Dood RL, et al. - Authors ascertained the high- and low-risk periods for all tumor types that could define when survivorship care might best be overseen by oncologists and when to transition to primary care physicians. Data demonstrated an inadequacy of a standardized 5-year surveillance period for some cancers, whereas it was excessive for others. The most resources with the longest high-risk period, highest persistent baseline mortality risk and longest period of primary cancer mortality were needed by the high-risk cancers, all arguing for longer follow-up with an oncologist in these cancers.

Methods

• Experts plotted excess mortality hazard, calculated as an annualized mortality risk above a baseline population in this pan-cancer, longitudinal, observational study.
• A high-risk period was defined by the time this hazard took to stabilize.
• The mortality gap was reported as the percent morality elevation above age- and sex-matched controls in the latter low-risk period.
• Cancer population was defined by the US population–based Surveillance, Epidemiology, and End Results database, and the controls were defined by the US Census life tables.
• Experts seperted the incident cases of patients with cancer into tumor types based on International Classification of Diseases for Oncology definitions.
• They compared the population-level data on incident cancer cases with the general US population.
• On observed cancer cases, overall mortality and cause of death were reported.

Results

• As per data, authors evaluated a total of 2,317,185 patients (median age, 63 years; 49.8% female) with 66 primary tumor types.
• Findings suggested that high-risk surveillance period durations ranged from less than 1 year (breast, prostate, lip, ocular, and parathyroid cancers) up to 19 years (unspecified gastrointestinal cancers).
• Results demonstrated the annualized mortality gap, representing the excess mortality in the stable period, ranged from a median 0.26% to 9.33% excess annual mortality (thyroid and hypopharyngeal cancer populations, respectively).
• Researchers noted that the cluster analysis produced 6 risk cluster groups: group 1, with median survival of 16.2 (5th to 95th percentile range [PR], 10.7-40.2) years and median high-risk period of 2.5 (PR, 0-5.0) years; group 2, 8.3 (PR, 5.1-23.3) and 2.5 (PR, 4.0-8.0) years; group 3, 2.8 (PR, 1.4-3.7) and 7.0 (PR, 6.0-11.1) years; group 4, 1.6 (PR, 1.5-1.8) and 6.0 (PR, 5.1-11.4) years; group 5, 0.8 (PR, 0.5-1.2) and 0.8 (PR, 0.5-1.2) years; and group 6, 0.5 (PR, 0.4-0.8) and 12.0 (PR, 9.3-12.9) years, respectively.
• Stratifying on stage and histologic type can change the risk cluster and guidance for care; as noted on subanalyses of selected tumor types in these groups.