1
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Drechsel KCE, Broer SL, Stoutjesdijk FS, Twisk JWR, van den Berg MH, Lambalk CB, van Leeuwen FE, Overbeek A, van den Heuvel-Eibrink MM, van Dorp W, de Vries ACH, Loonen JJ, van der Pal HJ, Kremer LC, Tissing WJ, Versluys B, Kaspers GJL, van Dulmen-den Broeder E, Veening MA. Clinical and self-reported markers of reproductive function in female survivors of childhood Hodgkin lymphoma. J Cancer Res Clin Oncol 2023; 149:13677-13695. [PMID: 37522923 PMCID: PMC10590326 DOI: 10.1007/s00432-023-05035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To evaluate the impact of treatment for Hodgkin lymphoma (HL) on clinical reproductive markers and pregnancy outcomes. METHODS This study was embedded within the DCOG LATER-VEVO study; a Dutch, multicenter, retrospective cohort study between 2004 and 2014. Serum anti-Müllerian hormone (AMH), follicle stimulating hormone (FSH), inhibin B, antral follicle count (AFC), and self-reported (first) pregnancy outcomes were evaluated in female childhood HL survivors and controls. RESULTS 84 HL survivors and 798 controls were included, aged 29.6 and 32.7 years old at time of assessment. Median age at HL diagnosis was 13.4 years. Cyclophosphamide equivalent dose (CED-score) exceeded 6000 mg/m2 in 56 women and 14 survivors received pelvic irradiation. All clinical markers were significantly deteriorated in survivors (odds-ratio for low AMH (< p10) 10.1 [95% CI 4.9; 20.6]; low AFC (< p10) 4.6 [95% CI 2.1; 9.9]; elevated FSH (> 10 IU/l) 15.3 [95% CI 5.7; 41.1], low Inhibin B (< 20 ng/l) 3.6 [ 95% CI 1.7; 7.7], p < 0.001). Pregnancy outcomes were comparable between survivors and controls (± 80% live birth, ± 20% miscarriage). However, survivors were significantly younger at first pregnancy (27.0 years vs 29.0 years, P = 0.04). Adjusted odds-ratio for time to pregnancy > 12 months was 2.5 [95% CI 1.1; 5.6] in survivors, p = 0.031. Adverse outcomes were specifically present after treatment with procarbazine and higher CED-score. CONCLUSION HL survivors appear to have an impaired ovarian reserve. However, chance to achieve pregnancy seems reassuring at a young age. Additional follow-up studies are needed to assess fertile life span and reproductive potential of HL survivors, in particular for current HL treatments that are hypothesized to be less gonadotoxic.
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Affiliation(s)
- K C E Drechsel
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Cancer Center Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands.
| | - S L Broer
- Department of Reproductive Medicine & Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F S Stoutjesdijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M H van den Berg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, The Netherlands
| | - C B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Overbeek
- Department of Obstetrics and Gynaecology, Northwest Clinics, Alkmaar, The Netherlands
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatric Hemato-Oncology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - W van Dorp
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatric Hemato-Oncology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J J Loonen
- Department of Hematology, Radboudumc Center of Expertise for Cancer Survivorship, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H J van der Pal
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - L C Kremer
- Cancer Center Amsterdam, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - W J Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Heamatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - E van Dulmen-den Broeder
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, The Netherlands
| | - M A Veening
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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2
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Teepen JC, Kok JL, Feijen EAM, Loonen JJ, van den Heuvel‐Eibrink MM, van der Pal HJ, Tissing WJE, Bresters D, Versluys B, Grootenhuis MA, Louwerens M, Neggers SJCMM, van Santen HM, de Vries A, Janssens GO, den Hartogh JG, van Leeuwen FE, Hollema N, Streefkerk N, Kilsdonk E, van der Heiden‐van der Loo M, van Dulmen‐den Broeder E, Ronckers CM, Kremer LCM. Questionnaire‐ and linkage‐based outcomes in Dutch childhood cancer survivors: Methodology of the
DCCSS LATER
study part 1. Cancer Med 2022; 12:7588-7602. [PMID: 36519590 PMCID: PMC10067029 DOI: 10.1002/cam4.5519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/07/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Childhood cancer survivors are at risk for developing long-term adverse health outcomes. To identify the risk of and risk factors for specific health outcomes, well-established cohorts are needed with detailed information on childhood cancer diagnosis, treatment, and health outcomes. We describe the design, methodology, characteristics, and data availability of the Dutch Childhood Cancer Survivor Study LATER cohort (1963-2001) part 1; questionnaire and linkage studies. METHODS The LATER cohort includes 5-year childhood cancer survivors, diagnosed in the period 1963-2001, and before the age of 18 in any of the seven former pediatric oncology centers in the Netherlands. Information on health outcomes from survivors and invited siblings of survivors was collected by questionnaires and linkages to medical registries. RESULTS In total, 6165 survivors were included in the LATER cohort. Extensive data on diagnosis and treatment have been collected. Information on a variety of health outcomes has been ascertained by the LATER questionnaire study and linkages with several registries for subsequent tumors, health care use, and hospitalizations. CONCLUSION Research with data of the LATER cohort will provide new insights into risks of and risk factors for long-term health outcomes. This can enhance risk stratification for childhood cancer survivors and inform surveillance guidelines and development of interventions to prevent (the impact of) long-term adverse health outcomes. The data collected will be a solid baseline foundation for future follow-up studies.
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Affiliation(s)
- Jop C. Teepen
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | - Judith L. Kok
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | | | - Jacqueline J. Loonen
- Radboudumc Center of Expertise for Cancer Survivorship, Department of Hematology Radboud University Medical Center Nijmegen The Netherlands
| | - Marry M. van den Heuvel‐Eibrink
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatric Oncology/Hematology, Erasmus Medical Center Rotterdam The Netherlands
| | | | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatric Oncology/Hematology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | | | - Marloes Louwerens
- Department of Internal Medicine Leiden University Medical Center Leiden The Netherlands
| | - Sebastian J. C. M. M. Neggers
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Medicine, Erasmus Medical Center Rotterdam The Netherlands
| | - Hanneke M. van Santen
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht The Netherlands
| | - Andrica de Vries
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatric Oncology/Hematology, Erasmus Medical Center Rotterdam The Netherlands
| | - Geert O. Janssens
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department Radiation Oncology, University Medical Center Utrecht Utrecht The Netherlands
| | | | - Flora E. van Leeuwen
- Department of Epidemiology and Biostatistics The Netherlands Cancer Institute Amsterdam The Netherlands
| | - Nynke Hollema
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital Nieuwegein The Netherlands
| | - Nina Streefkerk
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatrics, Erasmus Medical Center Rotterdam The Netherlands
| | - Ellen Kilsdonk
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | | | - Eline van Dulmen‐den Broeder
- Department of Pediatric Oncology/Hematology, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Cécile M. Ronckers
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Brandenburg Medical School Institute of Biostatistics and Registry Research Neuruppin Germany
| | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital Utrecht The Netherlands
- Emma Children's Hospital, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
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3
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Roshandel R, van Dijk M, Overbeek A, Kaspers G, Lambalk C, Beerendonk C, Bresters D, van der Heiden-van der Loo M, van den Heuvel-Eibrink M, Kremer L, Loonen J, van der Pal H, Ronckers C, Tissing W, Versluys B, van Leeuwen F, van den Berg M, van Dulmen-den Broeder E. Female reproductive function after treatment of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2021; 68:e28894. [PMID: 33459500 DOI: 10.1002/pbc.28894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim was to evaluate self-reported reproductive characteristics and markers of ovarian function in a nationwide cohort of female survivors of childhood acute lymphoblastic leukemia (ALL), because prior investigations have produced conflicting data. PROCEDURE Self-reported reproductive characteristics were assessed by questionnaire among 357 adult 5-year survivors, treated between 1964 and 2002, and 836 controls. Ovarian function was assessed by serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B and by antral follicle count (AFC). Differences between controls and (subgroups of) survivors (total group, chemotherapy [CT]-only group, CT and radiotherapy [RT] group) were analyzed. RESULTS Survivors treated with CT only do not differ from controls regarding timing of menarche, virginity status, desire for children, or pregnancy rates. Compared to controls, the CT+RT group was at significantly increased risk of a younger age at menarche (P < .01), virginity, an absent desire for children, and lower pregnancy rates (odds ratio [OR] [95% CI]: 0.3 [CI 0.1-0.6], 0.5 [0.3-0.9], and 0.4 [0.2-0.9], respectively). Survivors in the CT-only group were significantly younger at the birth of their first child. Pregnancy outcomes were not significantly different between any (sub)groups. Survivors treated with total body irradiation (TBI) or hematopoietic stem cell transplantation (HSCT) are at increased risk of abnormal markers of ovarian function. CONCLUSION Reproductive function of ALL survivors treated with CT only does not differ from controls. However, survivors additionally treated with RT seem to be at an increased risk of certain adverse reproductive outcomes. Providing personalized counseling about (future) reproductive health risks in this group is imperative.
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Affiliation(s)
- Roxanne Roshandel
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marloes van Dijk
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annelies Overbeek
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gertjan Kaspers
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Cornelis Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Catharina Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorine Bresters
- Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Leontien Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Cecile Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Paediatric Oncology and Heamatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Flora van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marleen van den Berg
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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4
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Meacham LR, Burns K, Orwig KE, Levine J. Standardizing Risk Assessment for Treatment-Related Gonadal Insufficiency and Infertility in Childhood Adolescent and Young Adult Cancer: The Pediatric Initiative Network Risk Stratification System. J Adolesc Young Adult Oncol 2020; 9:662-666. [DOI: 10.1089/jayao.2020.0012] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Lillian R. Meacham
- Department of Pediatrics, Division of Hematlogy and Oncology, Aflac Cancer Center of Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Karen Burns
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kyle E. Orwig
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jennifer Levine
- Department of Pediatrics, Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York, USA
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5
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Meijer AJM, Fiocco MF, Janssens GO, Clemens E, Tissing WJE, Loonen JJ, van Dulmen-den Broeder E, de Vries ACH, Bresters D, Versluys B, Ronckers CM, Kremer LCM, van der Pal HJ, Neggers SJCMM, van der Heiden-van der Loo M, Stokroos RJ, Hoetink AE, van Grotel M, van den Heuvel-Eibrink MM. Risk factors associated with tinnitus in 2948 Dutch survivors of childhood cancer: a Dutch LATER questionnaire study. Neurooncol Adv 2020; 2:vdaa122. [PMID: 33196041 PMCID: PMC7648591 DOI: 10.1093/noajnl/vdaa122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Tinnitus is a serious late effect of childhood cancer treatment. The aim of this study was to determine the occurrence and risk factors for tinnitus in a national cohort of childhood cancer survivors (CCS). Methods Data were collected within the national Dutch Childhood Oncology Group - Long-Term Effects after Childhood Cancer (DCOG-LATER) cohort by a self-reported health questionnaire among 5327 Dutch CCS treated between 1963 and 2002. Siblings (N = 1663) were invited to complete the same questionnaire. Relevant patient characteristics and treatment factors were obtained from the Dutch LATER database. The occurrence of tinnitus in survivors was compared to siblings. To study the effect of risk factors, multivariate logistic regression models were estimated. Results In total, 2948 CCS and 1055 siblings completed the tinnitus item. Tinnitus was reported in 9.5% of survivors and in 3.7% of siblings (odds ratio [OR] 3.0, 95% confidence interval [CI] 2.9-3.1). Risk factors associated with tinnitus in CCS were total cumulative dose cisplatin ≥400 mg/m2 (OR 2.4, 95% CI 1.4-4.0), age at diagnosis (≥10 years: OR 2.1, 95% CI 1.6-2.8), cranial irradiation/total body irradiation (TBI; OR 1.9, 95% CI 1.5-2.5), and neuro/ear, nose, throat (ENT) surgery (OR 1.8, 95% CI 1.1-2.9). Fifty-one percent of CCS with tinnitus had received treatment with either cisplatin, cranial irradiation/TBI, and/or neuro/ENT surgery. Conclusions Tinnitus in CCS was present nearly 3 times more often than in siblings. Awareness in CCS previously treated with cisplatin, cranial irradiation/TBI, and/or neuro/ENT surgery is warranted. As only half of affected CCS had a history of these treatments, it seems that other factors might be associated with tinnitus occurrence in this population.
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Affiliation(s)
| | - Marta F Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Biomedical Data Science, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.,Institute of Mathematics, Leiden University, Leiden, The Netherlands
| | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eva Clemens
- Department of Pediatric Oncology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, University Medical Center Groningen - Beatrix Children's Hospital, Groningen, The Netherlands
| | - Jacqueline J Loonen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, University Medical Center Utrecht - Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Academic Medical Center - Emma Children's Hospital, Amsterdam, The Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Academic Medical Center - Emma Children's Hospital, Amsterdam, The Netherlands
| | - Helena J van der Pal
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Academic Medical Center - Emma Children's Hospital, Amsterdam, The Netherlands
| | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht - Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Alex E Hoetink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht - Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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6
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van Dijk M, van Leeuwen FE, Overbeek A, Lambalk CB, van den Heuvel-Eibrink MM, van Dorp W, Tissing WJ, Kremer LC, Loonen JJ, Versluys B, Bresters D, Ronckers CM, van der Pal HJ, Beerendonk CCM, Kaspers GJL, van Dulmen-den Broeder E, van den Berg MH. Pregnancy, time to pregnancy and obstetric outcomes among female childhood cancer survivors: results of the DCOG LATER-VEVO study. J Cancer Res Clin Oncol 2020; 146:1451-1462. [PMID: 32221745 PMCID: PMC7230041 DOI: 10.1007/s00432-020-03193-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/20/2020] [Indexed: 12/02/2022]
Abstract
Purpose To evaluate pregnancy rates, time to pregnancy (TTP) and obstetric outcomes in female childhood cancer survivors (CCSs) and to identify specific diagnosis- and treatment-related factors associated with these outcomes. Methods The study is part of the DCOG LATER-VEVO study, a nationwide multicenter cohort study evaluating fertility among long-term Dutch female CCSs. Data were collected by questionnaire. The current study included 1095 CCSs and 812 controls, consisting of sisters of CCSs and a random sample of women from the general population. Results Among the subgroup of women who ever had the desire to become pregnant, the chance of becoming pregnant was significantly lower for CCSs than controls (OR 0.5, 95%CI 0.4–0.8). Moreover, TTP was 1.1 times longer for CCSs compared to controls (p = 0.09) and was significantly longer in survivors of CNS and renal tumours. Overall, no differences were found between CCSs and controls regarding the probability of ever having had a miscarriage, still birth, or induced abortion. However, CCSs had a significantly increased risk of delivering preterm (OR 2.2, 95%CI 1.3–3.7) and delivering via caesarean section (OR 1.8, 95%CI 1.2–2.6). Treatment with lower abdominal/pelvic radiotherapy was strongly associated with several adverse obstetric outcomes. Conclusion CCSs are less likely to have ever been pregnant. Among those who do become pregnant, certain subgroups of CCSs are at increased risk of longer TTP. Moreover, as pregnant CCSs, especially those treated with lower abdominal/pelvic radiotherapy, are more likely to develop various adverse obstetric outcomes, appropriate obstetric care is highly advocated. Electronic supplementary material The online version of this article (10.1007/s00432-020-03193-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M van Dijk
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - F E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Overbeek
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - W van Dorp
- Department of Gynaecology and Obstetrics, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - W J Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - L C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J J Loonen
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - D Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - H J van der Pal
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C C M Beerendonk
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G J L Kaspers
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - E van Dulmen-den Broeder
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M H van den Berg
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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7
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Kok JL, Teepen JC, van der Pal HJ, van Leeuwen FE, Tissing WJE, Neggers SJCMM, Loonen JJ, Louwerens M, Versluys B, van den Heuvel-Eibrink MM, van Dulmen-den Broeder E, Jaspers MMW, van Santen HM, van der Heiden-van der Loo M, Janssens GO, Maduro JH, Bruggink AH, Jongmans MC, Kremer LCM, Ronckers CM. Incidence of and Risk Factors for Histologically Confirmed Solid Benign Tumors Among Long-term Survivors of Childhood Cancer. JAMA Oncol 2020; 5:671-680. [PMID: 30920605 DOI: 10.1001/jamaoncol.2018.6862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Survivors of childhood cancer (CCSs) face risk of developing subsequent tumors. Solid benign tumors may be cancer precursors; benign tumors and cancers may share etiologic factors. However, comprehensive data on the risk for solid benign tumors are lacking. Objective To quantify the incidence of and treatment-related risk factors for histologically confirmed solid nonskin benign tumors among CCSs. Design, Setting, and Participants This record linkage study involves the Dutch Childhood Oncology Group-Long-Term Effects After Childhood Cancer (DCOG-LATER) cohort of 6165 individuals diagnosed with childhood cancer at younger than 18 years from January 1, 1963, through December 31, 2001, in 7 Dutch pediatric centers and who survived at least 5 years after the diagnosis. Study groups eligible for record linkage from 1990 onward included 5843 CCSs (94.8%) and 883 siblings. Benign tumors were identified from the population-based Dutch histopathology and cytopathology registry (PALGA). Follow-up was completed on May 1, 2015. Data were analyzed from January 1, 1990, through May 1, 2015. Main Outcomes and Measures Cumulative incidence of any subsequent benign tumor for cohort strata and multivariable Cox proportional hazards regression models (hazard ratios [HRs]) were used to evaluate potential risk factors for 8 major benign tumor subtypes. Results Of the 5843 eligible CCSs (55.9% male), 542 (9.3%) developed a histologically confirmed subsequent benign tumor after a median follow-up of 22.7 years (range, 5.0-52.2 years). Among women, abdominopelvic radiotherapy inferred dose-dependent increased risks for uterine leiomyoma (n = 43) for doses of less than 20 Gy (HR, 1.9; 95% CI, 0.5-7.0), 20 to less than 30 Gy (HR, 3.4; 95% CI, 1.1-10.4), and at least 30 Gy (HR, 5.4; 95% CI, 2.4-12.4) compared with no abdominopelvic radiotherapy (P = .002 for trend). High-dose radiotherapy to the trunk was not associated with breast fibroadenoma (n = 45). Of 23 osseous and/or chondromatous neoplasms, 16 occurred among leukemia survivors, including 11 after total body irradiation (HR, 37.4; 95% CI, 14.8-94.7). Nerve sheath tumors (n = 55) were associated with radiotherapy (HR at 31 years of age, 2.9; 95% CI, 1.5-5.5) and a crude indicator of neurofibromatosis type 1 or 2 status (HR, 5.6; 95% CI, 2.3-13.7). Subsequent risk for benign tumors was higher than the risks for subsequent nonskin solid malignant neoplasms and for benign tumors among siblings. Conclusions and Relevance This record linkage study uses a unique resource for valid and complete outcome assessment and shows that CCSs have an approximately 2-fold risk of developing subsequent benign tumors compared with siblings. Site-specific new findings, including for uterine leiomyoma, osteochondroma, and nervous system tumors, are important to enable early diagnosis; this information will be the first step for future surveillance guidelines that include some benign tumors in CCSs and will provide leads for in-depth etiologic studies.
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Affiliation(s)
- Judith L Kok
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jop C Teepen
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, University of Groningen/Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology and Medicine section Endocrinology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jacqueline J Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Birgitta Versluys
- Department of Pediatric Oncology and Hematology, Wilhelmina Children's Hospital/ University Medical Center Utrecht, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Pediatric Oncology/Hematology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Monique M W Jaspers
- Department of Medical Informatics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - John H Maduro
- Department of Radiation Oncology, University of Groningen/ University Medical Center Groningen, Groningen, the Netherlands
| | - Annette H Bruggink
- Foundation PALGA (Nationwide Network and Registry of Histopathology and Cytopathology), Houten, the Netherlands
| | - Marjolijn C Jongmans
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Human Genetics, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Cécile M Ronckers
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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8
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van Dijk M, van den Berg MH, Overbeek A, Lambalk CB, van den Heuvel-Eibrink MM, Tissing WJ, Kremer LC, van der Pal HJ, Loonen JJ, Versluys B, Bresters D, Kaspers GJL, van Leeuwen FE, van Dulmen-den Broeder E. Reproductive intentions and use of reproductive health care among female survivors of childhood cancer. Hum Reprod 2019; 33:1167-1174. [PMID: 29617794 DOI: 10.1093/humrep/dey058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/07/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do female childhood cancer survivors (CCSs) express a decreased desire to have children and do they use reproductive health care more often compared to women without a history of cancer? SUMMARY ANSWER Overall, no difference was found in the desire to have children between CCSs and controls, whereas CCSs consult a fertility specialist more often, at a younger age, and sooner after their first attempt at conceiving. WHAT IS KNOWN ALREADY Female CCSs may face a shorter than anticipated reproductive window as a result of their cancer treatment. Little is known about their desire to have children and use of reproductive health care, especially in relation to their former cancer treatment. STUDY DESIGN, SIZE, DURATION This study is part of the DCOG LATER-VEVO study, a nationwide retrospective cohort study on female fertility in Dutch CCSs. In total, 1749 CCSs and 1673 controls were invited for the study. Data collection took place between January 2008 and May 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS Data on the desire to have children and use of reproductive health care were collected by questionnaire. The control group consisted of sisters from CCSs and females from the general population. In total, 1106 (63%) CCSs and 818 (49%) controls completed the questionnaire. MAIN RESULTS AND THE ROLE OF CHANCE Overall, no difference was found in the desire to have children between CCSs and controls (86% and 89%, respectively). However, survivors of a CNS tumour were less likely to desire children and CCSs without biological children at time of study were more likely to report that their desire to have children was unfulfilled because of medical reasons (9%), compared to controls (1%). In total, 12% of CCSs ever consulted a fertility specialist compared to 10% of controls (OR = 1.7, 95% CI: 1.3-2.4). Mean (SD) age at time of their first visit was 27.7 (4.4) years for CCSs and 29.9 (3.9) years for controls (P < 0.01). In total, 43% of CCSs consulted a fertility specialist within 12 months after they had started trying to achieve a pregnancy, compared to 27% of controls. Risk factors for consulting a fertility specialist included a previous diagnosis of renal tumour, leukaemia, lymphoma or a CNS tumour, and treatment with alkylating chemotherapy, gonadotoxic radiotherapy or both. In total, 70% of CCSs reported a female factor as cause of subfertility compared to 34% of controls (OR = 4.5, 95% CI: 2.3-8.7) and in this specific group, CCSs seemed more likely to use fertility treatment (OR = 2.9, 95% CI: 1.0-8.2). LIMITATIONS, REASONS FOR CAUTION Because of the low number of CCSs who used fertility treatment, we were not able to look at specific diagnoses and treatment types associated with using fertility treatment. Nevertheless, we were able to identify diagnostic- and treatment-related risk factors for consulting a fertility specialist. Details regarding consultations with a fertility specialist and fertility treatment were based on self-report and may therefore be subject to recall bias. WIDER IMPLICATIONS OF THE FINDINGS Decisions about parenthood affect all CCSs. It's important to evaluate reproductive intentions and function timely after cancer treatment, so CCSs can be adequately counselled regarding family planning and fertility treatment. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Dutch Cancer Society (Grant no. VU 2006-3622) and the Children Cancer Free Foundation (Project no. 20). TRIAL REGISTRATION NUMBER NTR2922.
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Affiliation(s)
- M van Dijk
- Department of Paediatrics, Division of Oncology-Haematology, VU University Medical Center, PO Box 7057, 1000 MB Amsterdam, The Netherlands
| | - M H van den Berg
- Department of Paediatrics, Division of Oncology-Haematology, VU University Medical Center, PO Box 7057, 1000 MB Amsterdam, The Netherlands
| | - A Overbeek
- Department of Paediatrics, Division of Oncology-Haematology, VU University Medical Center, PO Box 7057, 1000 MB Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, VU University Medical Center, PO Box 7057, 1000 MB Amsterdam, The Netherlands
| | - C B Lambalk
- Department of Obstetrics and Gynaecology, VU University Medical Center, PO Box 7057, 1000 MB Amsterdam, The Netherlands
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584 EA Utrecht, The Netherlands.,Department of Paediatric Oncology/Haematology, Sophia Childrens' Hospital/Erasmus MC-University Medical Center, Wytemaweg 40, 3015 GJ Rotterdam, The Netherlands
| | - W J Tissing
- Department of Paediatric Oncology/Haematology, University of Groningen, University Medical Center Groningen, PO Box 3001, 9700 RB Groningen, The Netherlands
| | - L C Kremer
- Department of Paediatric Oncology, Emma Children's Hospital/Amsterdam Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - H J van der Pal
- Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - J J Loonen
- Department of Haematology, Radboud University, Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - B Versluys
- Department of Paediatric Oncology, Wilhelmina Children's Hospital/University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - D Bresters
- Willem-Alexander Children's Hospital/Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - G J L Kaspers
- Department of Paediatrics, Division of Oncology-Haematology, VU University Medical Center, PO Box 7057, 1000 MB Amsterdam, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - F E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - E van Dulmen-den Broeder
- Department of Paediatrics, Division of Oncology-Haematology, VU University Medical Center, PO Box 7057, 1000 MB Amsterdam, The Netherlands
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9
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van den Berg MH, Overbeek A, Lambalk CB, Kaspers GJL, Bresters D, van den Heuvel-Eibrink MM, Kremer LC, Loonen JJ, van der Pal HJ, Ronckers CM, Tissing WJE, Versluys AB, van der Heiden-van der Loo M, Heijboer AC, Hauptmann M, Twisk JWR, Laven JSE, Beerendonk CCM, van Leeuwen FE, van Dulmen-den Broeder E. Long-term effects of childhood cancer treatment on hormonal and ultrasound markers of ovarian reserve. Hum Reprod 2018; 33:1474-1488. [DOI: 10.1093/humrep/dey229] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/17/2018] [Accepted: 06/06/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- M H van den Berg
- Department of Paediatrics, Division of Paediatric Oncology/Haematology, VU University Medical Center, De Boelelaan 1117, HV, Amsterdam, The Netherlands
| | - A Overbeek
- Department of Paediatrics, Division of Paediatric Oncology/Haematology, VU University Medical Center, De Boelelaan 1117, HV, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, VU University Medical Center, De Boelelaan 1117, HV, Amsterdam, The Netherlands
| | - C B Lambalk
- Department of Obstetrics and Gynaecology, VU University Medical Center, De Boelelaan 1117, HV, Amsterdam, The Netherlands
| | - G J L Kaspers
- Department of Paediatrics, Division of Paediatric Oncology/Haematology, VU University Medical Center, De Boelelaan 1117, HV, Amsterdam, The Netherlands
- Princess Máxima Center for Paediatric Oncology, Lundlaan 6, EA, Utrecht, The Netherlands
| | - D Bresters
- Willem-Alexander Children’s Hospital, Leiden University Medical Center, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Paediatric Oncology, Lundlaan 6, EA, Utrecht, The Netherlands
- Department of Paediatric Oncology, Sophia Children’s Hospital/Erasmus MC University Medical Center, Wytemaweg 80, CN, Rotterdam, The Netherlands
| | - L C Kremer
- Princess Máxima Center for Paediatric Oncology, Lundlaan 6, EA, Utrecht, The Netherlands
- Department of Paediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - J J Loonen
- Department of Paediatric Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, GA, Nijmegen, The Netherlands
| | - H J van der Pal
- Princess Máxima Center for Paediatric Oncology, Lundlaan 6, EA, Utrecht, The Netherlands
| | - C M Ronckers
- Department of Paediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - W J E Tissing
- Department of Paediatric Oncology, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Hanzeplein 1, GZ, Groningen, The Netherlands
| | - A B Versluys
- Department of Paediatric Oncology, Wilhelmina’s Children’s Hospital/University Medical Center, Lundlaan 6, EA, Utrecht, The Netherlands
| | | | - A C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, De Boelelaan 1117, HV, Amsterdam, The Netherlands
| | - M Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Plesmanlaan 121, CX, Amsterdam, The Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, De Boelelaan 1117, HV, Amsterdam, The Netherlands
| | - J S E Laven
- Department of Gynaecology and Obstetrics, Division Reproductive Medicine, Erasmus MC University Medical Center, ‘s-Gravendijkwal 230, CE, Rotterdam, The Netherlands
| | - C C M Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, GA, Nijmegen, The Netherlands
| | - F E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Plesmanlaan 121, CX, Amsterdam, The Netherlands
| | - E van Dulmen-den Broeder
- Department of Paediatrics, Division of Paediatric Oncology/Haematology, VU University Medical Center, De Boelelaan 1117, HV, Amsterdam, The Netherlands
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10
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Winther JF, Kenborg L, Byrne J, Hjorth L, Kaatsch P, Kremer LCM, Kuehni CE, Auquier P, Michel G, de Vathaire F, Haupt R, Skinner R, Madanat-Harjuoja LM, Tryggvadottir L, Wesenberg F, Reulen RC, Grabow D, Ronckers CM, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, Schindler M, Berbis J, Holmqvist AS, Gudmundsdottir T, de Fine Licht S, Bonnesen TG, Asdahl PH, Bautz A, Kristoffersen AK, Himmerslev L, Hasle H, Olsen JH, Hawkins MM. Childhood cancer survivor cohorts in Europe. Acta Oncol 2015; 54:655-68. [PMID: 25813473 DOI: 10.3109/0284186x.2015.1008648] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
With the advent of multimodality therapy, the overall five-year survival rate from childhood cancer has improved considerably now exceeding 80% in developed European countries. This growing cohort of survivors, with many years of life ahead of them, has raised the necessity for knowledge concerning the risks of adverse long-term sequelae of the life-saving treatments in order to provide optimal screening and care and to identify and provide adequate interventions. Childhood cancer survivor cohorts in Europe. Considerable advantages exist to study late effects in individuals treated for childhood cancer in a European context, including the complementary advantages of large population-based cancer registries and the unrivalled opportunities to study lifetime risks, together with rich and detailed hospital-based cohorts which fill many of the gaps left by the large-scale population-based studies, such as sparse treatment information. Several large national cohorts have been established within Europe to study late effects in individuals treated for childhood cancer including the Nordic Adult Life after Childhood Cancer in Scandinavia study (ALiCCS), the British Childhood Cancer Survivor Study (BCCSS), the Dutch Childhood Oncology Group (DCOG) LATER study, and the Swiss Childhood Cancer Survivor Study (SCCSS). Furthermore, there are other large cohorts, which may eventually become national in scope including the French Childhood Cancer Survivor Study (FCCSS), the French Childhood Cancer Survivor Study for Leukaemia (LEA), and the Italian Study on off-therapy Childhood Cancer Survivors (OTR). In recent years significant steps have been taken to extend these national studies into a larger pan-European context through the establishment of two large consortia - PanCareSurFup and PanCareLIFE. The purpose of this paper is to present an overview of the current large, national and pan-European studies of late effects after childhood cancer. This overview will highlight the strong cooperation across Europe, in particular the EU-funded collaborative research projects PanCareSurFup and PanCareLIFE. Overall goal. The overall goal of these large cohort studies is to provide every European childhood cancer survivor with better care and better long-term health so that they reach their full potential, and to the degree possible, enjoy the same quality of life and opportunities as their peers.
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