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Diallo I, Allodji RS, Veres C, Bolle S, Llanas D, Ezzouhri S, Zrafi W, Debiche G, Souchard V, Fauchery R, Haddy N, Journy N, Demoor-Goldschmidt C, Winter DL, Hjorth L, Wiebe T, Haupt R, Robert C, Kremer L, Bardi E, Sacerdote C, Terenziani M, Kuehni CE, Schindera C, Skinner R, Winther JF, Lähteenmäki P, Byrn J, Jakab Z, Cardis E, Pasqual E, Tapio S, Baatout S, Atkinson M, Benotmane MA, Sugden E, Zaletel LZ, Ronckers C, Reulen RC, Hawkins MM, de Vathaire F. Radiation doses received by major organs at risk in children and young adolescents treated for cancer with external beam radiation therapy: a large-scale study from 12 European countries. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00446-2. [PMID: 38582233 DOI: 10.1016/j.ijrobp.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/27/2024] [Accepted: 03/20/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Childhood cancer survivors are at high risk of long-term iatrogenic events, in particular those treated with radiotherapy. The prediction of risk of such events is mainly based on the knowledge of the radiation dose received to healthy organs and tissues during treatment of childhood cancer diagnosed decades ago. PURPOSE We aimed to set up a standardised organ dose table in order to help former patients and clinician in charge of long term follow-up clinics. MATERIAL AND METHODS We performed whole body dosimetric reconstruction for 2646 patients from 12 European Countries treated between 1941 and 2006 (median: 1976). Most planning were 2D or 3D, 46% of patients were treated using Cobalt 60 and 41% using linear accelerator, the median prescribed dose being 27.2 Gy (IQ1-IQ3: 17.6-40.0 Gy), A patient specific voxel-based anthropomorphic phantom with more than 200 anatomical structures or sub-structures delineated as a surrogate of each subject's anatomy was used. The radiation therapy was simulated with a treatment planning system (TPS) based on available treatment information. The radiation dose received by any organ of the body was estimated by extending the TPS dose calculation to the whole-body, by type and localisation of childhood cancer. RESULTS The integral dose and normal-tissue doses to most of the 23 considered organs increased between the 1950's and the 1970's and decreased or plateaued thereafter. Whatever the organ considered, the type of childhood cancer explained most of the variability in organ dose. The country of treatment explained only a small part of the variability. CONCLUSION The detailed dose estimates provide very useful information for former patients or clinicians who have only limited knowledge about radiation therapy protocols or techniques, but who know the type and site of childhood cancer, gender, age and year of treatment. This will allow better prediction of the long-term risk of iatrogenic events and better referral to long-term follow-up clinics.
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Affiliation(s)
- Ibrahima Diallo
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France; Inserm, Radiothérapie Moléculaire et Innovation Thérapeutique, RAMO-IT-U1030, Villejuif, F-94805, France
| | - Rodrigue S Allodji
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France
| | - Cristina Veres
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France; Inserm, Radiothérapie Moléculaire et Innovation Thérapeutique, RAMO-IT-U1030, Villejuif, F-94805, France
| | | | - Damien Llanas
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France
| | - Safaa Ezzouhri
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France
| | - Wael Zrafi
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France
| | - Ghazi Debiche
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France
| | - Vincent Souchard
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France
| | - Romain Fauchery
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France
| | - Nadia Haddy
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France
| | - Neige Journy
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France
| | - Charlotte Demoor-Goldschmidt
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Pediatric oncology department, university hospital Angers, France; Department of radiotherapy and protontherapy, Centre François Baclesse, Caen, France
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Thomas Wiebe
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Riccardo Haupt
- DOPO Clinic - Department of Pediatric Hematology/Oncology IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, 16148, Genova, Italy
| | - Charlotte Robert
- Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France
| | - Leontien Kremer
- Department of Pediatric Oncology, EmmaChildren's Hospital/ Academic Medical Center Amsterdam, meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria and Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Monica Terenziani
- Pediatric Unit, Department of Onco-Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland; Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland; Division of Paediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Jeanette Falck Winther
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100, Copenhagen, Denmark
| | - Päivi Lähteenmäki
- Department of Pediatric and Adolescent Medicine, Fican-West, Turku University Hospital, Turku, Finland
| | - Julianne Byrn
- Boyne Research Institute, 5 Bolton Square, Drogheda, A92 RY6K Ireland
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Elisabeth Cardis
- Barcelona Institute of Global Health (ISGlobal), 88 Doctor Aiguader, E-08003 Barcelona, Spain; University Pompeu Fabra, Barcelona, Spain;; CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Elisa Pasqual
- Barcelona Institute of Global Health (ISGlobal), 88 Doctor Aiguader, E-08003 Barcelona, Spain; University Pompeu Fabra, Barcelona, Spain
| | - Soile Tapio
- Institute of Radiation Biology, Helmholtz Zentrum Muenchen-German Research Centre for Environmental Health, Neuherberg, Germany
| | - Sarah Baatout
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Boeretang 200, 2400 Mol, Belgium
| | - Mike Atkinson
- Deutsches Konsortium für Translationale Krebsforschung, Partner Site Munich, Munich, Germany
| | | | - Elaine Sugden
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Lorna Zadravec Zaletel
- Division of Radiotherapy, Institute of Oncology, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | | | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Florent de Vathaire
- Inserm, Radiation Epidemiology Team, Centre for Epidemiology and Population Health, CESP-U1018, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris-Saclay, F-93805, France.
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2
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Heymer EJ, Hawkins MM, Winter DL, Teepen JC, Sunguc C, Ronckers CM, Allodji RS, Alessi D, Sugden E, Belle FN, Bagnasco F, Byrne J, Bárdi E, Garwicz S, Grabow D, Jankovic M, Kaatsch P, Kaiser M, Michel G, Schindera C, Haddy N, Journy N, Česen Mazić M, Skinner R, Kok JL, Gunnes MW, Wiebe T, Sacerdote C, Maule MM, Terenziani M, Jakab Z, Winther JF, Lähteenmäki PM, Zadravec Zaletel L, Haupt R, Kuehni CE, Kremer LC, de Vathaire F, Hjorth L, Reulen RC. Risk of subsequent gliomas and meningiomas among 69,460 5-year survivors of childhood and adolescent cancer in Europe: the PanCareSurFup study. Br J Cancer 2024; 130:976-986. [PMID: 38243010 PMCID: PMC10951281 DOI: 10.1038/s41416-024-02577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Childhood cancer survivors are at risk of subsequent gliomas and meningiomas, but the risks beyond age 40 years are uncertain. We quantified these risks in the largest ever cohort. METHODS Using data from 69,460 5-year childhood cancer survivors (diagnosed 1940-2008), across Europe, standardized incidence ratios (SIRs) and cumulative incidence were calculated. RESULTS In total, 279 glioma and 761 meningioma were identified. CNS tumour (SIR: 16.2, 95% CI: 13.7, 19.2) and leukaemia (SIR: 11.2, 95% CI: 8.8, 14.2) survivors were at greatest risk of glioma. The SIR for CNS tumour survivors was still 4.3-fold after age 50 (95% CI: 1.9, 9.6), and for leukaemia survivors still 10.2-fold after age 40 (95% CI: 4.9, 21.4). Following cranial radiotherapy (CRT), the cumulative incidence of a glioma in CNS tumour survivors was 2.7%, 3.7% and 5.0% by ages 40, 50 and 60, respectively, whilst for leukaemia this was 1.2% and 1.7% by ages 40 and 50. The cumulative incidence of a meningioma after CRT in CNS tumour survivors doubled from 5.9% to 12.5% between ages 40 and 60, and in leukaemia survivors increased from 5.8% to 10.2% between ages 40 and 50. DISCUSSION Clinicians following up survivors should be aware that the substantial risks of meningioma and glioma following CRT are sustained beyond age 40 and be vigilant for symptoms.
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Affiliation(s)
- Emma J Heymer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ceren Sunguc
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Elaine Sugden
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Fabiën N Belle
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Julianne Byrne
- Boyne Research Institute, c/o no. 1, The Maples, Bettystown, Co Meath, A92 C635, Ireland
| | - Edit Bárdi
- St Anna Children's Hospital, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Hospital San Gerardo, Via Donizetti 33, Monza, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Neige Journy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Maja Česen Mazić
- University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Judith L Kok
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Maria W Gunnes
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Milena M Maule
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | - Riccardo Haupt
- DOPO Clinic, Division of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Heymer EJ, Jóźwiak K, Kremer LC, Winter DL, de Vathaire F, Sunguc C, Sugden E, Kok JL, van der Pal HJH, Hjorth L, Jakab Z, Maule MM, Haupt R, Bagnasco F, Terenziani M, Diallo I, Gunnes MW, Sommer G, Zadravec Zaletel L, Kuehni CE, Winther JF, Lähteenmäki PM, Gudmundsdottir T, Allodji RS, Skinner R, Ronckers CM, Hawkins MM, Reulen RC, Teepen JC. Cumulative Absolute Risk of Subsequent Colorectal Cancer After Abdominopelvic Radiotherapy Among Childhood Cancer Survivors: A PanCareSurFup Study. J Clin Oncol 2024; 42:336-347. [PMID: 37972325 DOI: 10.1200/jco.23.00452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Childhood cancer survivors are at the risk of developing subsequent colorectal cancers (CRCs), but the absolute risks by treatment modality are uncertain. We quantified the absolute risks by radiotherapy treatment characteristics using clinically accessible data from a Pan-European wide case-control study nested within a large cohort of childhood cancer survivors: the PanCareSurFup Study. METHODS Odds ratios (ORs) from a case-control study comprising 143 CRC cases and 143 controls nested within a cohort of 69,460 survivors were calculated. These, together with standardized incidence ratios for CRC for this cohort and European general population CRC incidence rates and survivors' mortality rates, were used to estimate cumulative absolute risks (CARs) by attained age for different categories of radiation to the abdominopelvic area. RESULTS Overall, survivors treated with abdominopelvic radiotherapy treatment (ART) were three times more likely to develop a subsequent CRC than those who did not receive ART (OR, 3.1 [95% CI, 1.4 to 6.6]). For male survivors treated with ART, the CAR was 0.27% (95% CI, 0.17 to 0.59) by age 40 years, 1.08% (95% CI, 0.69 to 2.34) by age 50 years (0.27% expected in the general population), and 3.7% (95% CI, 2.36 to 7.80) by age 60 years (0.95% expected). For female survivors treated with ART, the CAR was 0.29% (95% CI, 0.18 to 0.62) by age 40 years, 1.03% (95% CI, 0.65 to 2.22) by age 50 years (0.27% expected), and 3.0% (95% CI, 1.91 to 6.37) by age 60 years (0.82% expected). CONCLUSION We demonstrated that by age 40 years survivors of childhood cancer treated with ART already have a similar risk of CRC as those age 50 years in the general population for whom population-based CRC screening begins in many countries. This information should be used in the development of survivorship guidelines for the risk stratification of survivors concerning CRC risk.
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Affiliation(s)
- Emma J Heymer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Ceren Sunguc
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Elaine Sugden
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Judith L Kok
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics,Skane University Hospital, Lund University, Lund, Sweden
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Milena M Maule
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Riccardo Haupt
- Division of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, DOPO Clinic, Genova, Italy
| | | | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ibrahima Diallo
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Maria W Gunnes
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Grit Sommer
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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4
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Reulen RC, Winter DL, Diallo I, Veres C, Llanas D, Allodji RS, Bagnasco F, Bárdi E, Feijen EAM, Alessi D, Fidler-Benaoudia MM, Høgsholt S, Teepen JC, Linge H, Haddy N, Byrne J, Debiche G, Grabow D, Gudmundsdottir T, Fauchery R, Zrafi W, Michel G, Øfstaas H, Kaatsch P, Vu-Bezin G, Jenkinson H, Kaiser M, Skinner R, Cole T, Waespe N, Sommer G, Nordenfelt S, Jankovic M, Lähteenmäki Taalas T, Maule MM, van der Pal HJH, Ronckers CM, van Leeuwen FE, Kok JL, Terenziani M, Winther Gunnes M, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki PM, Zadravec Zaletel L, Kuehni CE, Winther JF, Kremer LCM, Hjorth L, de Vathaire F, Hawkins MM. Risk Factors for Primary Bone Cancer After Childhood Cancer: A PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies Nested Case-Control Study. J Clin Oncol 2023; 41:3735-3746. [PMID: 37235821 DOI: 10.1200/jco.22.02045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/09/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Radiation to the bone and exposure to alkylating agents increases the risk of bone cancer among survivors of childhood cancer, but there is uncertainty regarding the risks of bone tissue radiation doses below 10 Gy and the dose-response relationship for specific types of chemotherapy. METHODS Twelve European countries contributed 228 cases and 228 matched controls to a nested case-control study within a cohort of 69,460 5-year survivors of childhood cancer. Odds ratios (ORs) of developing bone cancer for different levels of cumulative radiation exposure and cumulative doses of specific types of chemotherapy were calculated. Excess ORs were calculated to investigate the shape and extent of any dose-response relationship. RESULTS The OR associated with bone tissue exposed to 1-4 Gy was 4.8-fold (95% CI, 1.2 to 19.6) and to 5-9 Gy was 9.6-fold (95% CI, 2.4 to 37.4) compared with unexposed bone tissue. The OR increased linearly with increasing dose of radiation (Ptrend < .001) up to 78-fold (95% CI, 9.2 to 669.9) for doses of ≥40 Gy. For cumulative alkylating agent doses of 10,000-19,999 and ≥20,000 mg/m2, the radiation-adjusted ORs were 7.1 (95% CI, 2.2 to 22.8) and 8.3 (95% CI, 2.8 to 24.4), respectively, with independent contributions from each of procarbazine, ifosfamide, and cyclophosphamide. Other cytotoxics were not associated with bone cancer. CONCLUSION To our knowledge, we demonstrate-for the first time-that the risk of bone cancer is increased 5- to 10-fold after exposure of bone tissue to cumulative radiation doses of 1-9 Gy. Alkylating agents exceeding 10,000 mg/m2 increase the risk 7- to 8-fold, particularly following procarbazine, ifosfamide, and cyclophosphamide. These substantially elevated risks should be used to develop/update clinical follow-up guidelines and survivorship care plans.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ibrahim Diallo
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Cristina Veres
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Damien Llanas
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | - Edit Bárdi
- St Anna Children's Hospital, Vienna, Austria
| | | | | | | | | | | | | | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | - Ghazi Debiche
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | - Romain Fauchery
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Wael Zrafi
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | | | - Giao Vu-Bezin
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jeanette F Winther
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | | | | | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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5
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Dudley IM, Sunguc C, Heymer EJ, Winter DL, Teepen JC, Belle FN, Bárdi E, Bagnasco F, Gudmundsdottir T, Skinner R, Michel G, Byrne J, Øfstaas H, Jankovic M, Mazić MČ, Mader L, Loonen J, Garwicz S, Wiebe T, Alessi D, Allodji RS, Haddy N, Grabow D, Kaatsch P, Kaiser M, Maule MM, Jakab Z, Gunnes MW, Terenziani M, Zaletel LZ, Kuehni CE, Haupt R, de Vathaire F, Kremer LC, Lähteenmäki PM, Winther JF, Hjorth L, Hawkins MM, Reulen RC. Risk of subsequent primary lymphoma in a cohort of 69,460 five-year survivors of childhood and adolescent cancer in Europe: The PanCareSurFup study. Cancer 2023; 129:426-440. [PMID: 36444554 PMCID: PMC10099796 DOI: 10.1002/cncr.34561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Survivors of Hodgkin lymphoma (HL) are at risk of developing non-Hodgkin lymphoma (NHL) after treatment; however, the risks of developing subsequent primary lymphomas (SPLs), including HL and NHL, after different types of childhood cancer are unknown. The authors quantified the risk of SPLs using the largest cohort of childhood cancer survivors worldwide. METHODS The Pan-European Network for Care of Survivors After Childhood and Adolescent Cancer (PanCare) Survivor Care and Follow-Up Studies (PanCareSurFup) cohort includes 69,460 five-year survivors of childhood cancer, diagnosed during 1940 through 2008, from 12 European countries. Risks of SPLs were quantified by standardized incidence ratios (SIRs) and relative risks (RRs) using multivariable Poisson regression. RESULTS Overall, 140 SPLs, including 104 NHLs and 36 HLs, were identified. Survivors were at 60% increased risk of an SPL compared with the general population (SIR, 1.6; 95% confidence interval [CI], 1.4-1.9). Survivors were twice as likely to develop NHL (SIR, 2.3; 95% CI, 1.9-2.8), with the greatest risks among survivors of HL (SIR, 7.1; 95% CI, 5.1-10.0), Wilms tumor (SIR, 3.1; 95% CI, 1.7-5.7), leukemia (SIR, 2.8; 95% CI, 1.8-4.4), and bone sarcoma (SIR, 2.7; 95% CI, 1.4-5.4). Treatment with chemotherapy for any cancer doubled the RR of NHL (RR, 2.1; 95% CI, 1.2-3.9), but treatment with radiotherapy did not (RR, 1.2; 95% CI, 0.7-2.0). Survivors were at similar risk of developing a subsequent HL as the general population (SIR, 1.1; 95% CI, 0.8-1.5). CONCLUSIONS In addition to HL, the authors show here for the first time that survivors of Wilms tumor, leukemia, and bone sarcoma are at risk of NHL. Survivors and health care professionals should be aware of the risk of NHL in these survivors and in any survivors treated with chemotherapy.
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Affiliation(s)
- Isabelle M. Dudley
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Ceren Sunguc
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Emma J. Heymer
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - David L. Winter
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Jop C. Teepen
- Princess Maxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Fabiën N. Belle
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Center for Primary Care and Public Health (Unisante)University of LausanneLausanneSwitzerland
| | - Edit Bárdi
- St Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineJohannes Kepler University LinzKepler University HospitalLinzAustria
| | | | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research CenterChildhood Cancer Research GroupCopenhagenDenmark
- Children's HospitalLandspitali University HospitalReykjavikIceland
| | - Roderick Skinner
- Great North Children's HospitalNewcastle upon Tyne Hospitals National Health Service Foundation TrustNewcastle upon TyneUK
- Newcastle University Center for CancerNewcastle UniversityNewcastle upon TyneUK
| | - Gisela Michel
- Department of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
| | | | - Hilde Øfstaas
- Division of Pediatric and Adolescent MedicineOslo University Hospital RikshospitaletOsloNorway
| | - Momcilo Jankovic
- Pediatric ClinicUniversity of Milano‐BicoccaHospital San GerardoMonzaItaly
| | - Maja Česen Mazić
- University Children's Hospital LjubljanaUniversity Medical Center LjubljanaLjubljanaSlovenia
| | - Luzius Mader
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Jaqueline Loonen
- Department of HematologyRadboud University Medical CenterNijmegenNetherlands
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Daniela Alessi
- Childhood Cancer Registry of PiedmontCancer Epidemiology UnitDepartment of Medical SciencesUniversity of TurinTurinItaly
- Reference Center for Epidemiology and Cancer Prevention‐PiemonteUniversity Hospital Citta della Salute e della Scienza di TorinoTurinItaly
| | - Rodrigue S. Allodji
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Nadia Haddy
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Desiree Grabow
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Peter Kaatsch
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Melanie Kaiser
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Milena M. Maule
- Childhood Cancer Registry of PiedmontCancer Epidemiology UnitDepartment of Medical SciencesUniversity of TurinTurinItaly
- Reference Center for Epidemiology and Cancer Prevention‐PiemonteUniversity Hospital Citta della Salute e della Scienza di TorinoTurinItaly
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer RegistrySecond Department of PediatricsSemmelweis UniversityBudapestHungary
| | - Maria Winther Gunnes
- Division of Pediatric and Adolescent MedicineOslo University Hospital RikshospitaletOsloNorway
- Department of RegistrationCancer Registry of NorwayOsloNorway
| | - Monica Terenziani
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Claudia E. Kuehni
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Division of Pediatric Hematology/OncologyDepartment of PediatricsUniversity Children's Hospital of BernUniversity of BernBernSwitzerland
| | - Riccardo Haupt
- Diagnosis, Observation, Prevention After Oncologic Treatment (DOPO) ClinicDivision of Hematology/OncologyIRCCS Istituto Giannina GasliniGenovaItaly
| | - Florent de Vathaire
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Leontien C. Kremer
- Princess Maxima Center for Pediatric OncologyUtrechtThe Netherlands
- Emma Children's HospitalAmsterdamNetherlands
| | - Päivi M. Lähteenmäki
- Department of Pediatrics and Adolescent MedicineTurku University and Turku University HospitalTurkuFinland
| | - Jeanette F. Winther
- Danish Cancer Society Research CenterChildhood Cancer Research GroupCopenhagenDenmark
- Department of Clinical MedicineFaculty of HealthAarhus University and University HospitalAarhusDenmark
| | - Lars Hjorth
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Michael M. Hawkins
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Raoul C. Reulen
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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6
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Sunguc C, Hawkins MM, Winter DL, Dudley IM, Heymer EJ, Teepen JC, Allodji RS, Belle FN, Bagnasco F, Byrne J, Bárdi E, Ronckers CM, Haddy N, Gudmundsdottir T, Garwicz S, Jankovic M, van der Pal HJH, Mazić MČ, Schindera C, Grabow D, Maule MM, Kaatsch P, Kaiser M, Fresneau B, Michel G, Skinner R, Wiebe T, Sacerdote C, Jakab Z, Gunnes MW, Terenziani M, Winther JF, Lähteenmäki PM, Zaletel LZ, Kuehni CE, Kremer LC, Haupt R, de Vathaire F, Hjorth L, Reulen RC. Risk of subsequent primary oral cancer in a cohort of 69,460 5-year survivors of childhood and adolescent cancer in Europe: the PanCareSurFup study. Br J Cancer 2023; 128:80-90. [PMID: 36319851 DOI: 10.1038/s41416-022-02016-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Survivors of childhood cancer are at risk of subsequent primary malignant neoplasms (SPNs), but the risk for rarer types of SPNs, such as oral cancer, is uncertain. Previous studies included few oral SPNs, hence large-scale cohorts are required to identify groups at risks. METHODS The PanCareSurFup cohort includes 69,460 5-year survivors of childhood cancer across Europe. Risks of oral SPNs were defined by standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence. RESULTS One hundred and forty-five oral SPNs (64 salivary gland, 38 tongue, 20 pharynx, 2 lip, and 21 other) were ascertained among 143 survivors. Survivors were at 5-fold risk of an oral SPN (95% CI: 4.4-5.6). Survivors of leukaemia were at greatest risk (SIR = 19.2; 95% CI: 14.6-25.2) followed by bone sarcoma (SIR = 6.4, 95% CI: 3.7-11.0), Hodgkin lymphoma (SIR = 6.2, 95% CI: 3.9-9.9) and soft-tissue sarcoma (SIR = 5.0, 95% CI: 3.0-8.5). Survivors treated with radiotherapy were at 33-fold risk of salivary gland SPNs (95% CI: 25.3-44.5), particularly Hodgkin lymphoma (SIR = 66.2, 95% CI: 43.6-100.5) and leukaemia (SIR = 50.5, 95% CI: 36.1-70.7) survivors. Survivors treated with chemotherapy had a substantially increased risk of a tongue SPN (SIR = 15.9, 95% CI: 10.6-23.7). CONCLUSIONS Previous radiotherapy increases the risk of salivary gland SPNs considerably, while chemotherapy increases the risk of tongue SPNs substantially. Awareness of these risks among both health-care professionals and survivors could play a crucial role in detecting oral SPNs early.
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Affiliation(s)
- Ceren Sunguc
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Isabelle M Dudley
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma J Heymer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Fabiën N Belle
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Julianne Byrne
- Boyne Research Institute, c/o no. 1, The Maples, Bettystown, Co Meath, A92 C635, Ireland
| | - Edit Bárdi
- St Anna Children's Hospital, Vienna, Austria and Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Hospital San Gerardo, Via Donizetti, 33, Monza, Italy
| | | | - Maja Česen Mazić
- University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Desiree Grabow
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Milena M Maule
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Brice Fresneau
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
- Department of Children and Adolescents Oncology, Gustave Roussy, F-94805, Villejuif, France
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Maria Winther Gunnes
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Department of Pediatrics, Amsterdam, the Netherlands
| | - Riccardo Haupt
- DOPO clinic, Division of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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7
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de Baat EC, Feijen EA, Reulen RC, Allodji RS, Bagnasco F, Bardi E, Belle FN, Byrne J, van Dalen EC, Debiche G, Diallo I, Grabow D, Hjorth L, Jankovic M, Kuehni CE, Levitt G, Llanas D, Loonen J, Zaletel LZ, Maule MM, Miligi L, van der Pal HJ, Ronckers CM, Sacerdote C, Skinner R, Jakab Z, Veres C, Haddy N, Winter DL, de Vathaire F, Hawkins MM, Kremer LC. Risk Factors for Heart Failure Among Pan-European Childhood Cancer Survivors: A PanCareSurFup and ProCardio Cohort and Nested Case-Control Study. J Clin Oncol 2023; 41:96-106. [PMID: 36075007 PMCID: PMC9788976 DOI: 10.1200/jco.21.02944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Heart failure (HF) is a potentially life-threatening complication of treatment for childhood cancer. We evaluated the risk and risk factors for HF in a large European study of long-term survivors. Little is known of the effects of low doses of treatment, which is needed to improve current treatment protocols and surveillance guidelines. METHODS This study includes the PanCareSurFup and ProCardio cohort of ≥ 5-year childhood cancer survivors diagnosed between 1940 and 2009 in seven European countries (N = 42,361). We calculated the cumulative incidence of HF and conducted a nested case-control study to evaluate detailed treatment-related risk factors. RESULTS The cumulative incidence of HF was 2% (95% CI, 1.7 to 2.2) by age 50 years. The case-control study (n = 1,000) showed that survivors who received a mean heart radiation therapy (RT) dose of 5 to < 15 Gy have an increased risk of HF (odds ratio, 5.5; 95% CI, 2.5 to 12.3), when compared with no heart RT. The risk associated with doses 5 to < 15 Gy increased with exposure of a larger heart volume. In addition, the HF risk increased in a linear fashion with higher mean heart RT doses. Regarding total cumulative anthracycline dose, survivors who received ≥ 100 mg/m2 had a substantially increased risk of HF and survivors treated with a lower dose showed no significantly increased risk of HF. The dose-response relationship appeared quadratic with higher anthracycline doses. CONCLUSION Survivors who received a mean heart RT dose of ≥ 5 Gy have an increased risk of HF. The risk associated with RT increases with larger volumes exposed. Survivors treated with < 100 mg/m2 total cumulative anthracycline dose have no significantly increased risk of HF. These new findings might have consequences for new treatment protocols for children with cancer and for cardiomyopathy surveillance guidelines.
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Affiliation(s)
- Esmée C. de Baat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands,Esmée C. de Baat, MD, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands; e-mail:
| | | | - Raoul C. Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Rodrigue S. Allodji
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria,Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Fabiën N. Belle
- Childhood Cancer Research Group, ISPM Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,PMU Unisanté, University of Lausanne, Lausanne, Switzerland
| | | | | | - Ghazi Debiche
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Ibrahima Diallo
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lund, Sweden
| | - Momcilo Jankovic
- Pediatric Clinic University of Milano-Bicocca, Foundation MBBM, Monza, Italy
| | - Claudia E. Kuehni
- Childhood Cancer Research Group, ISPM Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gill Levitt
- Department of Paediatric and Oncology, Great Ormond St Hospital for Children NHS Foundation Trust London, United Kingdom
| | - Damien Llanas
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Milena M. Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza, CPO-Piemonte, Turin, Italy
| | - Lucia Miligi
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Firenze, Italy
| | | | | | - Carlotta Sacerdote
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza, CPO-Piemonte, Turin, Italy
| | - Roderick Skinner
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom,Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, Budapest Hungary
| | - Cristina Veres
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Nadia Haddy
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - David L. Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Florent de Vathaire
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Michael M. Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Leontien C.M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands,Emma Children's Hospital, Amsterdam UMC, the Netherlands
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8
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Reulen RC, Guha J, Bright CJ, Henson KE, Feltbower RG, Hall M, Kelly JS, Winter DL, Kwok-Williams M, Skinner R, Cutter DJ, Frobisher C, Hawkins MM. Risk of cerebrovascular disease among 13 457 five-year survivors of childhood cancer: A population-based cohort study. Int J Cancer 2021; 148:572-583. [PMID: 32683688 DOI: 10.1002/ijc.33218] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/09/2020] [Accepted: 06/23/2020] [Indexed: 11/07/2022]
Abstract
Survivors of childhood cancer treated with cranial irradiation are at risk of cerebrovascular disease (CVD), but the risks beyond age 50 are unknown. In all, 13457 survivors of childhood cancer included in the population-based British Childhood Cancer Survivor Study cohort were linked to Hospital Episode Statistics data for England. Risk of CVD related hospitalisation was quantified by standardised hospitalisation ratios (SHRs), absolute excess risks and cumulative incidence. Overall, 315 (2.3%) survivors had been hospitalised at least once for CVD with a 4-fold risk compared to that expected (95% confidence interval [CI]: 3.7-4.3). Survivors of a central nervous system (CNS) tumour and leukaemia treated with cranial irradiation were at greatest risk of CVD (SHR = 15.6, 95% CI: 14.0-17.4; SHR = 5.4; 95% CI: 4.5-6.5, respectively). Beyond age 60, on average, 3.1% of CNS tumour survivors treated with cranial irradiation were hospitalised annually for CVD (0.4% general population). Cumulative incidence of CVD increased from 16.0% at age 50 to 26.0% at age 65 (general population: 1.4-4.2%). In conclusion, among CNS tumour survivors treated with cranial irradiation, the risk of CVD continues to increase substantially beyond age 50 up to at least age 65. Such survivors should be: counselled regarding this risk; regularly monitored for hypertension, dyslipidaemia and diabetes; advised on life-style risk behaviours. Future research should include the recall for counselling and brain MRI to identify subgroups that could benefit from pharmacological or surgical intervention and establishment of a case-control study to comprehensively determine risk-factors for CVD.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joyeeta Guha
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Public Health England and NHS England & Improvement, Birmingham, UK
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Katherine E Henson
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | | | - Marlous Hall
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Julie S Kelly
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, and Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
- Newcastle University Centre for Cancer, Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David J Cutter
- Clinical Trial Service Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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9
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Reulen RC, Wong KF, Bright CJ, Winter DL, Alessi D, Allodji RM, Bagnasco F, Bárdi E, Bautz A, Byrne J, Feijen EA, Fidler-Benaoudia MM, Diallo I, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Haddy N, Høgsholt S, Jankovic M, Kaatsch P, Kaiser M, Kuonen R, Linge H, Øfstaas H, Ronckers CM, Hau EM, Skinner R, van Leeuwen FE, Teepen JC, Veres C, Zrafi W, Debiche G, Llanas D, Terenziani M, Vu-Bezin G, Wesenberg F, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki PM, Zadravec Zaletel L, Kuehni CE, Winther JF, de Vathaire F, Kremer LC, Hjorth L, Hawkins MM. Risk of digestive cancers in a cohort of 69 460 five-year survivors of childhood cancer in Europe: the PanCareSurFup study. Gut 2020; 70:gutjnl-2020-322237. [PMID: 33139271 DOI: 10.1136/gutjnl-2020-322237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/11/2020] [Accepted: 09/28/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Survivors of childhood cancer are at risk of subsequent primary neoplasms (SPNs), but the risk of developing specific digestive SPNs beyond age 40 years remains uncertain. We investigated risks of specific digestive SPNs within the largest available cohort worldwide. METHODS The PanCareSurFup cohort includes 69 460 five-year survivors of childhood cancer from 12 countries in Europe. Risks of digestive SPNs were quantified using standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence. RESULTS 427 digestive SPNs (214 colorectal, 62 liver, 48 stomach, 44 pancreas, 59 other) were diagnosed in 413 survivors. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR 12.1; 95% CI 9.6 to 15.1; SIR 7.3; 95% CI 5.9 to 9.0, respectively). The cumulative incidence increased the most steeply with increasing age for WT survivors, reaching 7.4% by age 55% and 9.6% by age 60 years (1.0% expected based on general population rates). Regarding colorectal SPNs, WT and HL survivors were at greatest risk; both seven times that expected. By age 55 years, 2.3% of both WT (95% CI 1.4 to 3.9) and HL (95% CI 1.6 to 3.2) survivors had developed a colorectal SPN-comparable to the risk among members of the general population with at least two first-degree relatives affected. CONCLUSIONS Colonoscopy surveillance before age 55 is recommended in many European countries for individuals with a family history of colorectal cancer, but not for WT and HL survivors despite a comparable risk profile. Clinically, serious consideration should be given to the implementation of colonoscopy surveillance while further evaluation of its benefits, harms and cost-effectiveness in WT and HL survivors is undertaken.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
| | - Kwok F Wong
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Chloe J Bright
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Italy, Childhood cancer registry of piedmont, Turin, Italy
| | - Rodrigue M Allodji
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, Instituto Giannina Gaslini, Genova, Italy
| | - Edit Bárdi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Kepler Universitätsklinikum, Linz, Austria
| | - Andrea Bautz
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Miranda M Fidler-Benaoudia
- Epidemiology and Prevention Research, Departments of Oncology and Community Health Sciences, Calgary, Alberta, Canada
| | - Ibrahim Diallo
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Stanislaw Garwicz
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry, University Medical Centre Mainz, Mainz, Germany
| | - Thorgerdur Gudmundsdottir
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Joyeeta Guha
- Public Health England and NHS England & Improvement, Birmingham, UK
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Stine Høgsholt
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Moncilo Jankovic
- Pediatric Clinic, University of Milan-Bicocca, Hospital San Gerardo, Monza, Lombardia, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Rahel Kuonen
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Helena Linge
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Hilde Øfstaas
- Norwegian National Advisory Unit on solid tumors in children, Oslo, Norway
| | - Cecile M Ronckers
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of pediatric Oncology, Emma Children's Hospital & Academic Medical Center, Amsterdam, The Netherlands
| | - Eva-Maria Hau
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, BE, Switzerland
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle Upon Tyne, UK
| | - Flora E van Leeuwen
- Department of Epidemiology, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jop C Teepen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Cristina Veres
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Wael Zrafi
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Ghazi Debiche
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Damien Llanas
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Giao Vu-Bezin
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Finn Wesenberg
- Norwegian Cancer Registry and Dept. of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of medicine, University of Oslo, Oslo, Norway
| | - Thomas Wiebe
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Italy, Childhood cancer registry of piedmont, Turin, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, 2nd Department of Pediatrics, Budapest, Hungary
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, BE, Switzerland
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Leontien C Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of pediatric Oncology, Emma Children's Hospital & Academic Medical Center, Amsterdam, The Netherlands
| | - Lars Hjorth
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
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10
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Fidler-Benaoudia MM, Oeffinger KC, Yasui Y, Robison LL, Winter DL, Reulen RC, Leisenring WM, Chen Y, Armstrong GT, Hawkins MM. A Comparison of Late Mortality Among Survivors of Childhood Cancer in the United States and United Kingdom. J Natl Cancer Inst 2020; 113:562-571. [PMID: 33002115 DOI: 10.1093/jnci/djaa151] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/10/2020] [Accepted: 09/17/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND It is unclear whether late-effect risks among childhood cancer survivors vary internationally. We compared late mortality in the North American Childhood Cancer Survivor Study (CCSS) and British Childhood Cancer Survivor Study (BCCSS). METHODS Late mortality was assessed among 49 822 5-year survivors of childhood cancer diagnosed before 15 years of age from 1970 to 1999 (CCSS, n = 31 596; BCCSS, n = 18 226) using cumulative mortality probabilities (CM%) and adjusted ratios of the standardized mortality ratio. RESULTS The all-cause CM% at 10 years from diagnosis was statistically significantly lower in the CCSS (4.7%, 95% confidence interval [CI] = 4.5% to 5.0%) compared with the BCCSS (6.9%, 95% CI = 6.5% to 7.2%), attributable to a lower probability of death from recurrence or progression of the primary cancer, with statistically significant differences observed in survivors of leukemia, lymphoma, central nervous system tumors, and sarcoma. However, at 40 years from diagnosis, the CCSS had a greater CM% (22.3% vs 19.3%), attributable to a twofold higher risk of mortality from subsequent malignant neoplasms, cardiac and respiratory diseases, and other health-related causes. Differences increased when assessed by follow-up interval, with the CCSS faring worse as time-since-diagnosis increased. Finally, the gap in all-cause mortality widened more recently, with CCSS survivors diagnosed in 1990-1999 experiencing one-half the excess deaths observed in the BCCSS (ratios of the standardized mortality ratio = 0.5, 95% CI = 0.5 to 0.6). CONCLUSIONS Our findings suggest that US survivors may have received more intensive regimens to achieve sustainable remission and cure, but the cost of this approach was a higher risk of death from late effects. Although the clinical impact of these differences is unclear, our results provide important evidence to aid the discussion of late effects management.
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Affiliation(s)
- Miranda M Fidler-Benaoudia
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada.,Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, University of Birmingham, Birmingham, West Midlands, UK
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, University of Birmingham, Birmingham, West Midlands, UK
| | | | - Yan Chen
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, University of Birmingham, Birmingham, West Midlands, UK
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11
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Feijen EAM, van Dalen EC, van der Pal HJH, Reulen RC, Winter DL, Keuhni CE, Morsellino V, Alessi D, Allodji RS, Byrne J, Bardi E, Jakab Z, Grabow D, Garwicz S, Haddy N, Jankovic M, Kaatsch P, Levitt GA, Ronckers CM, Schindera C, Skinner R, Zalatel L, Hjorth L, Tissing WJE, De Vathaire F, Hawkins MM, Kremer LCM. Increased risk of cardiac ischaemia in a pan-European cohort of 36 205 childhood cancer survivors: a PanCareSurFup study. Heart 2020; 107:33-40. [PMID: 32826285 DOI: 10.1136/heartjnl-2020-316655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE In this report, we determine the cumulative incidence of symptomatic cardiac ischaemia and its risk factors among European 5-year childhood cancer survivors (CCS) participating in the PanCareSurFup study. METHODS Eight data providers (France, Hungary, Italy (two cohorts), the Netherlands, Slovenia, Switzerland and the UK) participating in PanCareSurFup ascertained and validated symptomatic cardiac events among their 36 205 eligible CCS. Data on symptomatic cardiac ischaemia were graded according to the Criteria for Adverse Events V.3.0 (grade 3-5). We calculated cumulative incidences, both overall and for different subgroups based on treatment and malignancy, and used multivariable Cox regression to analyse risk factors. RESULTS Overall, 302 out of the 36 205 CCS developed symptomatic cardiac ischaemia during follow-up (median follow-up time after primary cancer diagnosis: 23.0 years). The cumulative incidence by age 60 was 5.4% (95% CI 4.6% to 6.2%). Men (7.1% (95% CI 5.8 to 8.4)) had higher rates than women (3.4% (95% CI 2.4 to 4.4)) (p<0.0001). Of importance is that a significant number of patients (41/302) were affected as teens or young adults (14-30 years). Treatment with radiotherapy/chemotherapy conferred twofold risk (95% CI 1.5 to 3.0) and cases in these patients appeared earlier than in CCS without treatment/surgery only (15% vs 3% prior to age 30 years, respectively (p=0.04)). CONCLUSIONS In this very large European childhood cancer cohort, we found that by age 60 years, 1 in 18 CCS will develop a severe, life-threatening or fatal cardiac ischaemia, especially in lymphoma survivors and CCS treated with radiotherapy and chemotherapy increases the risk significantly.
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Affiliation(s)
| | - Elvira C van Dalen
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Heleen J H van der Pal
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | - Zsuzsanna Jakab
- Markusovszky University Teaching Hospital, Szombathely, Vas, Hungary
| | | | | | | | | | | | - Gill A Levitt
- Great Ormond Street Hospital for Children, London, UK
| | - Cecile M Ronckers
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Lorna Zalatel
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Lars Hjorth
- Skåne University Hospital Lund, Lund, Sweden
| | - Wim J E Tissing
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Pediatric Oncology, University of Groningen, Groningen, The Netherlands
| | | | | | - Leontien C M Kremer
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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12
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Allodji RS, Hawkins MM, Bright CJ, Fidler-Benaoudia MM, Winter DL, Alessi D, Fresneau B, Journy N, Morsellino V, Bárdi E, Bautz A, Byrne J, Feijen ELA, Teepen JC, Vu-Bezin G, Rubino C, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Hau EM, Jankovic M, Kaatsch P, Kaiser M, Linge H, Muraca M, Llanas D, Veres C, Øfstaas H, Diallo I, Mansouri I, Ronckers CM, Skinner R, Terenziani M, Wesenberg F, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki P, Zaletel LZ, Kuehni CE, Winther JF, Michel G, Kremer LCM, Hjorth L, Haddy N, de Vathaire F, Reulen RC. Risk of subsequent primary leukaemias among 69,460 five-year survivors of childhood cancer diagnosed from 1940 to 2008 in Europe: A cohort study within PanCareSurFup. Eur J Cancer 2019; 117:71-83. [PMID: 31260818 DOI: 10.1016/j.ejca.2019.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Survivors of childhood cancers are at risk of developing subsequent primary leukaemias (SPLs), but the long-term risks beyond 20 years of treatment are still unclear. We investigated the risk of SPLs in five-year childhood cancer survivors using a large-scale pan-European (PanCareSurFup) cohort and evaluated variations in the risk by cancer and demographic factors. METHODS This largest-ever assembled cohort comprises 69,460 five-year childhood cancer survivors from 12 European countries. Standardised incidence ratios (SIRs) and absolute excess risks (AERs) were calculated. RESULTS One hundred fifteen survivors developed an SPL including 86 myeloid leukaemias (subsequent primary myeloid leukaemias [SPMLs]), 17 lymphoid leukaemias and 12 other types of leukaemias; of these SPLs, 31 (27%) occurred beyond 20 years from the first childhood cancer diagnosis. Compared with the general population, childhood cancer survivors had a fourfold increased risk (SIR = 3.7, 95% confidence interval [CI]: 3.1 to 4.5) of developing leukaemia, and eight leukaemias per 100,000 person-years (AER = 7.5, 95% CI: 6.0 to 9.2) occurred in excess of that expected. The risks remained significantly elevated beyond 20 years from the first primary malignancy (SIR = 2.4, 95% CI: 1.6 to 3.4). Overall, the risk ratio for SPML (SIR = 5.8, 95% CI: 4.6 to 7.1) was higher than that for other SPLs. CONCLUSIONS We demonstrate that beyond 20 years after childhood cancer diagnosis, survivors experience an increased risk for SPLs compared with that expected from the general population. Our findings highlight the need for awareness by survivors and their healthcare providers for potential risk related to SPL.
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Affiliation(s)
- Rodrigue S Allodji
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France; Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, 01 P.O. Box 2009, Cotonou, Benin.
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Miranda M Fidler-Benaoudia
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città Della Salute e Della Scienza di Torino, Italy
| | - Brice Fresneau
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France; Department of Pediatric Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Neige Journy
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Vera Morsellino
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Edit Bárdi
- St Anna Kinderspital Wien, Austria; Department of Paediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria
| | - Andrea Bautz
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
| | | | - Elizabeth Lieke Am Feijen
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jop C Teepen
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Giao Vu-Bezin
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Carole Rubino
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Stanislaw Garwicz
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Thorgerdur Gudmundsdottir
- Department of Paediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Joyeeta Guha
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Eva-Maria Hau
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland; Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Switzerland
| | - Momcilo Jankovic
- Foundation MBBM, Hemato-Oncology Center, University of Milano-Bicocca, Via Cadore 38, 20900 Monza, MB, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Helena Linge
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Monica Muraca
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Damien Llanas
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Cristina Veres
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Hilde Øfstaas
- Norwegian National Advisory Unit on Solid Tumors in Children, Norway
| | - Ibrahima Diallo
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Imene Mansouri
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Cecile M Ronckers
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, And Northern Institute of Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Finn Wesenberg
- Norwegian Cancer Registry and Dept. of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Thomas Wiebe
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città Della Salute e Della Scienza di Torino, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Päivi Lähteenmäki
- Turku University and Turku University Hospital, Department of Pediatric and Adolescent Medicine, Turku, Finland
| | | | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland; Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Switzerland
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Gisela Michel
- Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Nadia Haddy
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Florent de Vathaire
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
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13
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Fidler MM, Oeffinger KC, Yasui Y, Winter DL, Leisenring W, Robison LL, Reulen R, Chen Y, Armstrong GT, Hawkins M. Comparing late mortality risks among childhood cancer survivors: A report from the Childhood Cancer Survivor Study and British Childhood Cancer Survivor Study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10017 Background: It is unclear whether late-effect risks are comparable across international settings. We compared late mortality risks in the Childhood Cancer Survivor Study (CCSS) and British Childhood Cancer Survivor Study (BCCSS). Methods: 46,474 5-year survivors of childhood cancer diagnosed from 1970-1999 and < 15 years age were included: 28,248 from the CCSS and 18,226 from the BCCSS. Late mortality (death ≥5 years from diagnosis) was assessed by linking to national vital statistics records. Adjusted ratios of the standardized mortality ratio (RSMR) and cumulative mortality probabilities were used to compare risks between cohorts. Treatment exposures were not available for the BCCSS, precluding comparison. Results: The cumulative all-cause mortality at 10 years from diagnosis was significantly lower in the CCSS (4.8%;95%CI:4.6%-5.0%) compared to the BCCSS (6.9%;95%CI:6.5%-7.2%); this was due to a lower probability of death from recurrence/progression of the primary cancer (CCSS = 3.3% vs. BCCSS = 5.8%), with significant differences observed in survivors of leukemia (7.9% vs 4.0%), Hodgkin lymphoma (2.5% vs 1.3%), CNS tumors (6.4% vs 4.4%), and sarcoma (6.5% vs 4.0%). However, with increasing time from diagnosis, risks became more similar. The CCSS ultimately had a greater cumulative mortality at 40 years from diagnosis, attributable to a 2-fold higher mortality from subsequent neoplasms (SNs) (RSMR:2.0;95%CI:1.8-2.3), cardiac (RSMR:1.7;95%CI:1.4-2.3) and pulmonary (RSMR:1.9;95%CI:1.4-2.5) causes, and other health-related deaths (RSMR:2.4;95%CI:2.1-2.9). When assessed by follow-up interval, the differences between the CCSS and BCCSS increased significantly for deaths due to SNs, cardiac and pulmonary causes, and other health-related deaths as time increased. Among those diagnosed more recently, the gap in all-cause mortality widened, with CCSS survivors diagnosed 1990-1999 experiencing approximately half the excess (RSMR:0.5;95%CI:0.5-0.6) observed in the BCCSS; this widening was driven by declines in the RSMR for most non-recurrence/progression causes of death. Conclusions: Our findings suggest that North American survivors may have received more intensive regimens during this time period to achieve sustainable remission and cure. However, the cost of this approach was a higher risk of death from late-effects. Which approach confers a net survival advantage will depend critically on the magnitude of the excess risk of late-effect deaths as the cohorts age.
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Affiliation(s)
| | | | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | | | - Raoul Reulen
- University of Birmingham, Birmingham, United Kingdom
| | - Yan Chen
- University of Alberta, Calgary, AB, Canada
| | | | - Mike Hawkins
- University of Birmingham, Birmingham, United Kingdom
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14
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Bright CJ, Reulen RC, Winter DL, Stark DP, McCabe MG, Edgar AB, Frobisher C, Hawkins MM. Risk of subsequent primary neoplasms in survivors of adolescent and young adult cancer (Teenage and Young Adult Cancer Survivor Study): a population-based, cohort study. Lancet Oncol 2019; 20:531-545. [PMID: 30797674 PMCID: PMC6494975 DOI: 10.1016/s1470-2045(18)30903-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 12/12/2022]
Abstract
Background Few studies have investigated the risks of subsequent primary neoplasms after adolescent and young adult (AYA) cancer. We investigated the risks of specific subsequent primary neoplasms after each of 16 types of AYA cancer. Methods The Teenage and Young Adult Cancer Survivor Study is a population-based cohort of 200 945 survivors of cancer diagnosed when aged 15–39 years in England and Wales from Jan 1, 1971, to Dec 31, 2006. The cohort was established using cancer registrations from the Office for National Statistics and the Welsh Cancer registry. Follow-up was from 5-year survival until the first occurrence of death, emigration, or study end date (Dec 31, 2012). In this analysis, we focus on the risk of specific subsequent primary neoplasms after 16 types of AYA cancer: breast; cervical; testicular; Hodgkin lymphoma (female); Hodgkin lymphoma (male); melanoma; CNS (intracranial); colorectal; non-Hodgkin lymphoma; thyroid; soft-tissue sarcoma; ovarian; bladder; other female genital; leukaemia; and head and neck cancer. We report absolute excess risks (AERs; per 10 000 person-years) and cumulative incidence of specific types of subsequent primary neoplasm after each type of AYA cancer. Findings During the 2 631 326 person-years of follow-up (median follow-up 16·8 years, IQR 10·5–25·2), 12 321 subsequent primary neoplasms were diagnosed in 11 565 survivors, most frequently among survivors of breast cancer, cervical cancer, testicular cancer, and Hodgkin lymphoma. AERs of any subsequent primary neoplasms were 19·5 per 10 000 person-years (95% CI 17·4–21·5) in survivors of breast cancer, 10·2 (8·0–12·4) in survivors of cervical cancer, 18·9 (16·6–21·1) in survivors of testicular cancer, 55·7 (50·4–61·1) in female survivors of Hodgkin lymphoma, and 29·9 (26·3–33·6) in male survivors of Hodgkin lymphoma. The cumulative incidence of all subsequent primary neoplasms 35 years after diagnosis was 11·9% (95% CI 11·3–12·6) in survivors of breast cancer, 15·8% (14·8–16·7) in survivors of cervical cancer, 20·2% (18·9–21·5) in survivors of testicular cancer, 26·6% (24·7–28·6) in female survivors of Hodgkin lymphoma, and 16·5% (15·2–18·0) in male survivors of Hodgkin lymphoma. In patients who had survived at least 30 years from diagnosis of cervical cancer, testicular cancer, Hodgkin lymphoma in women, breast cancer, and Hodgkin lymphoma in men, we identified a small number of specific subsequent primary neoplasms that account for 82%, 61%, 58%, 45%, and 41% of the total excess number of neoplasms, respectively. Lung cancer accounted for a notable proportion of the excess number of neoplasms across all AYA groups investigated. Interpretation Our finding that a small number of specific subsequent primary neoplasms account for a large percentage of the total excess number of neoplasms in long-term survivors of cervical, breast, and testicular cancer, and Hodgkin lymphoma provides an evidence base to inform priorities for clinical long-term follow-up. The prominence of lung cancer after each of these AYA cancers indicates the need for further work aimed at preventing and reducing the burden of this cancer in future survivors of AYA cancer. Funding Cancer Research UK, National Institute for Health Research, Academy of Medical Sciences, and Children with Cancer UK.
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Affiliation(s)
- Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Daniel P Stark
- Leeds Institute of Medical Research at St James's, School of Medicine, St James's University Hospital, Leeds, UK
| | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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15
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Fidler MM, Reulen RC, Bright CJ, Henson KE, Kelly JS, Jenney M, Ng A, Whelan J, Winter DL, Frobisher C, Hawkins MM. Respiratory mortality of childhood, adolescent and young adult cancer survivors. Thorax 2018; 73:959-968. [PMID: 29748251 PMCID: PMC6166601 DOI: 10.1136/thoraxjnl-2017-210683] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 02/20/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exposure to radiation and/or chemotherapy during cancer treatment can compromise respiratory function. We investigated the risk of long-term respiratory mortality among 5-year cancer survivors diagnosed before age 40 years using the British Childhood Cancer Survivor Study (BCCSS) and Teenage and Young Adult Cancer Survivor Study (TYACSS). METHODS The BCCSS comprises 34 489 cancer survivors diagnosed before 15 years from 1940 to 2006 in Great Britain. The TYACSS includes 200 945 cancer survivors diagnosed between 15 years and 39 years from 1971 to 2006 in England and Wales. Standardised mortality ratios and absolute excess risks were used. FINDINGS Overall, 164 and 1079 respiratory deaths were observed in the BCCSS and TYACSS cohorts respectively, which was 6.8 (95% CI 5.8 to 7.9) and 1.7 (95% CI 1.6 to 1.8) times that expected, but the risks varied substantially by type of respiratory death. Greatest excess numbers of deaths were experienced after central nervous system (CNS) tumours in the BCCSS and after lung cancer, leukaemia, head and neck cancer and CNS tumours in the TYACSS. The excess number of respiratory deaths increased with increasing attained age, with seven (95% CI 2.4 to 11.3) excess deaths observed among those aged 50+ years in the BCCSS and three (95% CI 1.4 to 4.2) excess deaths observed among those aged 60+ years in the TYACSS. It was reassuring to see a decline in the excess number of respiratory deaths among those diagnosed more recently in both cohorts. CONCLUSIONS Prior to this study, there was almost nothing known about the risks of respiratory death after cancer diagnosed in young adulthood, and this study addresses this gap. These new findings will be useful for both survivors and those involved in their clinical management and follow-up.
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Affiliation(s)
- Miranda M Fidler
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katherine E Henson
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Clinical Trial Service Unite, University of Oxford, Oxford, UK
| | - Julie S Kelly
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Meriel Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - Antony Ng
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, UK
| | - Jeremy Whelan
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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16
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Bright CJ, Hawkins MM, Winter DL, Alessi D, Allodji RS, Bagnasco F, Bárdi E, Bautz A, Byrne J, Feijen EAM, Fidler MM, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Haddy N, Jankovic M, Kaatsch P, Kaiser M, Kuehni CE, Linge H, Øfstaas H, Ronckers CM, Skinner R, Teepen JC, Terenziani M, Vu-Bezin G, Wesenberg F, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki P, Zaletel LZ, Kuonen R, Winther JF, de Vathaire F, Kremer LC, Hjorth L, Reulen RC. Risk of Soft-Tissue Sarcoma Among 69 460 Five-Year Survivors of Childhood Cancer in Europe. J Natl Cancer Inst 2018; 110:649-660. [PMID: 29165710 PMCID: PMC6005019 DOI: 10.1093/jnci/djx235] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/09/2017] [Accepted: 10/10/2017] [Indexed: 12/20/2022] Open
Abstract
Background Childhood cancer survivors are at risk of subsequent primary soft-tissue sarcomas (STS), but the risks of specific STS histological subtypes are unknown. We quantified the risk of STS histological subtypes after specific types of childhood cancer. Methods We pooled data from 13 European cohorts, yielding a cohort of 69 460 five-year survivors of childhood cancer. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated. Results Overall, 301 STS developed compared with 19 expected (SIR = 15.7, 95% confidence interval [CI] = 14.0 to 17.6). The highest standardized incidence ratios were for malignant peripheral nerve sheath tumors (MPNST; SIR = 40.6, 95% CI = 29.6 to 54.3), leiomyosarcomas (SIR = 29.9, 95% CI = 23.7 to 37.2), and fibromatous neoplasms (SIR = 12.3, 95% CI = 9.3 to 16.0). SIRs for MPNST were highest following central nervous system tumors (SIR = 80.5, 95% CI = 48.4 to 125.7), Hodgkin lymphoma (SIR = 81.3, 95% CI = 35.1 to 160.1), and Wilms tumor (SIR = 76.0, 95% CI = 27.9 to 165.4). Standardized incidence ratios for leiomyosarcoma were highest following retinoblastoma (SIR = 342.9, 95% CI = 245.0 to 466.9) and Wilms tumor (SIR = 74.2, 95% CI = 37.1 to 132.8). AERs for all STS subtypes were generally low at all years from diagnosis (AER < 1 per 10 000 person-years), except for leiomyosarcoma following retinoblastoma, for which the AER reached 52.7 (95% CI = 20.0 to 85.5) per 10 000 person-years among patients who had survived at least 45 years from diagnosis of retinoblastoma. Conclusions For the first time, we provide risk estimates of specific STS subtypes following childhood cancers and give evidence that risks of MPNSTs, leiomyosarcomas, and fibromatous neoplasms are particularly increased. While the multiplicative excess risks relative to the general population are substantial, the absolute excess risk of developing any STS subtype is low, except for leiomyosarcoma after retinoblastoma. These results are likely to be informative for both survivors and health care providers.
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Affiliation(s)
- Chloe J Bright
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Mike M Hawkins
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - David L Winter
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Rodrigue S Allodji
- Cancer and Radiation Team, U1018 INSERM, Gustave Roussy, Villejuif, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy
| | - Edit Bárdi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Kepler Universitätsklinikum, Linz, Austria
| | - Andrea Bautz
- Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark
| | | | - Elizabeth A M Feijen
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Miranda M Fidler
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Stanislaw Garwicz
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark
- Childreńs Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Joyeeta Guha
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Nadia Haddy
- Cancer and Radiation Team, U1018 INSERM, Gustave Roussy, Villejuif, France
| | - Momcilo Jankovic
- Foundation MBBM, Hemato-Oncology Center, University of Milano-Bicocca, Monza, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Helena Linge
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Hilde Øfstaas
- Norwegian National Advisory Unit on Solid Tumors in Children, Oslo, Norway
| | - Cecile M Ronckers
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Jop C Teepen
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giao Vu-Bezin
- Cancer and Radiation Team, U1018 INSERM, Gustave Roussy, Villejuif, France
| | - Finn Wesenberg
- Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Thomas Wiebe
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, Budapest, Hungary
| | - Riccardo Haupt
- Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy
| | - Päivi Lähteenmäki
- Department of Pediatric and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | | | - Jeanette F Winther
- Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Leontien C Kremer
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
- Department of Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Raoul C Reulen
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
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17
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Grabow D, Kaiser M, Hjorth L, Byrne J, Alessi D, Allodji RS, Bagnasco F, Bárdi E, Bautz A, Bright CJ, de Vathaire F, Feijen EAM, Garwicz S, Hagberg O, Haupt R, Hawkins MM, Jakab Z, Kremer LCM, Kuehni CE, Kuonen R, Lähteenmäki PM, Reulen RC, Ronckers CM, Sacerdote C, Vu-Bezin G, Wesenberg F, Wiebe T, Winter DL, Winther JF, Zaletel LZ, Kaatsch P. The PanCareSurFup cohort of 83,333 five-year survivors of childhood cancer: a cohort from 12 European countries. Eur J Epidemiol 2018; 33:335-349. [PMID: 29497894 PMCID: PMC5889790 DOI: 10.1007/s10654-018-0370-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 02/15/2018] [Indexed: 11/30/2022]
Abstract
Childhood cancer survivors face risks from a variety of late effects, including cardiac events, second cancers, and late mortality. The aim of the pan-European PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies (PanCareSurFup) Consortium was to collect data on incidence and risk factors for these late effects among childhood cancer survivors in Europe. This paper describes the methodology of the data collection for the overall PanCareSurFup cohort and the outcome-related cohorts. In PanCareSurFup 13 data providers from 12 countries delivered data to the data centre in Mainz. Data providers used a single variable list that covered all three outcomes. After validity and plausibility checks data was provided to the outcome-specific working groups. In total, we collected data on 115,596 patients diagnosed with cancer from 1940 to 2011, of whom 83,333 had survived 5 years or more. Due to the eligibility criteria and other requirements different numbers of survivors were eligible for the analysis of each of the outcomes. Thus, 1014 patients with at least one cardiac event were identified from a cohort of 39,152 5-year survivors; for second cancers 3995 survivors developed at least one second cancer from a cohort of 71,494 individuals, and from the late mortality cohort of 79,441 who had survived at least 5 years, 9247 died subsequently. Through the close cooperation of many European countries and the establishment of one central data collection and harmonising centre, the project succeeded in generating the largest cohort of children with cancer to date.
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Affiliation(s)
- Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lars Hjorth
- Department of Clinical Sciences, Skane University Hospital, Lund University, Pediatrics, Lund, Sweden
| | - Julianne Byrne
- Boyne Research Institute, 5 Bolton Square, East, Drogheda, Co. Louth, A92 RY6K, Ireland
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Citta' della Salute e della Scienza Hospital-University of Turin and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy
| | - Rodrigue S Allodji
- Cancer and Radiation, Unit 1018 INSERM, University Paris-Saclay, Gustave Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, Gaslini Children's Hospital, Via Gerolamo Gaslini, 5, 16148, Genova, Italy
| | - Edit Bárdi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Kepler Universitätsklinikum, Linz, Austria
| | - Andrea Bautz
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Florent de Vathaire
- Cancer and Radiation, Unit 1018 INSERM, University Paris-Saclay, Gustave Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France
| | - Elizabeth A M Feijen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Stanislaw Garwicz
- Department of Clinical Sciences, Skane University Hospital, Lund University, Pediatrics, Lund, Sweden
| | | | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, Gaslini Children's Hospital, Via Gerolamo Gaslini, 5, 16148, Genova, Italy
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Rahel Kuonen
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Päivi Maria Lähteenmäki
- Department of Pediatric and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Cécile M Ronckers
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Citta' della Salute e della Scienza Hospital-University of Turin and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy
| | - Giao Vu-Bezin
- Cancer and Radiation, Unit 1018 INSERM, University Paris-Saclay, Gustave Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France
| | - Finn Wesenberg
- Norwegian Cancer Register Department of Pediatric Medicine, Faculty of Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Wiebe
- Department of Clinical Sciences, Skane University Hospital, Lund University, Pediatrics, Lund, Sweden
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Lorna Zadravec Zaletel
- Division of Radiotherapy, Institute of Oncology, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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18
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Frobisher C, Glaser A, Levitt GA, Cutter DJ, Winter DL, Lancashire ER, Oeffinger KC, Guha J, Kelly J, Reulen RC, Hawkins MM. Risk stratification of childhood cancer survivors necessary for evidence-based clinical long-term follow-up. Br J Cancer 2017; 117:1723-1731. [PMID: 29065109 PMCID: PMC5729444 DOI: 10.1038/bjc.2017.347] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/09/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Reorganisation of clinical follow-up care in England was proposed by the National Cancer Survivorship Initiative (NCSI), based on cancer type and treatment, ranging from Level 1 (supported self-management) to Level 3 (consultant-led care). The objective of this study was to provide an investigation of the risks of serious adverse health-outcomes associated with NCSI Levels of clinical care using a large population-based cohort of childhood cancer survivors. METHODS The British Childhood Cancer Survivor Study (BCCSS) was used to investigate risks of specific causes of death, subsequent primary neoplasms (SPNs) and non-fatal non-neoplastic outcomes by NCSI Level. RESULTS Cumulative (excess) risks of specified adverse outcomes by 45 years from diagnosis among non-leukaemic survivors assigned to NCSI Levels 1, 2 and 3 were for: SPNs-5% (two-fold expected), 14% (four-fold expected) and 21% (eight-fold expected); non-neoplastic death-2% (two-fold expected), 4% (three-fold expected) and 8% (seven-fold expected); non-fatal non-neoplastic condition-14%, 27% and 40%, respectively. Consequently overall cumulative risks of any adverse health outcome were 21%, 45% and 69%, respectively. CONCLUSIONS Despite its simplicity the risk stratification tool provides clear and strong discrimination between survivors assigned to different NCSI Levels in terms of long-term cumulative and excess risks of serious adverse outcomes.
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Affiliation(s)
- Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham B15 2TY, UK
| | - Adam Glaser
- Leeds Institute of Cancer and Pathology, Clinical Sciences Building, University of Leeds, St James’s University Hospital, Leeds LS9 7TF, UK
| | - Gill A Levitt
- Department of Haematology/Oncology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JN, UK
| | - David J Cutter
- Nuffield Department of Population Health, Clinical Trial Service Unit, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham B15 2TY, UK
| | - Emma R Lancashire
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham B15 2TY, UK
| | - Kevin C Oeffinger
- Departments of Paediatrics and Medicine, Memorial Sloan-Kettering Cancer Centre, 300 East 66th Street, New York, NY 10065, USA
| | - Joyeeta Guha
- Public Health England, Birmingham And The Black Country Area Team, St Chads Court, 213 Hagley Road, Edgbaston, Birmingham B16 9RG, UK
| | - Julie Kelly
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham B15 2TY, UK
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham B15 2TY, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham B15 2TY, UK
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19
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Fidler MM, Reulen RC, Winter DL, Allodji RS, Bagnasco F, Bárdi E, Bautz A, Bright CJ, Byrne J, Feijen EAM, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Haddy N, Jankovic M, Kaatsch P, Kaiser M, Kuonen R, Linge H, Maule M, Merletti F, Øfstaas H, Ronckers CM, Skinner R, Teepen J, Terenziani M, Vu-Bezin G, Wesenberg F, Wiebe T, Jakab Z, Haupt R, Lähteenmäki P, Zaletel LZ, Kuehni CE, Winther JF, de Vathaire F, Kremer LC, Hjorth L, Hawkins MM. Risk of Subsequent Bone Cancers Among 69 460 Five-Year Survivors of Childhood and Adolescent Cancer in Europe. J Natl Cancer Inst 2017; 110:4237499. [PMID: 28954302 DOI: 10.1093/jnci/djx165] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/19/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction We investigate the risks of subsequent primary bone cancers after childhood and adolescent cancer in 12 European countries. For the first time, we satisfactorily address the risks beyond 40 years from diagnosis and beyond 40 years of age among all survivors. Methods This largest-ever assembled cohort comprises 69 460 five-year survivors of cancer diagnosed before age 20 years. Standardized incidence ratios, absolute excess risks, and multivariable-adjusted relative risks and relative excess risks were calculated. All statistical tests were two-sided. Results Overall, survivors were 21.65 times (95% confidence interval = 18.97 to 24.60 times) more likely to be diagnosed with a subsequent primary bone cancer than expected from the general population. The greatest excess numbers of bone cancers were observed after retinoblastoma, bone sarcoma, and soft tissue sarcoma. The excess number of bone cancers declined linearly with both years since diagnosis and attained age (all P < .05). Beyond 40 years from diagnosis and age 40 years, there were at most 0.45 excess bone cancers among all survivors per 10 000 person-years at risk; beyond 30 years from diagnosis and age 30 years, there were at most 5.02 excess bone cancers after each of retinoblastoma, bone sarcoma, and soft tissue sarcoma, per 10 000 person-years at risk. Conclusions For all survivors combined and the cancer groups with the greatest excess number of bone cancers, the excess numbers observed declined with both age and years from diagnosis. These results provide novel, reliable, and unbiased information about risks and risk factors among long-term survivors of childhood and adolescent cancer.
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Affiliation(s)
- Miranda M Fidler
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Rodrigue S Allodji
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Francesca Bagnasco
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Edit Bárdi
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Andrea Bautz
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Julianne Byrne
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Elizabeth A M Feijen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Stanislaw Garwicz
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Desiree Grabow
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Thorgerdur Gudmundsdottir
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Joyeeta Guha
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Nadia Haddy
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Momcilo Jankovic
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Peter Kaatsch
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Melanie Kaiser
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Rahel Kuonen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Helena Linge
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Milena Maule
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Franco Merletti
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Hilde Øfstaas
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Cecile M Ronckers
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Roderick Skinner
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jop Teepen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Monica Terenziani
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Giao Vu-Bezin
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Finn Wesenberg
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Thomas Wiebe
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Zsuzsanna Jakab
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Riccardo Haupt
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Päivi Lähteenmäki
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Lorna Zadravec Zaletel
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jeanette F Winther
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Florent de Vathaire
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Leontien C Kremer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Lars Hjorth
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
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Reulen RC, Bright CJ, Winter DL, Fidler MM, Wong K, Guha J, Kelly JS, Frobisher C, Edgar AB, Skinner R, Wallace WHB, Hawkins MM. Pregnancy and Labor Complications in Female Survivors of Childhood Cancer: The British Childhood Cancer Survivor Study. J Natl Cancer Inst 2017; 109:3738120. [PMID: 28419299 PMCID: PMC5409032 DOI: 10.1093/jnci/djx056] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/08/2017] [Indexed: 11/12/2022] Open
Abstract
Background: Female survivors of childhood cancer treated with abdominal radiotherapy who manage to conceive are at risk of delivering premature and low-birthweight offspring, but little is known about whether abdominal radiotherapy may also be associated with additional complications during pregnancy and labor. We investigated the risk of developing pregnancy and labor complications among female survivors of childhood cancer in the British Childhood Cancer Survivor Study (BCCSS). Methods: Pregnancy and labor complications were identified by linking the BCCSS cohort (n = 17 980) to the Hospital Episode Statistics (HES) for England. Relative risks (RRs) of pregnancy and labor complications were calculated by site of radiotherapy treatment (none/abdominal/cranial/other) and other cancer-related factors using log-binomial regression. All statistical tests were two-sided. Results: A total of 2783 singleton pregnancies among 1712 female survivors of childhood cancer were identified in HES. Wilms tumor survivors treated with abdominal radiotherapy were at threefold risk of hypertension complicating pregnancy (relative risk = 3.29, 95% confidence interval [CI] = 2.29 to 4.71), while all survivors treated with abdominal radiotherapy were at risk of gestational diabetes mellitus (RR = 3.35, 95% CI = 1.41 to 7.93) and anemia complicating pregnancy (RR = 2.10, 95% CI = 1.27 to 3.46) compared with survivors treated without radiotherapy. Survivors treated without radiotherapy had similar risks of pregnancy and labor complications as the general population, except survivors were more likely to opt for an elective cesarean section (RR = 1.39, 95% CI = 1.16 to 1.70). Conclusions: Treatment with abdominal radiotherapy increases the risk of developing hypertension complicating pregnancy in Wilms tumor survivors, and diabetes mellitus and anemia complicating pregnancy in all survivors. These patients may require extra vigilance during pregnancy.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, UK
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, UK
| | - Miranda M Fidler
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kwok Wong
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, UK
| | - Joyeeta Guha
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, UK
| | - Julie S Kelly
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, UK
| | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, UK
| | - Angela B Edgar
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, UK
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology and Oncology, and Children's BMT Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - W Hamish B Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, UK
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, UK
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Frobisher C, Lancashire ER, Jenkinson H, Winter DL, Kelly J, Reulen RC, Hawkins MM. Employment status and occupational level of adult survivors of childhood cancer in Great Britain: The British childhood cancer survivor study. Int J Cancer 2017; 140:2678-2692. [PMID: 28316069 PMCID: PMC5434894 DOI: 10.1002/ijc.30696] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 02/15/2017] [Accepted: 02/23/2017] [Indexed: 11/06/2022]
Abstract
The British Childhood Cancer Survivor Study (BCCSS) provides the first detailed investigation of employment and occupation to be undertaken in a large population-based cohort. Previous studies have been limited by design issues such as using small numbers of survivors with specific diagnoses, and involved limited assessment of employment status and occupational level. The BCCSS includes 17,981 5-year survivors of childhood cancer. Employment status and occupational level were ascertained by questionnaire from eligible survivors (n = 14,836). Multivariate logistic regression was used to explore factors associated with employment and occupation, and to compare survivors to their demographic peers in the general population. Employment status was available for 10,257 survivors. Gender, current age, cancer type, radiotherapy, age at diagnosis and epilepsy were consistently associated with being: employed; unable to work; in managerial or non-manual occupations. Overall, survivors were less likely to be working than expected (OR (99% CI): 0.89 (0.81-0.98)), and this deficit was greatest for irradiated CNS neoplasm survivors (0.34 (0.28-0.41)). Compared to the general population, survivors were fivefold more likely to be unable to work due to illness/disability; the excess was 15-fold among CNS neoplasm survivors treated with radiotherapy. Overall survivors were less likely to be in managerial occupations than expected (0.85 (0.77-0.94)). However, bone sarcoma survivors were more likely to be in these occupations than expected (1.37 (1.01-1.85)) and also similarly for non-manual occupations (1.90 (1.37-2.62)). Survivors of retinoblastoma (1.55 (1.20-2.01)) and 'other' neoplasm group (1.62 (1.30-2.03)) were also more likely to be in non-manual occupations than expected.
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Affiliation(s)
- Clare Frobisher
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Emma R Lancashire
- Department of Public Health, Epidemiology and Biostatistics, WAVES study office, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Helen Jenkinson
- Department of Oncology, Birmingham Children's Hospital, NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom
| | - David L Winter
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Julie Kelly
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Raoul C Reulen
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Michael M Hawkins
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, United Kingdom
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Bright CJ, Hawkins MM, Guha J, Henson KE, Winter DL, Kelly JS, Feltbower RG, Hall M, Cutter DJ, Edgar AB, Frobisher C, Reulen RC. Risk of Cerebrovascular Events in 178 962 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The TYACSS (Teenage and Young Adult Cancer Survivor Study). Circulation 2017; 135:1194-1210. [PMID: 28122884 PMCID: PMC7614827 DOI: 10.1161/circulationaha.116.025778] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/17/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Survivors of teenage and young adult cancer are at risk of cerebrovascular events, but the magnitude of and extent to which this risk varies by cancer type, decade of diagnosis, age at diagnosis, and attained age remains uncertain. This is the largest-ever cohort study to evaluate the risks of hospitalization for a cerebrovascular event among long-term survivors of teenage and young adult cancer. METHODS The population-based TYACSS (Teenage and Young Adult Cancer Survivor Study) (N=178,962) was linked to Hospital Episode Statistics data for England to investigate the risks of hospitalization for a cerebrovascular event among 5-year survivors of cancer diagnosed when 15 to 39 years of age. Observed numbers of first hospitalizations for cerebrovascular events were compared with that expected from the general population using standardized hospitalization ratios (SHRs) and absolute excess risks per 10 000 person-years. Cumulative incidence was calculated with death considered a competing risk. RESULTS Overall, 2782 cancer survivors were hospitalized for a cerebrovascular event-40% higher than expected (SHR=1.4, 95% confidence interval, 1.3-1.4). Survivors of central nervous system (CNS) tumors (SHR=4.6, 95% confidence interval, 4.3-5.0), head and neck tumors (SHR=2.6, 95% confidence interval, 2.2-3.1), and leukemia (SHR=2.5, 95% confidence interval, 1.9-3.1) were at greatest risk. Males had significantly higher absolute excess risks than females (absolute excess risks =7 versus 3), especially among head and neck tumor survivors (absolute excess risks =30 versus 11). By 60 years of age, 9%, 6%, and 5% of CNS tumor, head and neck tumor, and leukemia survivors, respectively, had been hospitalized for a cerebrovascular event. Beyond 60 years of age, every year, 0.4% of CNS tumor survivors were hospitalized for a cerebral infarction (versus 0.1% expected), whereas at any age, every year, 0.2% of head and neck tumor survivors were hospitalized for a cerebral infarction (versus 0.06% expected). CONCLUSIONS Survivors of a CNS tumor, head and neck tumor, and leukemia are particularly at risk of hospitalization for a cerebrovascular event. The excess risk of cerebral infarction among CNS tumor survivors increases with attained age. For head and neck tumor survivors, this excess risk remains high across all ages. These groups of survivors, particularly males, should be considered for surveillance of cerebrovascular risk factors and potential pharmacological interventions for cerebral infarction prevention.
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Affiliation(s)
- Chloe J Bright
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Mike M Hawkins
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Joyeeta Guha
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Katherine E Henson
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - David L Winter
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Julie S Kelly
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Richard G Feltbower
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Marlous Hall
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - David J Cutter
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Angela B Edgar
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Clare Frobisher
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Raoul C Reulen
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
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Fidler MM, Reulen RC, Henson K, Kelly J, Cutter D, Levitt GA, Frobisher C, Winter DL, Hawkins MM. Population-Based Long-Term Cardiac-Specific Mortality Among 34 489 Five-Year Survivors of Childhood Cancer in Great Britain. Circulation 2017; 135:951-963. [PMID: 28082386 PMCID: PMC5338891 DOI: 10.1161/circulationaha.116.024811] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/03/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increased risks of cardiac morbidity and mortality among childhood cancer survivors have been described previously. However, little is known about the very long-term risks of cardiac mortality and whether the risk has decreased among those more recently diagnosed. We investigated the risk of long-term cardiac mortality among survivors within the recently extended British Childhood Cancer Survivor Study. METHODS The British Childhood Cancer Survivor Study is a population-based cohort of 34 489 five-year survivors of childhood cancer diagnosed from 1940 to 2006 and followed up until February 28, 2014, and is the largest cohort to date to assess late cardiac mortality. Standardized mortality ratios and absolute excess risks were used to quantify cardiac mortality excess risk. Multivariable Poisson regression models were used to evaluate the simultaneous effect of risk factors. Likelihood ratio tests were used to test for heterogeneity and trends. RESULTS Overall, 181 cardiac deaths were observed, which was 3.4 times that expected. Survivors were 2.5 times and 5.9 times more at risk of ischemic heart disease and cardiomyopathy/heart failure death, respectively, than expected. Among those >60 years of age, subsequent primary neoplasms, cardiac disease, and other circulatory conditions accounted for 31%, 22%, and 15% of all excess deaths, respectively, providing clear focus for preventive interventions. The risk of both overall cardiac and cardiomyopathy/heart failure mortality was greatest among those diagnosed from 1980 to 1989. Specifically, for cardiomyopathy/heart failure deaths, survivors diagnosed from 1980 to 1989 had 28.9 times the excess number of deaths observed for survivors diagnosed either before 1970 or from 1990 on. CONCLUSIONS Excess cardiac mortality among 5-year survivors of childhood cancer remains increased beyond 50 years of age and has clear messages in terms of prevention strategies. However, the fact that the risk was greatest in those diagnosed from 1980 to 1989 suggests that initiatives to reduce cardiotoxicity among those treated more recently may be having a measurable impact.
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Affiliation(s)
- Miranda M Fidler
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK (M.M.F., R.C.R., K.H., J.K., C.F., D.L.W., M.M.H.); Nuffield Department of Population Health, University of Oxford, Oxford, UK (K.H., D.C.); Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK (D.C.); and Great Ormond Street Hospital NHS Foundation Trust, London, UK (G.A.L.)
| | - Raoul C Reulen
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK (M.M.F., R.C.R., K.H., J.K., C.F., D.L.W., M.M.H.); Nuffield Department of Population Health, University of Oxford, Oxford, UK (K.H., D.C.); Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK (D.C.); and Great Ormond Street Hospital NHS Foundation Trust, London, UK (G.A.L.)
| | - Katherine Henson
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK (M.M.F., R.C.R., K.H., J.K., C.F., D.L.W., M.M.H.); Nuffield Department of Population Health, University of Oxford, Oxford, UK (K.H., D.C.); Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK (D.C.); and Great Ormond Street Hospital NHS Foundation Trust, London, UK (G.A.L.)
| | - Julie Kelly
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK (M.M.F., R.C.R., K.H., J.K., C.F., D.L.W., M.M.H.); Nuffield Department of Population Health, University of Oxford, Oxford, UK (K.H., D.C.); Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK (D.C.); and Great Ormond Street Hospital NHS Foundation Trust, London, UK (G.A.L.)
| | - David Cutter
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK (M.M.F., R.C.R., K.H., J.K., C.F., D.L.W., M.M.H.); Nuffield Department of Population Health, University of Oxford, Oxford, UK (K.H., D.C.); Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK (D.C.); and Great Ormond Street Hospital NHS Foundation Trust, London, UK (G.A.L.)
| | - Gill A Levitt
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK (M.M.F., R.C.R., K.H., J.K., C.F., D.L.W., M.M.H.); Nuffield Department of Population Health, University of Oxford, Oxford, UK (K.H., D.C.); Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK (D.C.); and Great Ormond Street Hospital NHS Foundation Trust, London, UK (G.A.L.)
| | - Clare Frobisher
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK (M.M.F., R.C.R., K.H., J.K., C.F., D.L.W., M.M.H.); Nuffield Department of Population Health, University of Oxford, Oxford, UK (K.H., D.C.); Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK (D.C.); and Great Ormond Street Hospital NHS Foundation Trust, London, UK (G.A.L.)
| | - David L Winter
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK (M.M.F., R.C.R., K.H., J.K., C.F., D.L.W., M.M.H.); Nuffield Department of Population Health, University of Oxford, Oxford, UK (K.H., D.C.); Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK (D.C.); and Great Ormond Street Hospital NHS Foundation Trust, London, UK (G.A.L.)
| | - Michael M Hawkins
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK (M.M.F., R.C.R., K.H., J.K., C.F., D.L.W., M.M.H.); Nuffield Department of Population Health, University of Oxford, Oxford, UK (K.H., D.C.); Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK (D.C.); and Great Ormond Street Hospital NHS Foundation Trust, London, UK (G.A.L.).
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Henson KE, Reulen RC, Winter DL, Bright CJ, Fidler MM, Frobisher C, Guha J, Wong KF, Kelly J, Edgar AB, McCabe MG, Whelan J, Cutter DJ, Darby SC, Hawkins MM. Cardiac Mortality Among 200 000 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The Teenage and Young Adult Cancer Survivor Study. Circulation 2016; 134:1519-1531. [PMID: 27821538 PMCID: PMC5106083 DOI: 10.1161/circulationaha.116.022514] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/21/2016] [Indexed: 11/28/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Survivors of teenage and young adult cancer are acknowledged as understudied. Little is known about their long-term adverse health risks, particularly of cardiac disease that is increased in other cancer populations where cardiotoxic treatments have been used. Methods: The Teenage and Young Adult Cancer Survivor Study cohort comprises 200 945 5-year survivors of cancer diagnosed at 15 to 39 years of age in England and Wales from 1971 to 2006, and followed to 2014. Standardized mortality ratios, absolute excess risks, and cumulative risks were calculated. Results: Two thousand sixteen survivors died of cardiac disease. For all cancers combined, the standardized mortality ratios for all cardiac diseases combined was greatest for individuals diagnosed at 15 to 19 years of age (4.2; 95% confidence interval, 3.4–5.2) decreasing to 1.2 (95% confidence interval, 1.1–1.3) for individuals aged 35 to 39 years (2P for trend <0.0001). Similar patterns were observed for both standardized mortality ratios and absolute excess risks for ischemic heart disease, valvular heart disease, and cardiomyopathy. Survivors of Hodgkin lymphoma, acute myeloid leukaemia, genitourinary cancers other than bladder cancer, non-Hodgkin lymphoma, lung cancer, leukaemia other than acute myeloid, central nervous system tumour, cervical cancer, and breast cancer experienced 3.8, 2.7, 2.0, 1.7, 1.7, 1.6, 1.4, 1.3 and 1.2 times the number of cardiac deaths expected from the general population, respectively. Among survivors of Hodgkin lymphoma aged over 60 years, almost 30% of the total excess number of deaths observed were due to heart disease. Conclusions: This study of over 200 000 cancer survivors shows that age at cancer diagnosis was critical in determining subsequent cardiac mortality risk. For the first time, risk estimates of cardiac death after each cancer diagnosed between the ages of 15 and 39 years have been derived from a large population-based cohort with prolonged follow-up. The evidence here provides an initial basis for developing evidence-based follow-up guidelines.
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Affiliation(s)
- Katherine E Henson
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Raoul C Reulen
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - David L Winter
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Chloe J Bright
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Miranda M Fidler
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Clare Frobisher
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Joyeeta Guha
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Kwok F Wong
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Julie Kelly
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Angela B Edgar
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Martin G McCabe
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Jeremy Whelan
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - David J Cutter
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Sarah C Darby
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Mike M Hawkins
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D).
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Feijen EAM, Font-Gonzalez A, van Dalen EC, van der Pal HJH, Reulen RC, Winter DL, Kuehni CE, Haupt R, Alessi D, Byrne J, Bardi E, Jakab Z, Grabow D, Garwicz S, Jankovic M, Levitt GA, Skinner R, Zadravec Zaletel L, Hjorth L, Tissing WJE, de Vathaire F, Hawkins MM, Kremer LCM. Late Cardiac Events after Childhood Cancer: Methodological Aspects of the Pan-European Study PanCareSurFup. PLoS One 2016; 11:e0162778. [PMID: 27643694 PMCID: PMC5028033 DOI: 10.1371/journal.pone.0162778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/29/2016] [Indexed: 01/24/2023] Open
Abstract
Background and Aim Childhood cancer survivors are at high risk of long-term adverse effects of cancer and its treatment, including cardiac events. The pan-European PanCareSurFup study determined the incidence and risk factors for cardiac events among childhood cancer survivors. The aim of this article is to describe the methodology of the cardiac cohort and nested case-control study within PanCareSurFup. Methods Eight data providers in Europe participating in PanCareSurFup identified and validated symptomatic cardiac events in their cohorts of childhood cancer survivors. Data on symptomatic heart failure, ischemia, pericarditis, valvular disease and arrhythmia were collected and graded according to the Criteria for Adverse Events. Detailed treatment data, data on potential confounders, lifestyle related risk factors and general health problems were collected. Results The PanCareSurFup cardiac cohort consisted of 59,915 5-year childhood cancer survivors with malignancies diagnosed between 1940 and 2009 and classified according to the International Classification of Childhood Cancer 3. Different strategies were used to identify cardiac events such as record linkage to population/ hospital or regional based databases, and patient- and general practitioner-based questionnaires. Conclusion The cardiac study of the European collaborative research project PanCareSurFup will provide the largest cohort of 5-year childhood cancer survivors with systematically ascertained and validated data on symptomatic cardiac events. The result of this study can provide information to minimize the burden of cardiac events in childhood cancer survivors by tailoring the follow-up of childhood cancer survivors at high risk of cardiac adverse events, transferring this knowledge into evidence-based clinical practice guidelines and providing a platform for future research studies in childhood cancer patients.
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Affiliation(s)
- Elizabeth A. M. Feijen
- Department of Pediatric Oncology, Emma Children’s Hospital/ Academic Medical Center Amsterdam, meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- * E-mail:
| | - Anna Font-Gonzalez
- Department of Pediatric Oncology, Emma Children’s Hospital/ Academic Medical Center Amsterdam, meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Elvira C. van Dalen
- Department of Pediatric Oncology, Emma Children’s Hospital/ Academic Medical Center Amsterdam, meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Helena J. H. van der Pal
- Department of Pediatric Oncology, Emma Children’s Hospital/ Academic Medical Center Amsterdam, meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Department of Medical Oncology, Academic Medical Center Amsterdam, meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Raoul C. Reulen
- Department of Medical Oncology, Academic Medical Center Amsterdam, meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - David L. Winter
- Department of Medical Oncology, Academic Medical Center Amsterdam, meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Claudia E. Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Section, Gaslini Children Hospital, Via Gerolamo Gaslini, 5, 16148, Genova, Italy
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Citta' della Salute e della Scienza Hospital-University of Turin and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Torino, Italy
| | - Julianne Byrne
- Boyne Research Institute, Tiernan House, Fair Green, Drogheda, Ireland
| | - Edit Bardi
- 2nd Department of Pediatrics, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
| | - Zsuzsanna Jakab
- Department of Pediatric Oncology, Markusovszky Hospital, Markusovszky Lajos u. 5, 9700, Szombathely, Hungary
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Stanislaw Garwicz
- Department of Pediatrics, Skåne University Lund, Getingevägen 4, 222 41, Lund, Sweden
| | - Momcilo Jankovic
- Pediatric Hematology Unit, San Gerardo Hospital, Via Primo Maggio, 22, 38089, Monza, Italy
| | - Gill A. Levitt
- Department of Paediatric and Adolescent Haematology and Oncology, and Children's BMT Unit, Great North Children's Hospital, Newcastle, United Kingdom
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology and Oncology, and Children's BMT Unit, Great North Children's Hospital, and Northern Institute of Cancer Research, Newcastle University, Newcastle, United Kingdom
| | - Lorna Zadravec Zaletel
- Division of Radiotherapy, Institute of Oncology, Zaloška cesta 2 SI– 1000, Ljubljana, Slovenia
| | - Lars Hjorth
- Department of Pediatrics, Skåne University Lund, Getingevägen 4, 222 41, Lund, Sweden
| | - Wim J. E. Tissing
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Florent de Vathaire
- Radiation Epidemiology Group, Gustave Roussy, Inserm, UMR1018, Villejuif, France
| | - Mike M. Hawkins
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Leontien C. M. Kremer
- Department of Pediatric Oncology, Emma Children’s Hospital/ Academic Medical Center Amsterdam, meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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Fidler MM, Reulen RC, Winter DL, Kelly J, Jenkinson HC, Skinner R, Frobisher C, Hawkins MM. Long term cause specific mortality among 34 489 five year survivors of childhood cancer in Great Britain: population based cohort study. BMJ 2016; 354:i4351. [PMID: 27586237 PMCID: PMC5008696 DOI: 10.1136/bmj.i4351] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To determine whether modern treatments for cancer are associated with a net increased or decreased risk of death from neoplastic and non-neoplastic causes among survivors of childhood cancer. DESIGN Population based cohort study. SETTING British Childhood Cancer Survivor Study. PARTICIPANTS Nationwide population based cohort of 34 489 five year survivors of childhood cancer with a diagnosis from 1940 to 2006 and followed up until 28 February 2014. MAIN OUTCOME MEASURES Cause specific standardised mortality ratios and absolute excess risks are reported. Multivariable Poisson regression models were utilised to evaluate the simultaneous effect of risk factors. Likelihood ratio tests were used to test for heterogeneity or trend. RESULTS Overall, 4475 deaths were observed, which was 9.1 (95% confidence interval 8.9 to 9.4) times that expected in the general population, corresponding to 64.2 (95% confidence interval 62.1 to 66.3) excess deaths per 10 000 person years. The number of excess deaths from all causes declined among those treated more recently; those treated during 1990-2006 experienced 30% of the excess number of deaths experienced by those treated before 1970. The corresponding percentages for the decline in excess deaths from recurrence or progression and non-neoplastic causes were 30% and 60%, respectively. Among survivors aged 50-59 years, 41% and 22% of excess deaths were attributable to subsequent primary neoplasms and circulatory conditions, respectively, whereas the corresponding percentages among those aged 60 years or more were 31% and 37%. CONCLUSIONS The net effects of changes in cancer treatments, and surveillance and management for late effects, over the period 1940 to 2006 was to reduce the excess number of deaths from both recurrence or progression and non-neoplastic causes among those treated more recently. Among survivors aged 60 years or more, the excess number of deaths from circulatory causes exceeds the excess number of deaths from subsequent primary neoplasms. The important message for the evidence based surveillance aimed at preventing excess mortality and morbidity in survivors aged 60 years or more is that circulatory disease overtakes subsequent primary neoplasms as the leading cause of excess mortality.
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Affiliation(s)
- Miranda M Fidler
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Julie Kelly
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Helen C Jenkinson
- Department of Oncology, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | - Rod Skinner
- Department of Paediatric and Adolescent Haematology and Oncology, and Children's BMT Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
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Wong KF, Reulen RC, Winter DL, Guha J, Fidler MM, Kelly J, Lancashire ER, Pritchard-Jones K, Jenkinson HC, Sugden E, Levitt G, Frobisher C, Hawkins MM. Risk of Adverse Health and Social Outcomes Up to 50 Years After Wilms Tumor: The British Childhood Cancer Survivor Study. J Clin Oncol 2016; 34:1772-9. [DOI: 10.1200/jco.2015.64.4344] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Survivors of Wilms tumor (WT) are at risk for adverse health and social outcomes but risks beyond 30 years from diagnosis remain uncertain. We investigated the risks of adverse outcomes among 5-year survivors of WT, in particular, those between 30 and 50 years from diagnosis. Patients and Methods The British Childhood Cancer Survivor Study includes 1,441 5-year survivors of WT. We investigated cause-specific mortality, risk of subsequent primary neoplasms (SPNs), and, for those who completed a questionnaire, the extent of smoking and drinking, educational achievement, health status, and health service use compared with the general population. Results Cumulative risk of death from all causes, excluding recurrence, increased substantially from 5.4% to 22.7% at 30 years and 50 years, respectively, after WT diagnosis—75% of excess deaths beyond 30 years from diagnosis were attributable to SPNs (50%) and cardiac diseases (25%). Digestive cancer, most frequently bowel, accounted for 41% of excess cancers beyond 30 years. Conclusion Between 30 and 50 years from diagnosis, survivors of WT are at a substantially increased risk of premature mortality, and 75% of excess deaths were accounted for by SPNs and cardiac diseases. Radiotherapy exposure was a risk factor for both outcomes. The proportion of patients with WT who are exposed to radiotherapy has reduced substantially in recent decades because of initiatives such as the SIOP WT 2001 clinical trial, which sought to reduce late effects; however, the majority of current survivors, who are at least 30 years from diagnosis, received radiotherapy. Surveillance of this group should focus on SPNs, in particular, bowel and breast cancers, and cardiac conditions.
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Affiliation(s)
- Kwok F. Wong
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Raoul C. Reulen
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - David L. Winter
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Joyeeta Guha
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Miranda M. Fidler
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Julie Kelly
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Emma R. Lancashire
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Kathryn Pritchard-Jones
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Helen C. Jenkinson
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Elaine Sugden
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Gill Levitt
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Clare Frobisher
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Michael M. Hawkins
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
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Fidler MM, Ziff OJ, Wang S, Cave J, Janardhanan P, Winter DL, Kelly J, Mehta S, Jenkinson H, Frobisher C, Reulen RC, Hawkins MM. Aspects of mental health dysfunction among survivors of childhood cancer. Br J Cancer 2016; 113:1121-32. [PMID: 26418531 PMCID: PMC4651126 DOI: 10.1038/bjc.2015.310] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/28/2015] [Accepted: 08/09/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Some previous studies have reported that survivors of childhood cancer are at an increased risk of developing long-term mental health morbidity, whilst others have reported that this is not the case. Therefore, we analysed 5-year survivors of childhood cancer using the British Childhood Cancer Survivor Study (BCCSS) to determine the risks of aspects of long-term mental health dysfunction. PROCEDURE Within the BCCSS, 10 488 survivors completed a questionnaire that ascertained mental health-related information via 10 questions from the Short Form-36 survey. Internal analyses were conducted using multivariable logistic regression to determine risk factors for mental health dysfunction. External analyses were undertaken using direct standardisation to compare mental health dysfunction in survivors with UK norms. RESULTS This study has shown that overall, childhood cancer survivors had a significantly higher prevalence of mental health dysfunction for 6/10 questions analysed compared to UK norms. Central nervous system (CNS) and bone sarcoma survivors reported the greatest dysfunction, compared to expected, with significant excess dysfunction in 10 and 6 questions, respectively; the excess ranged from 4.4-22.3% in CNS survivors and 6.9-15.9% in bone sarcoma survivors. Compared to expected, excess mental health dysfunction increased with attained age; this increase was greatest for reporting 'limitations in social activities due to health', where the excess rose from 4.5% to 12.8% in those aged 16-24 and 45+, respectively. Within the internal analyses, higher levels of educational attainment and socio-economic classification were protective against mental health dysfunction. CONCLUSIONS Based upon the findings of this large population-based study, childhood cancer survivors report significantly higher levels of mental health dysfunction than those in the general population, where deficits were observed particularly among CNS and bone sarcoma survivors. Limitations were also observed to increase with age, and thus it is important to emphasise the need for mental health evaluation and services across the entire lifespan. There is evidence that low educational attainment and being unemployed or having never worked adversely impacts long-term mental health. These findings provide an evidence base for risk stratification and planning interventions.
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Affiliation(s)
- Miranda M Fidler
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Oliver J Ziff
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Sarra Wang
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Joshua Cave
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Pradeep Janardhanan
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - David L Winter
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Julie Kelly
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Susan Mehta
- Department of Oncology, University College London Hospital, 1st Floor Central, 250 Euston Road, London NW1 2PG, UK
| | - Helen Jenkinson
- Department of Oncology, Birmingham Children's Hospital, NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Clare Frobisher
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Raoul C Reulen
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Michael M Hawkins
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
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Rebholz CE, Reulen RC, Toogood AA, Frobisher C, Lancashire ER, Winter DL, Kuehni CE, Hawkins MM. Health care use of long-term survivors of childhood cancer: the British Childhood Cancer Survivor Study. J Clin Oncol 2011; 29:4181-8. [PMID: 21947833 DOI: 10.1200/jco.2011.36.5619] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Survivors of childhood cancer are at high risk of chronic conditions, but few studies investigated whether this translates into increased health care utilization. We compared health care service utilization between childhood cancer survivors and the general British population and investigated potential risk factors. METHODS We used data from the British Childhood Cancer Survivor Study, a population-based cohort of 17,981 individuals diagnosed with childhood cancer (1940-1991) and surviving ≥ 5 years. Frequency of talks to a doctor, hospital outpatient visits, and day-patient and inpatient hospitalizations were ascertained by questionnaire in 10,483 survivors and were compared with the General Household Survey 2002 data by using logistic regression. RESULTS Among survivors, 16.5% had talked to a doctor in the last 2 weeks, 25.5% had attended the outpatient department of a hospital in the last 3 months, 11.9% had been hospitalized as a day patient in the last 12 months, and 9.8% had been hospitalized as an inpatient in the last 12 months. Survivors had talked slightly more often to a doctor than the general population (odds ratio [OR], 1.2; 95% CI, 1.1 to 1.3) and experienced increased hospital outpatient visits (OR, 2.5; 95% CI, 2.3 to 2.8), day-patient hospitalizations (OR, 1.4; 95% CI, 1.3 to 1.6) and inpatient hospitalizations (OR, 1.9; 95% CI, 1.7 to 2.2). Survivors of Hodgkin's lymphoma, neuroblastoma, and Wilms tumor had the highest ORs for day-patient care, whereas survivors of CNS tumors and bone sarcomas had the highest OR for outpatient and inpatient care. The OR of health care use did not vary significantly with age of survivor. CONCLUSION We have quantified how excess morbidity experienced by survivors of childhood cancer translates into increased use of health care facilities.
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Affiliation(s)
- Cornelia E Rebholz
- Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT United Kingdom
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Brabant G, Toogood AA, Shalet SM, Frobisher C, Lancashire ER, Reulen RC, Winter DL, Hawkins MM. Hypothyroidism following childhood cancer therapy-an under diagnosed complication. Int J Cancer 2011; 130:1145-50. [DOI: 10.1002/ijc.26086] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 02/18/2011] [Indexed: 11/07/2022]
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Reulen RC, Frobisher C, Winter DL, Kelly J, Lancashire ER, Stiller CA, Pritchard-Jones K, Jenkinson HC, Hawkins MM. Long-term risks of subsequent primary neoplasms among survivors of childhood cancer. JAMA 2011; 305:2311-9. [PMID: 21642683 DOI: 10.1001/jama.2011.747] [Citation(s) in RCA: 239] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Survivors of childhood cancer are at excess risk of developing subsequent primary neoplasms but the long-term risks are uncertain. OBJECTIVES To investigate long-term risks of subsequent primary neoplasms in survivors of childhood cancer, to identify the types that contribute most to long-term excess risk, and to identify subgroups of survivors at substantially increased risk of particular subsequent primary neoplasms that may require specific interventions. DESIGN, SETTING, AND PARTICIPANTS British Childhood Cancer Survivor Study--a population-based cohort of 17,981 5-year survivors of childhood cancer diagnosed with cancer at younger than 15 years between 1940 and 1991 in Great Britain, followed up through December 2006. MAIN OUTCOME MEASURES Standardized incidence ratios (SIRs), absolute excess risks (AERs), and cumulative incidence of subsequent primary neoplasms. RESULTS After a median follow-up time of 24.3 years (mean = 25.6 years), 1354 subsequent primary neoplasms were ascertained; the most frequently observed being central nervous system (n = 344), nonmelanoma skin cancer (n = 278), digestive (n = 105), genitourinary (n = 100), breast (n = 97), and bone (n = 94). The overall SIR was 4 times more than expected (SIR, 3.9; 95% confidence interval [CI], 3.6-4.2; AER, 16.8 per 10,000 person-years). The AER at older than 40 years was highest for digestive and genitourinary subsequent primary neoplasms (AER, 5.9 [95% CI, 2.5-9.3]; and AER, 6.0 [95%CI, 2.3-9.6] per 10,000 person-years, respectively); 36% of the total AER was attributable to these 2 subsequent primary neoplasm sites. The cumulative incidence of colorectal cancer for survivors treated with direct abdominopelvic irradiation was 1.4% (95% CI, 0.7%-2.6%) by age 50 years, comparable with the 1.2% risk in individuals with at least 2 first-degree relatives affected by colorectal cancer. CONCLUSION Among a cohort of British childhood cancer survivors, the greatest excess risk associated with subsequent primary neoplasms at older than 40 years was for digestive and genitourinary neoplasms.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
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Taylor AJ, Little MP, Winter DL, Sugden E, Ellison DW, Stiller CA, Stovall M, Frobisher C, Lancashire ER, Reulen RC, Hawkins MM. Population-based risks of CNS tumors in survivors of childhood cancer: the British Childhood Cancer Survivor Study. J Clin Oncol 2010; 28:5287-93. [PMID: 21079138 DOI: 10.1200/jco.2009.27.0090] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE CNS tumors are the most common second primary neoplasm (SPN) observed after childhood cancer in Britain, but the relationship of risk to doses of previous radiotherapy and chemotherapy is uncertain. METHODS The British Childhood Cancer Survivor Study is a national, population-based, cohort study of 17,980 individuals surviving at least 5 years after diagnosis of childhood cancer. Linkage to national, population-based cancer registries identified 247 SPNs of the CNS. Cohort and nested case-control studies were undertaken. RESULTS There were 137 meningiomas, 73 gliomas, and 37 other CNS neoplasms included in the analysis. The risk of meningioma increased strongly, linearly, and independently with each of dose of radiation to meningeal tissue and dose of intrathecal methotrexate. Those whose meningeal tissue received 0.01 to 9.99, 10.00 to 19.99, 20.00 to 29.99, 30.00 to 39.99 and≥40 Gy had risks that were two-fold, eight-fold, 52-fold, 568-fold, and 479-fold, respectively, the risks experienced by those whose meningeal tissue was unexposed. The risk of meningioma among individuals receiving 1 to 39,40 to 69, and at least 70 mg/m2 of intrathecal methotrexate was 15-fold, 11-fold, and 36-fold, respectively, the risk experienced by those unexposed. The standardized incidence ratio for gliomas was 10.8 (95% CI, 8.5 to 13.6). The risk of glioma/primitive neuroectodermal tumors increased linearly with dose of radiation, and those who had CNS tissue exposed to at least 40 Gy experienced a risk four-fold that experienced by those who had CNS tissue unexposed. CONCLUSION The largest-ever study, to our knowledge, of CNS tumors in survivors of childhood cancer indicates that the risk of meningioma increases rapidly with increased dose of radiation to meningeal tissue and with increased dose of intrathecal methotrexate.
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Affiliation(s)
- Aliki J Taylor
- Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, University of Birmingham, Public Health Building, Edgbaston, Birmingham, B15 2TT, United Kingdom
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Frobisher C, Gurung PM, Leiper A, Reulen RC, Winter DL, Taylor AJ, Lancashire ER, Woodhouse CR, Hawkins MM. Risk of bladder tumours after childhood cancer: The British Childhood Cancer Survivor Study. BJU Int 2010; 106:1060-9. [DOI: 10.1111/j.1464-410x.2010.09224.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reulen RC, Winter DL, Frobisher C, Lancashire ER, Stiller CA, Jenney ME, Skinner R, Stevens MC, Hawkins MM. Long-term cause-specific mortality among survivors of childhood cancer. JAMA 2010; 304:172-9. [PMID: 20628130 DOI: 10.1001/jama.2010.923] [Citation(s) in RCA: 314] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Survivors of childhood cancer are at increased risk of premature mortality compared with the general population, but little is known about the long-term risks of specific causes of death, particularly beyond 25 years from diagnosis at ages when background mortality in the general population starts to increase substantially. OBJECTIVE To investigate long-term cause-specific mortality among 5-year survivors of childhood cancer in a large-scale population-based cohort. DESIGN, SETTING, AND PATIENTS British Childhood Cancer Survivor Study, a population-based cohort of 17,981 5-year survivors of childhood cancer diagnosed with cancer before age 15 years between 1940 and 1991 in Britain and followed up until the end of 2006. MAIN OUTCOME MEASURES Cause-specific standardized mortality ratios (SMRs) and absolute excess risks (AERs). RESULTS Overall, 3049 deaths were observed, which was 11 times the number expected (SMR, 10.7; 95% confidence interval [CI], 10.3-11.1). The SMR declined with follow-up but was still 3-fold higher than expected (95% CI, 2.5-3.9) 45 years from diagnosis. The AER for deaths from recurrence declined from 97 extra deaths (95% CI, 92-101) per 10,000 person-years at 5 to 14 years from diagnosis, to 8 extra deaths (95% CI, 3-22) beyond 45 years from diagnosis. In contrast, during the same periods of follow-up, the AER for deaths from second primary cancers and circulatory causes increased from 8 extra deaths (95% CI, 7-10) and 2 extra deaths (95% CI, 2-3) to 58 extra deaths (95% CI, 38-90) and 29 extra deaths (95% CI, 16-56), respectively. Beyond 45 years from diagnosis, recurrence accounted for 7% of the excess number of deaths observed while second primary cancers and circulatory deaths together accounted for 77%. CONCLUSION Among a cohort of British survivors of childhood cancer, excess mortality from second primary cancers and circulatory diseases continued to occur beyond 25 years from diagnosis.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, England.
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Frobisher C, Lancashire ER, Reulen RC, Winter DL, Stevens MC, Hawkins MM. Extent of Alcohol Consumption among Adult Survivors of Childhood Cancer: The British Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2010; 19:1174-84. [DOI: 10.1158/1055-9965.epi-10-0006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lancashire ER, Frobisher C, Reulen RC, Winter DL, Glaser A, Hawkins MM. Educational attainment among adult survivors of childhood cancer in Great Britain: a population-based cohort study. J Natl Cancer Inst 2010; 102:254-70. [PMID: 20107164 DOI: 10.1093/jnci/djp498] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies of educational attainment among childhood cancer survivors were small, had contradictory findings, and were not population based. This study investigated educational attainment in a large population-based cohort of survivors of all types of childhood cancer in Great Britain. METHODS Four levels of educational attainment among 10,183 cancer survivors--degree, teaching qualification, advanced (A') levels, and ordinary (O') levels--were compared with expected levels in the general population. A questionnaire was used to obtain educational attainment data for survivors, and comparable information for the general population was available from the General Household Survey. Factors associated with level of educational attainment achieved by cancer survivors were identified using multivariable logistic regression together with likelihood ratio tests. Logistic regression adjusting for age and sex was used for comparisons with the general population. All statistical tests were two-sided. RESULTS Childhood cancer survivors had lower educational attainment than the general population (degree: odds ratio [OR] = 0.77, 99% confidence interval [CI] = 0.68 to 0.87; teaching qualification: OR = 0.85, 99% CI = 0.77 to 0.94; A'level: OR = 0.85, 99% CI = 0.78 to 0.93; O'level: OR = 0.81, 99% CI = 0.74 to 0.90; P < .001, all levels). Statistically significant deficits were restricted to central nervous system (CNS) neoplasm and leukemia survivors. For leukemia, only those treated with radiotherapy were considered. Odds ratios for achievement by irradiated CNS tumor survivors were 50%-74% of those for cranially irradiated leukemia or nonirradiated CNS tumor survivors. Survivors at greater risk of poorer educational outcomes included those treated with cranial irradiation, diagnosed with a CNS tumor, older at questionnaire completion, younger at diagnosis, diagnosed with epilepsy, and who were female. CONCLUSIONS Specific groups of childhood cancer survivors achieve lower-than-expected educational attainment. Detailed educational support and implementation of regular cognitive assessment may be indicated for some groups to maximize long-term function.
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Affiliation(s)
- E R Lancashire
- Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Bldg, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Frobisher C, Lancashire ER, Winter DL, Taylor AJ, Reulen RC, Hawkins MM. Long-term population-based divorce rates among adult survivors of childhood cancer in Britain. Pediatr Blood Cancer 2010; 54:116-22. [PMID: 19774635 DOI: 10.1002/pbc.22290] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previously from the British Childhood Cancer Survivor Study (BCCSS) it was seen that adult survivors of childhood cancer were less likely to marry than the general population. The objectives of this study were to assess the number of childhood cancer survivors from the BCCSS who were currently divorced or separated, examine factors associated with marriage dissolution and compare survivor divorce rates to population rates. PROCEDURE The BCCSS is a population-based cohort of 18,119 individuals diagnosed with cancer aged 0-14 years between 1940 and 1991, and survived at least 5 years. 14,539 were alive, aged 16 years or over and eligible to receive a questionnaire, which ascertained marital status. RESULTS From 8,155 survivors, who were aged at least 20 years at questionnaire completion, the proportions currently divorced and divorced or separated were 13.5% and 18.1%, respectively. Only current age, educational attainment and age at marriage were associated with divorce, and for divorce and separation status only age at marriage (P < 0.05). Overall the survivors were no different to the general population for being currently divorced (odds ratio (OR) (95% confidence intervals (95% CI)): 0.94 (0.81-1.10)). However, the survivors overall (OR (95% CI): 0.82 (0.72-0.94)), and separately for those diagnosed with non-Hodgkin lymphoma (OR (95% CI): 0.55 (0.34-0.89)) and leukaemia (OR (95% CI): 0.70 (0.52-0.95)), were less likely to be currently divorced or separated than the general population. CONCLUSIONS It is reassuring that survivors do not experience more divorce than the general population, and that no cancer or treatment factors were shown to be associated with marriage dissolution.
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Affiliation(s)
- Clare Frobisher
- Centre for Childhood Cancer Survivor Studies (CCCSS), School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham, UK.
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Taylor AJ, Frobisher C, Ellison DW, Reulen RC, Winter DL, Taylor RE, Stiller CA, Lancashire ER, Tudor EC, Baggott C, May S, Hawkins MM. Survival After Second Primary Neoplasms of the Brain or Spinal Cord in Survivors of Childhood Cancer: Results From the British Childhood Cancer Survivor Study. J Clin Oncol 2009; 27:5781-7. [DOI: 10.1200/jco.2009.22.4386] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose Survival after brain or spinal cord neoplasms is poor and varies by diagnostic group, age, grade, treatment and pretreatment factors, and location and size of tumor. We carried out a study to investigate survival and factors affecting survival of all diagnostic types of second primary brain or spinal cord neoplasms. Patients and Methods The British Childhood Cancer Survivor Study (BCCSS) is a long-term population-based follow-up study of 17,980 5-year survivors of childhood cancer. We used relative survival and multivariate Cox regression analysis to determine 5-year relative survival and factors affecting survival in second primary meningiomas and gliomas that developed in survivors included in the BCCSS. Results There were 247 second primary brain or spinal cord neoplasms, including 137 meningiomas and 73 gliomas in a young adult population. Five-year relative survival after meningiomas was similar for males (84.0%; 95% CI, 72.6% to 91.1%) and females (81.7%; 95% CI, 69.9% to 89.3%). For gliomas, 5-year relative survival was 19.5% (95% CI, 8.6% to 33.7%) for males and females. Multivariate analysis showed significant heterogeneity by decade of treatment (P = .04), grade (P = .03), and genetic risk (P = .03) for rate of mortality after a meningioma. For gliomas, survival was significantly affected by grade (P < .001). Conclusion Our results indicate survival is poor after second primary glioma in this young adult population, although survival after second primary meningioma is good. Our study has clinical implications for the surveillance of childhood cancer survivors at risk of developing second primary brain tumors, in particular survivors of childhood acute lymphoblastic leukemia or childhood brain tumors.
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Affiliation(s)
- Aliki J. Taylor
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Clare Frobisher
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - David W. Ellison
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Raoul C. Reulen
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - David L. Winter
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Roger E. Taylor
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Charles A. Stiller
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Emma R. Lancashire
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Edward C.G. Tudor
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Christina Baggott
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Shaun May
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Mike M. Hawkins
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
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Taylor AJ, Croft AP, Palace AM, Winter DL, Reulen RC, Stiller CA, Stevens MCG, Hawkins MM. Risk of thyroid cancer in survivors of childhood cancer: results from the British Childhood Cancer Survivor Study. Int J Cancer 2009; 125:2400-5. [PMID: 19610069 DOI: 10.1002/ijc.24581] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Second primary neoplasms (SPNs) are a recognised late effect of treatment for childhood cancer. Thyroid SPNs can develop after exposure to low-dose radiation, due to the radio-sensitivity of the thyroid gland. The British Childhood Cancer Survivor Study (BCCSS) was set up to directly monitor the late effects of treatment, including risk of SPNs, in childhood cancer survivors and includes 17,980 5-year survivors. We carried out a cohort analysis to determine the risk of thyroid SPNs in the BCCSS, and estimated risk using standardised incidence ratios (SIRs), relative risk (RR) using multivariate Poisson regression and cumulative incidence curves. There were 340,202 person years at risk subsequent to a 5-year survival, median follow-up 17.4 years per survivor. We identified 50 thyroid SPNs including 31 (62%) papillary carcinomas, 15 (30%) follicular carcinomas and 4 (8%) other types. 88% of thyroid SPNs developed after exposure to radiotherapy in or around the thyroid gland. SIR overall was 18.0 (95% confidence interval 13.4-23.8). Risk of thyroid cancer was highest after Hodgkin's disease: RR 3.3 (1.1-10.1) and Non Hodgkin's Lymphoma: RR 3.4 (1.1-10.7) relative to leukaemia (RR 1.0) (p < 0.001). Survivors treated with radiotherapy in childhood had a RR of 4.6 (1.4-15.1) relative to survivors not treated with radiotherapy (RR 1.0), p = 0003. In conclusion, the risk of thyroid cancer in childhood cancer survivors is relatively high in this cohort of childhood cancer survivors. These results will be of use in counselling survivors of childhood cancer exposed to radiation in or around the thyroid area.
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Affiliation(s)
- Aliki J Taylor
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Reulen RC, Taylor AJ, Winter DL, Stiller CA, Frobisher C, Lancashire ER, McClanahan FM, Sugden EM, Hawkins MM. Long-term population-based risks of breast cancer after childhood cancer. Int J Cancer 2008; 123:2156-63. [DOI: 10.1002/ijc.23743] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hawkins MM, Lancashire ER, Winter DL, Frobisher C, Reulen RC, Taylor AJ, Stevens MCG, Jenney M. The British Childhood Cancer Survivor Study: Objectives, methods, population structure, response rates and initial descriptive information. Pediatr Blood Cancer 2008; 50:1018-25. [PMID: 17849473 DOI: 10.1002/pbc.21335] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In Britain 75% of individuals diagnosed with childhood cancer survive at least 5 years. The British Childhood Cancer Survivor Study was established to determine the risks of adverse health and social outcomes among survivors. To be eligible individuals were diagnosed with childhood cancer in Britain between 1940 and 1991 and survived at least 5 years. The entire cohort of 17,981 form the basis of population-based studies of late mortality and the risks/causes of second malignant neoplasms using national registration systems. METHODS A postal questionnaire was sent to survivors who were alive and aged at least 16 years via their primary care physician. RESULTS Of the 14,836 survivors eligible to receive a questionnaire, 10,483 (71%) returned it completed. Of the 13,211 who were mailed a questionnaire by their primary care physician 10,483 (79%) returned it completed. Outline treatment information concerning initial radiotherapy, chemotherapy and surgery is available. CONCLUSIONS This is the largest available population-based cohort of childhood cancer survivors to have included investigation of a wide spectrum of adverse outcomes (the risk of which might be increased as a result of childhood cancer or its treatment). The study should provide useful information for counselling survivors, planning long-term clinical follow-up and evaluating the long-term risks likely to be associated with proposed treatment strategies.
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Affiliation(s)
- M M Hawkins
- Centre for Childhood Cancer Survivor Studies, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham, UK.
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Taylor AJ, Winter DL, Pritchard-Jones K, Stiller CA, Frobisher C, Lancashire ER, Reulen RC, Hawkins MM. Second primary neoplasms in survivors of Wilms' tumour--a population-based cohort study from the British Childhood Cancer Survivor Study. Int J Cancer 2008; 122:2085-93. [PMID: 18196579 DOI: 10.1002/ijc.23333] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A British population-based cohort study was carried out to determine the risk of second primary neoplasms in survivors of Wilms' tumour. The cohort was obtained from the British Childhood Cancer Survivor Study, a population-based cohort study of treatment toxicities in 18,044 individuals diagnosed with childhood cancer, at an age of less than 15 years, between 1940 and 1991 in Britain. There were 1,441 Wilms' tumour survivors in the cohort: 732 males (50.8%) and 709 females (49.2%). Total follow-up from 5-year survival was 27,841 person years, mean follow-up of 19.3 years per survivor. There were 81 second primary neoplasms, including 52 solid neoplasms, 3 acute myeloid leukaemias and 26 basal cell carcinomas. Thirty-five of the 39 solid neoplasms that developed in the thoracic, abdominal or pelvic region occurred within irradiated tissue. The standardised incidence ratio for all solid second primary neoplasms was 6.7 (95% CI: 5.0-8.8). Cumulative incidence for all solid second primary neoplasms by ages 30, 40 and 50 years was 2.3% (1.4-3.5%), 6.8% (4.6-9.5%) and 12.2% (7.3-18.4%). The overall risk of second primary neoplasms in survivors of Wilms' tumour treated between 1940 and 1991 was substantial, and solid second tumours tended to develop in the irradiated tissue. Continued follow-up of these survivors is important to monitor such late effects of treatment. It is also important to evaluate the risk of second primary neoplasms following more recent lower radiation dose treatment practices.
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Affiliation(s)
- Aliki J Taylor
- Centre for Childhood Cancer Survivor Studies, Department of Public Health and Epidemiology, The University of Birmingham, Edgbaston, Birmingham, UK.
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Frobisher C, Lancashire ER, Winter DL, Jenkinson HC, Hawkins MM. Long-term population-based marriage rates among adult survivors of childhood cancer in Britain. Int J Cancer 2007; 121:846-55. [PMID: 17450524 DOI: 10.1002/ijc.22742] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objectives of this study were to assess the number of adult survivors of childhood cancer who ever married and the factors influencing marriage, compare observed marriages to those expected from the general population, and assess age at marriage and influencing factors. The data is based on the British Childhood Cancer Survivor Study (BCCSS), which is a population-based cohort of 18,119 individuals who were diagnosed with childhood cancer between 1940 and 91 and survived at least 5 years. Fourteen thousand five hundred thirty-nine were alive, aged at least 16 years and eligible to receive a postal questionnaire, which ascertained marriage status. Thirty-four percent of 9,954 survivors had married. Survivors with the following characteristics: males, CNS neoplasm, received radiotherapy, diagnosed with mental retardation, registered blind, low social functioning score (calculated from SF-36 health status measure), and achieved the highest level of educational attainment, were less likely to have married than the complementary survivor groups. The deficits in the proportion ever married compared to the general population were mostly between 9 and 18% among males and 7-10% among females. The largest ever married deficits were among male CNS neoplasm survivors aged 30 years or over (29-38%). Age at first marriage among survivors was related to: sex, childhood cancer type, age at diagnosis, chemotherapy, radiotherapy, mental retardation, and level of educational attainment. Regular follow-up for these survivors should address not just physical late-effects of the childhood cancer and treatment, but also psychosocial needs throughout the lifespan of the survivors to help them achieve life events as they occur in the general population.
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Affiliation(s)
- Clare Frobisher
- CCCSS, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, B15 2TT, United Kingdom.
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Jenkinson HC, Winter DL, Marsden HB, Stovall MA, Stevens MCG, Stiller CA, Hawkins MM. A study of soft tissue sarcomas after childhood cancer in Britain. Br J Cancer 2007; 97:695-9. [PMID: 17653071 PMCID: PMC2360363 DOI: 10.1038/sj.bjc.6603908] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 06/29/2007] [Accepted: 06/29/2007] [Indexed: 11/09/2022] Open
Abstract
Among 16 541 3-year survivors of childhood cancer in Britain, 39 soft tissue sarcomas (STSs) occurred and 1.1 sarcomas were expected, yielding a standardised incidence ratio (SIR) of 16.1. When retinoblastomas were excluded from the cohort, the SIR for STSs was 15.9, and the cumulative risk of developing a soft tissue tumour after childhood cancer within 20 years of 3-year survival was 0.23%. In the case-control study, there was a significant excess of STSs in those patients exposed to both radiotherapy (RT) and chemotherapy, which was five times that observed among those not exposed (P=0.02). On the basis of individual radiation dosimetry, there was evidence of a strong dose-response effect with a significant increase in the risk of STS with increasing dose of RT (P<0.001). This effect remained significant in a multivariate model. The adjusted risk in patients exposed to RT doses of over 3000 cGy was over 50 times the risk in the unexposed. There was evidence of a dose-response effect with exposure to alkylating agents, the risk increasing substantially with increasing cumulative dose (P=0.05). This effect remained after adjusting for the effect of radiation exposure.
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Affiliation(s)
- H C Jenkinson
- Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - D L Winter
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT, UK
| | - H B Marsden
- Department of Paediatric Pathology, Royal Manchester Children's Hospital, Manchester M27 4HA, UK
| | - M A Stovall
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - M C G Stevens
- Institute of Child Life and Health, University of Bristol, Bristol BS2 8AE, UK
| | - C A Stiller
- Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford OX2 6HJ, UK
| | - M M Hawkins
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT, UK
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Reulen RC, Winter DL, Lancashire ER, Zeegers MP, Jenney ME, Walters SJ, Jenkinson C, Hawkins MM. Health-status of adult survivors of childhood cancer: a large-scale population-based study from the British Childhood Cancer Survivor Study. Int J Cancer 2007; 121:633-40. [PMID: 17405119 DOI: 10.1002/ijc.22658] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to investigate the effect of childhood cancer and its treatment on self-reported health-status in 10,189 adult survivors of childhood cancer in Britain. Age- and sex-adjusted scores on the SF-36 Mental and Physical Component Summary scales (MCS, PCS, respectively) were compared between survivors and UK norms, and between subgroups of survivors, by multiple regression. Survivors had comparable scores to UK-norms on the MCS scale (difference (D) = -0.1, 99% CI: -0.5, 0.3). The difference in scores between survivors and UK-norms on the PCS scale varied by age (p(heterogeneity) < 0.001). Young survivors (16-19 years) scored similarly to UK-norms (D = 0.5, (-1.1, 2.2), whereas the age groups of 25 and older scored statistically and clinically significantly below UK-norms (all p-values < 0.0001), with Ds ranging between -2.3 (-3.5, -1.2) and -3.7 (-5.0, -2.4). Survivors of central nervous system (CNS) and bone tumors scored significantly (p-value at all ages <0.003) below UK-norms on the PCS scale. Specifically, these survivors were substantially more limited in specific daily activities such as, for example, walking a mile (40, 63%, respectively) when compared to UK-norms (16%). In conclusion, childhood cancer survivors rate their mental health broadly similarly to those in the general population. Survivors of CNS and bone tumors report their physical health-status to be importantly below population norms. Although self-reported physical health is at least as good as in the general population among young survivors, this study suggests that perceived physical health declines more rapidly over time than in the general population.
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Affiliation(s)
- Raoul C Reulen
- Department of Public Health and Epidemiology, Centre for Childhood Cancer Survivor Studies, University of Birmingham, Birmingham, United Kingdom.
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Reulen RC, Zeegers MP, Lancashire ER, Winter DL, Hawkins MM. Offspring sex ratio and gonadal irradiation in the British Childhood Cancer Survivor Study. Br J Cancer 2007; 96:1439-41. [PMID: 17426701 PMCID: PMC2360164 DOI: 10.1038/sj.bjc.6603736] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We investigated offspring sex ratio among 6232 offspring born to 3218 survivors of childhood cancer in relation to therapeutic irradiation, and pooled our data with those from two other large-scale studies giving a total of 9685 offspring. Exposure to high-dose gonadal irradiation was not associated with a significant alteration in offspring sex ratio compared to low doses (men: P=0.58, women: P=0.66). There was also no evidence that the ratio varied with time since cancer diagnosis when comparing survivors treated with radiotherapy vs those without (men: P=0.51; women: P=0.46). This, the largest study to date, finds no evidence that exposure to radiation affects the offspring sex ratio among survivors of childhood cancer.
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Affiliation(s)
- R C Reulen
- Centre for Childhood Cancer Survivor Studies, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Taylor AJ, Winter DL, Stiller CA, Murphy M, Hawkins MM. Risk of breast cancer in female survivors of childhood Hodgkin's disease in Britain: a population-based study. Int J Cancer 2007; 120:384-91. [PMID: 17066449 DOI: 10.1002/ijc.22261] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is now widespread evidence that female survivors of Hodgkin's disease who have been treated with supradiaphragmatic radiotherapy are at an increased risk of breast cancer. Mantle irradiation, which includes irradiation of the mediastinum, conveys a particularly high risk. Previously published studies have found a wide variation in risk. To provide British estimates of risk to inform surveillance programmes, we carried out the first British population-based cohort study of breast cancer in female survivors of childhood Hodgkin's disease. From the underlying cohort of the British Childhood Cancer Survivor Study, a cohort of 18,123 British 5-year survivors of childhood cancer diagnosed between 1940 and 1991, there were in total 383 female 5-year survivors of childhood Hodgkin's disease. Sixteen of these 383 survivors went on to develop invasive breast cancer subsequent to 5-year survival (standardised incidence ratio, 11.5; 95% confidence interval (95% CI), 6.6-18.6) and all of these 16 survivors had been treated with supradiaphragmatic irradiation as treatment for childhood Hodgkin's disease. The cumulative risk of breast cancer by 25 years of follow up was 9.9% (95% CI, 3.3-16.6) for all patients and 12.2% (95% CI, 4.3-20.1) for those treated with supradiaphragmatic radiotherapy. The cumulative risk of breast cancer in female survivors of childhood Hodgkin's disease in Britain is at the lower end of previous estimates. We hope that our data may provide a basis for future surveillance and for counselling survivors as to their likely risk of breast cancer.
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Affiliation(s)
- Aliki J Taylor
- Centre for Childhood Cancer Survivor Studies, Department of Public Health and Epidemiology, The University of Birmingham, Edgbaston, Birmingham, United Kingdom.
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Reulen RC, Zeegers MP, Jenkinson C, Lancashire ER, Winter DL, Jenney ME, Hawkins MM. The use of the SF-36 questionnaire in adult survivors of childhood cancer: evaluation of data quality, score reliability, and scaling assumptions. Health Qual Life Outcomes 2006; 4:77. [PMID: 17022814 PMCID: PMC1618832 DOI: 10.1186/1477-7525-4-77] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 10/05/2006] [Indexed: 11/14/2022] Open
Abstract
Background The SF-36 has been used in a number of previous studies that have investigated the health status of childhood cancer survivors, but it never has been evaluated regarding data quality, scaling assumptions, and reliability in this population. As health status among childhood cancer survivors is being increasingly investigated, it is important that the measurement instruments are reliable, validated and appropriate for use in this population. The aim of this paper was to determine whether the SF-36 questionnaire is a valid and reliable instrument in assessing self-perceived health status of adult survivors of childhood cancer. Methods We examined the SF-36 to see how it performed with respect to (1) data completeness, (2) distribution of the scale scores, (3) item-internal consistency, (4) item-discriminant validity, (5) internal consistency, and (6) scaling assumptions. For this investigation we used SF-36 data from a population-based study of 10,189 adult survivors of childhood cancer. Results Overall, missing values ranged per item from 0.5 to 2.9 percent. Ceiling effects were found to be highest in the role limitation-physical (76.7%) and role limitation-emotional (76.5%) scales. All correlations between items and their hypothesised scales exceeded the suggested standard of 0.40 for satisfactory item-consistency. Across all scales, the Cronbach's alpha coefficient of reliability was found to be higher than the suggested value of 0.70. Consistent across all cancer groups, the physical health related scale scores correlated strongly with the Physical Component Summary (PCS) scale scores and weakly with the Mental Component Summary (MCS) scale scores. Also, the mental health and role limitation-emotional scales correlated strongly with the MCS scale score and weakly with the PCS scale score. Moderate to strong correlations with both summary scores were found for the general health perception, energy/vitality, and social functioning scales. Conclusion The findings presented in this paper provide support for the validity and reliability of the SF-36 when used in long-term survivors of childhood cancer. These findings should encourage other researchers and health care practitioners to use the SF-36 when assessing health status in this population, although it should be recognised that ceiling effects can occur.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, University of Birmingham, Department of Public Health and Epidemiology, Edgbaston, Birmingham, B15 2TT, UK
| | - Maurice P Zeegers
- Unit of Genetic Epidemiology, Department of Public Health and Epidemiology, Birmingham, University of Birmingham, UK
- Department of General Practice, Comprehensive Cancer Institute Limburg, Catholic University of Leuven, Leuven, Belgium
| | - Crispin Jenkinson
- Health Services Research Unit, Department of Public Health, University of Oxford, Institute of Health Sciences, Oxford, UK
| | - Emma R Lancashire
- Centre for Childhood Cancer Survivor Studies, University of Birmingham, Department of Public Health and Epidemiology, Edgbaston, Birmingham, B15 2TT, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, University of Birmingham, Department of Public Health and Epidemiology, Edgbaston, Birmingham, B15 2TT, UK
| | - Meriel E Jenney
- Children's Hospital for Wales, Paediatric Oncology Department, Heath Park, Cardiff, UK
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, University of Birmingham, Department of Public Health and Epidemiology, Edgbaston, Birmingham, B15 2TT, UK
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Jenkinson HC, Hawkins MM, Stiller CA, Winter DL, Marsden HB, Stevens MCG. Long-term population-based risks of second malignant neoplasms after childhood cancer in Britain. Br J Cancer 2005; 91:1905-10. [PMID: 15534607 PMCID: PMC2409766 DOI: 10.1038/sj.bjc.6602226] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In a population-based, retrospective cohort study of 16 541 3-year survivors of childhood cancer treated in Britain up to the end of 1987, 278 second malignant neoplasms (SMNs) were identified against 39.4 expected giving a standardised incidence ratio (SIR) of 6.2. The overall cumulative risk of an SMN by 25 years from 3-year survival from childhood cancer was 4.2%. Analysis of the cohort of nonretinoblastoma childhood cancers combined revealed a significant decline in SIR of SMN with increasing duration of follow-up. There was a greater risk of developing a SMN, particularly secondary acute myeloid leukaemia, in those diagnosed with childhood cancer from 1980 onwards. However, on multivariate modeling, this was not an independent risk factor. There was significant heterogeneity (P<0.001) in SIR of SMN across different treatment groups, the greatest risk observed in the group exposed to both radiotherapy and chemotherapy. The risks of SMN observed were comparable with those in other population-based studies. While the decline in SIR with duration of follow-up and the small excess numbers of cancers observed over later decades after diagnosis are reassuring, the high excess risk, particularly of leukaemia, associated with recent more intense therapy is of concern.
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Affiliation(s)
- H C Jenkinson
- Department of Paediatric Oncology, Birmingham Children's Hospital NHS Trust, Birmingham B4 6NH, UK
- Department of Public Health and Epidemiology, Centre for Childhood Cancer Survivor Studies, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - M M Hawkins
- Department of Public Health and Epidemiology, Centre for Childhood Cancer Survivor Studies, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Department of Public Health and Epidemiology, Centre for Childhood Cancer Survivor Studies, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. E-mail:
| | - C A Stiller
- Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford OX2 6HJ, UK
| | - D L Winter
- Department of Public Health and Epidemiology, Centre for Childhood Cancer Survivor Studies, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - H B Marsden
- Department of Paediatric Pathology, Royal Manchester Children's Hospital, Pendlebury, Manchester M27 4HA, UK
| | - M C G Stevens
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
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Winter DL, Hanlon AL, Raysor SL, Watkins-Bruner D, Pinover WH, Hanks GE, Tricoli JV. Plasma levels of IGF-1, IGF-2, and IGFBP-3 in white and African-American men at increased risk of prostate cancer. Urology 2001; 58:614-8. [PMID: 11597555 DOI: 10.1016/s0090-4295(01)01273-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To further investigate the relationship between the plasma levels of insulin-like growth factor-1 (IGF-1), insulin-like growth factor-2 (IGF-2), insulin-like growth factor binding protein-3 (IGFBP-3), growth hormone, testosterone, and demographic factors, particularly race, within a group of men at increased risk of prostate cancer development. METHODS Enzyme-linked immunosorbent assays or an immunosorbent assay was used to quantitate the plasma levels of IGF-1, IGF-2, IGFBP-3, growth hormone, and testosterone. The study group consisted of 169 men (85 African-American, 84 white) aged 35 to 69 years, with no personal history of prostate cancer, but having at least one first-degree relative diagnosed with the disease, unless they were African-American. The relationships between the plasma levels and the categorical covariates were assessed using the nonparametric Wilcoxon test and between the continuous variables using Spearman's correlation coefficient. RESULTS The mean plasma levels of IGFBP-3 were significantly lower in African-American (2657 ng/mL) than in white (2965 ng/mL) men (P = 0.0062). The plasma levels of IGF-2 were also lower in the African-American (503.5 ng/mL) than in the white (549.1 ng/mL) men (P = 0.0084). Overall, the IGF-1 plasma levels correlated positively with the IGF-2, IGFBP-3, and growth hormone levels and the IGF-2 plasma levels correlated negatively with the testosterone levels. CONCLUSIONS Our results demonstrate that lower plasma levels of IGFBP-3 and IGF-2 are associated with race in a population of men at increased risk of developing prostate cancer. The ability of these markers to predict earlier disease onset is currently under investigation.
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Affiliation(s)
- D L Winter
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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