Causes of death among patients with primary malignant brain tumors in the US from 2000 to 2021.
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OBJECTIVE: The aim of this study was to characterize the causes of death among patients with primary malignant brain tumors in relation to calendar year, patient age, and time after diagnosis. METHODS: Patients diagnosed with 12 types of primary malignant brain tumors between 2000 and 2021 were identified from the Surveillance, Epidemiology, and End Results program. Causes of death, including 25 non-cancer causes, were characterized in relation to calendar year, patient age, and time after diagnosis. Standardized mortality ratios (SMRs) were calculated to determine the relative risk of death compared to the general population. RESULTS: Of the 96,798 patients in the final cohort, 68,998 died during the follow-up period. Among these, 92.2 % (n = 63,624) died from diagnosed brain tumors, 7.2 % (n = 4946) from non-cancer causes, and 0.6 % (n = 428) from subsequent cancers. The leading non-cancer causes of death were heart diseases (n = 884) and cerebrovascular diseases (n = 365). Patients with malignant meningioma and pilocytic astrocytoma exhibited the highest proportions of non-cancer deaths. The proportion of different causes of death remained stable among patients with glioblastoma from 2000 to 2021, while there was an observed increase in relative non-cancer deaths among patients with other brain tumors. When stratified by age, SMRs for the leading non-cancer causes of death were particularly higher among younger patients. SMRs peaked in the first year following diagnosis for both cancer and most non-cancer deaths. The AUC of 1-year survival prediction was 0.811 (95 % CI: 0.807-0.815) for cancer deaths and 0.682 (95 % CI: 0.678-0.686) for non-cancer deaths. A prediction tool was developed and publicly available for external validation (https://malignantbraintumors.shinyapps.io/calculator/). CONCLUSION: This study provides valuable insights into the causes of death and may inform the development of comprehensive care guidelines aimed at improving patient outcomes.