FIGURE 4.1 All-cause mortality, by sex (Childhood Cancer Survivor Study). US population: Age-adjusted expected survival rates. Cancer survivor: All-cause mortality experience from five years after inital canccer diagnosis.

SOURCE: Mertens et al., 2001. Reprinted with permission of the American Society of Clinical Oncology.

observed in this cohort. The risk was highest among females, those diagnosed with cancer before the age of 5, and those with an initial diagnosis of leukemia or central nervous system (CNS) tumor (Mertens et al., 2001; Moller et al., 2001).

The cumulative cause-specific mortality was highest for cancer recurrence (7 percent at 25 years from diagnosis) (Figure 4.2). Death rates due to subsequent cancers and other causes increased more rapidly in the time period 15 to 25 years after diagnosis than from 5 to 15 years after diagnosis.

Despite the relatively high prevalence of late effects, recent evidence suggests that survivors of childhood cancer view themselves as being in relatively good health. Only 11 percent of 9,434 members of the CCSS cohort reported that they were in fair or poor general health when recently surveyed (Kevin Oeffinger, personal communication to Maria Hewitt, August 16, 2002). This assessment may not necessarily indicate a lack of limitations or disability. People with serious chronic illness, recurring disease, or disability sometimes report being in good health because they

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