Causes of Death in Cancer Patients (CoDiCa)

Abstract

Cancer remains the leading cause of premature death worldwide. While the survival rate of cancer patients continues to improve, non-cancer events including potential long-term and late effects are now competing with cancer as the underlying cause of death. However, limited studies have focused on the cause-specific mortality in overall population of patients with cancer. Mortality patterns and the risk of non-cancer mortality in patients with cancer remain unknown. Therefore, the purpose of this study is to characterize the causes of death among patients with cancer. The results will provide critical insights into shifting mortality trends, helping to improve survivorship care and long-term outcomes for cancer patients.

The objective of this study is to analyze cause-specific mortality among cancer patients in Germany. The study will evaluate mortality patterns based on: (1) cancer type (and stage), (2) calendar year, (3) sex and patient age, (4) time after diagnosis, and (5) histology and mode of treatment (in a later study based on clinical dataset). The corresponding hypotheses are: (1) patients with highly lethal cancers and cancers in advanced stage are more likely to die from cancer-related causes; (2) there are changes in mortality pattern from 1998 to 2021; the proportion of cancer deaths among patients with cancer decreases, while the proportion of non-cancer death gradually increases; (3) older patients with cancer are more likely to die from non-cancer related causes compared to younger patients with cancer; (4) patients with cancer are more likely to die from non-cancer related causes after 10 years compared to the time of their initial cancer diagnosis; (5) patients with cancer who receive chemotherapy are at a higher risk of mortality due to non-cancer diseases such as infectious diseases and ischemic heart disease; (6) patients with advanced cancer are at higher risk of suicide.