall, 5339 (9.3%) of 57,288 patients developed SPCs and 2494 died from SPCs during the follow-up. While the cumulative incidence of first cancer deaths at 5, 10, 15 and 20-years gradually decreased over periods of first cancer diagnosis, the cumulative incidence of SPC deaths did not. The SHRs for SPC-specific deaths increased from the reference period 1980-1984 to a peak for first cancers diagnosed in 1995-1999 (SHR = 1.18, 95%CI 1.03-1.35), before a decrease in 2005-2009 (SHR = 0.82, 95%CI 0.70-0.95) in competing risk models. However, this pattern was not consistent in CHRs. For individuals with specific first cancers, those with a first prostate cancer in 1995-1999 ha d the greatest SPC mortality risk (SHR = 2.08, 95%CI 1.29-3.36).Conclusion: Competing risk models, but not Cox models, demonstrated temporal increases in SPC-specific mortality. Greater detection of non-fatal first prostate cancers appears to have contributed to this trend.

Item Type: Article
Authors/Creators:Ye, Y and Otahal, P and Wills, KE and Neil, AL and Venn, AJ
Keywords: cancer, competing mortality, population-based, subsequent primary cancers, trends
Journal or Publication Title: Cancer Epidemiology
Publisher: Elsevier Inc.
ISSN: 1877-7821
DOI / ID Number: 10.1016/j.canep.2018.05.005
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© 2018 Elsevier Ltd. All rights reserved.

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