Risk stratification of childhood cancer survivors necessary for evidence-based clinical long-term follow-up Journal Article
| Authors: | Frobisher, C.; Glaser, A.; Levitt, G. A.; Cutter, D. J.; Winter, D. L.; Lancashire, E. R.; Oeffinger, K. C.; Guha, J.; Kelly, J.; Reulen, R. C.; Hawkins, M. M.; on behalf of the National Cancer Survivorship Initiative (NCSI) and the British Childhood Cancer Survivor Study (BCCSS) Steering Group |
| Article Title: | Risk stratification of childhood cancer survivors necessary for evidence-based clinical long-term follow-up |
| 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. © 2017 Cancer Research UK. All rights reserved. |
| Keywords: | adolescent; cancer chemotherapy; cancer survival; child; cancer surgery; primary tumor; major clinical study; cancer patient; cancer radiotherapy; follow up; antineoplastic agent; cancer diagnosis; cohort analysis; evidence based practice; retinoblastoma; cancer mortality; acute lymphoblastic leukemia; childhood cancer; hodgkin disease; skull irradiation; risk assessment; questionnaire; cause of death; patient care; population research; nonhodgkin lymphoma; adverse outcome; infant; neuroblastoma; newborn; risk stratification; soft tissue sarcoma; cancer epidemiology; bone marrow transplantation; standardized incidence ratio; childhood cancer survivor; adverse health outcomes; long term survival; clinical follow-up; human; priority journal; article; standardized mortality ratio; mortality risk |
| Journal Title: | British Journal of Cancer |
| Volume: | 117 |
| Issue: | 11 |
| ISSN: | 0007-0920 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2017-11-21 |
| Start Page: | 1723 |
| End Page: | 1731 |
| Language: | English |
| DOI: | 10.1038/bjc.2017.347 |
| PROVIDER: | scopus |
| PMCID: | PMC5729444 |
| PUBMED: | 29065109 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 January 2018 -- Source: Scopus |
