Causes of Death After Rectal Cancer Diagnosis: A population-based study

Abstract BACKGROUND The focus on non-rectal cancer causes of death in patients with rectal cancer remains superficial. The purpose of the current study was to review the causes of death in rectal cancer survivors. METHODS We used the population-based Surveillance, Epidemiology, and End Results (SEER) cancer registry data to evaluate the causes of death in rectal cancer patients. We summarized characteristics of patients after diagnosis and survival outcomes, using Kaplan–Meier analysis and multivariate Cox proportional hazard regression analysis for survival analysis. RESULTS The study included 121742 patients who were diagnosed with rectal cancer, of whom 72,007 (59.1%) died during follow-up. Most deaths occurred from rectal cancer (n =31,505, 43.80%), and the number of rectal cancer deaths decreased as more years passed after diagnosis. >10 years after diagnosis, the most common causes of death were heart disease followed by rectal cancer. The 5-year overall survival rate, rectal cancer-specific survival rate, and non-rectal cancer-specific survival rate were 32.0%, 17.3% and 56.6%, respectively. And the 10-year overall survival rate, rectal cancer-specific survival rate and non-rectal cancer-specific survival rate were 14.6%, 4.4% and 31.8%, respectively. On multivariate analysis, factors associated with heart disease-specific survival among rectal cancer survivors include white race, female, married, grade I, earlier stages, surgery and chemotherapy. CONCLUSIONS Rectal cancer is the most common cause of death after diagnosis, however, the proportion of non-rectal cancer causes increases with longer survival. Routine follow-up care for rectal cancer survivors should be given more attention than ever.