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Mogensen H, Erdmann F, Mader L, Vrelits Sørensen G, Talbäck M, Tjørnelund Nielsen T, Hasle H, Heyman M, Winther JF, Feychting M, Tettamanti G, Kenborg L. Early mortality in children with cancer in Denmark and Sweden: The role of social background in a setting with universal healthcare. Int J Cancer 2024; 154:1719-1730. [PMID: 38259167 DOI: 10.1002/ijc.34851] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Abstract
Socioeconomic differences in overall survival from childhood cancer have been shown previously, but the underlying mechanisms remain unclear. We aimed to investigate if social inequalities were seen already for early mortality in settings with universal healthcare. From national registers, all children diagnosed with cancer at ages 0-19 years, during 1991-2014, in Sweden and Denmark, were identified, and information on parental social characteristics was collected. We estimated odds ratios (OR) and 95% confidence intervals (CI) of early mortality (death within 90 days after cancer diagnosis) by parental education, income, employment, cohabitation, and country of birth using logistic regression. For children with acute lymphoblastic leukaemia (ALL), clinical characteristics were obtained. Among 13,926 included children, 355 (2.5%) died within 90 days after diagnosis. Indications of higher early mortality were seen among the disadvantaged groups, with the most pronounced associations observed for maternal education (ORadj_Low_vs_High 1.65 [95% CI 1.22-2.23]) and income (ORadj_Q1(lowest)_vs_Q4(highest) 1.77 [1.25-2.49]). We found attenuated or null associations between social characteristics and later mortality (deaths occurring 1-5 years after cancer diagnosis). In children with ALL, the associations between social factors and early mortality remained unchanged when adjusting for potential mediation by clinical characteristics. In conclusion, this population-based cohort study indicated differences in early mortality after childhood cancer by social background, also in countries with universal healthcare. Social differences occurring this early in the disease course requires further investigation, also regarding the timing of diagnosis.
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Affiliation(s)
- Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Cancer Registry Bern-Solothurn, University of Bern, Bern, Switzerland
| | - Gitte Vrelits Sørensen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mats Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giorgio Tettamanti
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
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2
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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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3
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Mogensen H, Tettamanti G, Frederiksen LE, Talbäck M, Härkonen J, Modig K, Pedersen C, Krøyer A, Hirvonen E, Kyrönlahti A, Heyman M, Holmqvist AS, Hasle H, Madanat-Harjuoja L, Malila N, Winther JF, Erdmann F, Feychting M. Educational attainment in survivors of childhood cancer in Denmark, Finland, and Sweden. Br J Cancer 2024; 130:260-268. [PMID: 37993542 PMCID: PMC10803319 DOI: 10.1038/s41416-023-02499-1] [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: 02/14/2023] [Revised: 10/29/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Survivors of childhood cancer may face difficulties at school. We investigated whether childhood cancer affects attainment of upper secondary education, in a register-based cohort study from Denmark, Finland, and Sweden, where we limit bias from selection and participation. METHODS From the national cancer registers, we identified all long-term survivors of childhood cancer diagnosed aged 0-14 years in 1971-2005 (n = 7629), compared them to matched population comparisons (n = 35,411) and siblings (n = 6114), using odds ratios (OR) and 95% confidence intervals (CI). RESULTS Overall, 6127 survivors (80%) had attained upper secondary education by age 25, compared to 84% among comparison groups. Elevated OR for not attaining this level were mainly confined to survivors of central nervous system (CNS) tumours (ORSurv_PopComp2.05, 95%CI: 1.83-2.29). Other risk groups were survivors who had spent more time in hospital around cancer diagnosis and those who had hospital contacts in early adulthood, particularly psychiatric. Survivors of all cancer types were less likely to have attained upper secondary education without delay. CONCLUSIONS Although survivors of childhood cancer experienced delays in their education, many had caught up by age 25. Except for survivors of CNS tumours, survivors attained upper secondary education to almost the same extent as their peers.
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Affiliation(s)
- Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Giorgio Tettamanti
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Juho Härkonen
- Department of Political and Social Sciences, European University Institute, Florence, Italy
- Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Pedersen
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
| | - Elli Hirvonen
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Anniina Kyrönlahti
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
- New children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mats Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sällfors Holmqvist
- Department of Clinical Sciences, Lund University, Childhood Cancer Center, Skåne University Hospital, Lund, Sweden
| | - Henrik Hasle
- Department of pediatric and adolescent medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Nea Malila
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Research group Aetiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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4
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Scobioala S, Parfitt R, Matulat P, Byrne J, Langer T, Troschel FM, Hesping AE, Clemens E, Kaatsch P, Grabow D, Kaiser M, Spix C, Kremer LC, Calaminus G, Baust K, Kuehni CE, Weiss A, Strebel S, Kuonen R, Elsner S, Haupt R, Garré ML, Gruhn B, Kepak T, Kepakova K, Winther JF, Kenborg L, Rechnitzer C, Hasle H, Kruseova J, Luks A, Lackner H, Bielack S, Beck JD, Jürgens H, van den Heuvel-Eibrink MM, Zolk O, Eich HT, Am Zehnhoff-Dinnesen A. The impact of the temporal sequence of cranial radiotherapy and platin-based chemotherapy on hearing impairment in pediatric and adolescent CNS and head-and-neck cancer patients: A report from the PanCareLIFE consortium. Int J Cancer 2024; 154:320-331. [PMID: 37715472 DOI: 10.1002/ijc.34732] [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: 04/18/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023]
Abstract
The impact of the temporal sequence by which cranial radiotherapy (CRT) and platin-based chemotherapy (PCth) are administered on sensorineural hearing loss (SNHL) in pediatric and adolescent central nervous system (CNS) and head-and-neck (HN) cancer patients has not yet been studied in detail. We examined the ototoxic effects of sequentially applied CRT and PCth. This study included children and adolescents with CNS and HN tumors who participated in the multicountry PanCareLIFE (PCL) consortium. Audiological outcomes were compared between patients who received CRT prior to PCth and those who received it afterwards. The incidence, degree and posttreatment progression of SNHL, defined as Muenster classification grade ≥MS2b, were evaluated in 141 patients. One hundred and nineteen patients were included in a time-to-onset analysis. Eighty-eight patients received CRT prior to PCth (Group 1) and 53 patients received PCth before CRT (Group 2). Over a median follow-up time of 1.6 years, 72.7% of patients in Group 1 experienced SNHL ≥ MS2b compared to 33.9% in Group 2 (P < .01). A time-to-onset analysis was performed for 74 patients from Group 1 and 45 patients from Group 2. Median time to hearing loss (HL) ≥ MS2b was 1.2 years in Group 1 and 4.4 years in Group 2 (P < .01). Thus, audiological outcomes were better for patients who received CRT after PCth than before. This finding should be further evaluated and considered within clinical practice in order to minimize hearing loss in children and adolescents with CNS and HN tumors.
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Affiliation(s)
- Sergiu Scobioala
- Clinic for Radiotherapy, Radiooncology University Hospital Muenster, Muenster, Germany
| | - Ross Parfitt
- Department for Phoniatrics and Pedaudiology, University Hospital, Muenster, UKM, Germany
| | - Peter Matulat
- Department for Phoniatrics and Pedaudiology, University Hospital, Muenster, UKM, Germany
| | | | - Thorsten Langer
- Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, University of Luebeck, Luebeck, Germany
| | - Fabian M Troschel
- Clinic for Radiotherapy, Radiooncology University Hospital Muenster, Muenster, Germany
| | - Amélie E Hesping
- Department for Phoniatrics and Pedaudiology, University Hospital, Muenster, UKM, Germany
| | - Eva Clemens
- Erasmus University Medical Centre (EMC), Rotterdam, The Netherlands
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leontien C Kremer
- Academisch Medisch Centrum bij de Universiteit van Amsterdam (AMC), Amsterdam, The Netherlands
- Princess Maxima Center for Pediatric Oncology (PMC), and University of Utrecht, Utrecht, The Netherlands
| | - Gabriele Calaminus
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annette Weiss
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sven Strebel
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Rahel Kuonen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Susanne Elsner
- Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, University of Luebeck, Luebeck, Germany
| | - Riccardo Haupt
- DOPO Clinic and Neuroncology Unit, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini (IGG), Genoa, Italy
| | - Maria-Luisa Garré
- DOPO Clinic and Neuroncology Unit, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini (IGG), Genoa, Italy
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - Tomas Kepak
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Paediatric Oncology, University Hospital Brno, Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Paediatric Oncology, University Hospital Brno, Brno, Czech Republic
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Catherine Rechnitzer
- Pediatric and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ales Luks
- Motol Teaching Hospital, Prague, Czech Republic
| | - Herwig Lackner
- Pediatric Hematology and Oncology, Medical University of Graz, Graz, Austria
| | - Stefan Bielack
- Pediatrics 5 (Oncology, Hematology, Immunology), Center for Pediatric, Adolescent, and Women's Medicine, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Jörn-Dirk Beck
- Pediatric Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Heribert Jürgens
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | | | - Oliver Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School, Rüdersdorf, Germany
| | - Hans Theodor Eich
- Clinic for Radiotherapy, Radiooncology University Hospital Muenster, Muenster, Germany
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5
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Kjaer TK, Andersen EAW, Ursin G, Larsen SB, Bidstrup PE, Winther JF, Borre M, Johansen C, Dalton SO. Cumulative incidence of second primary cancers in a large nationwide cohort of Danish cancer survivors: a population-based retrospective cohort study. Lancet Oncol 2024; 25:126-136. [PMID: 38048803 DOI: 10.1016/s1470-2045(23)00538-7] [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: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND A new primary cancer is a serious late effect of a pre-existing cancer diagnosis, and can be attributed to hereditary cancer syndromes, immune or hormonal factors, cancer treatment, or modifiable lifestyle or environmental factors. We investigated the absolute and relative incidence of second primary cancers in a large cohort of Danish cancer survivors. Furthermore, we examined the association between alcohol-related, smoking-related, virus-related, and hormone-related first and second primary cancers. METHODS In this retrospective cohort study, we identified a cohort of Danish adults (aged ≥40 years) diagnosed with cancer from Jan 1, 1997, to Dec 31, 2014 and alive 1 year after diagnosis. Follow-up was from date of first cancer diagnosis and lasted up to 24 years, ending on Dec 31, 2020. Cohort identification and information on second primary cancers was obtained from the Danish Cancer Registry, and comorbidity and sociodemographic information was obtained from Danish population-based registries. Overall, and for 27 cancer types, cumulative incidence functions and Cox proportional hazard regression models were used to estimate the incidence of second primary cancer and death, and hazard ratios (HRs) and 95% CIs of second primary cancer adjusted for sex, age and year of diagnosis, cohabitation status, income, and comorbidity. FINDINGS 457 334 Danish adults were included in our study (230 150 [50·3%] male individuals and 227 184 [49·7%] female individuals; median age at diagnosis 68·3 years, IQR 59·7-76·6; median follow-up 3·6 years, IQR 0·6-9·3). The cumulative incidence of second primary cancer increased over time from 6·3% (95% CI 6·2-6·4) 5 years after diagnosis to 10·5% (10·4-10·6) 10 years after diagnosis and to 13·5% (13·4-13·7) 15 years after diagnosis. The highest cumulative incidence of second primary cancer 10 years after diagnosis was observed in survivors of cancers in the larynx (21·8%, 20·5-23·1), oropharynx and oral cavity (19·5%, 18·7-20·3), and bladder and urinary tract (18·5%, 18·0-19·0). Survivors of cancers related to alcohol (HR 1·09, 95% CI 1·06-1·13), smoking (1·73, 1·68-1·78), diet high in red or processed meat (1·32, 1·24-1·39), or virus (1·23, 1·13-1·35) were at increased risk of developing a second cancer with the same aetiology, whereas having had a hormone-related first cancer was associated with lower risk of a second hormone-related cancer (0·77, 0·73-0·81). INTERPRETATION Our results could help optimise prevention efforts targeting modifiable risk factors to reduce risk of developing a second primary cancer. FUNDING Nordic Cancer Union and The Health Foundation (Helsefonden).
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Affiliation(s)
| | | | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Signe Benzon Larsen
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Michael Borre
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Center for Cancer Late Effect Research CASTLE, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark; Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
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6
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Larsen PA, Amidi A, Ghith N, Winther JF, Pedersen C. Quality of life of adolescent and adult survivors of childhood cancer in Europe-A systematic review. Int J Cancer 2023; 153:1356-1375. [PMID: 37377041 DOI: 10.1002/ijc.34634] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/08/2023] [Accepted: 04/19/2023] [Indexed: 06/29/2023]
Abstract
Advances in diagnostics and treatment of childhood cancer during the past few decades have substantially increased survival, resulting in a growing population of survivors of childhood cancer. Somatic and mental late effects of the cancer and the treatment may impact the quality of life (QoL). Previous reviews of QoL in survivors of childhood cancer have shown contradictory findings across studies and the majority of studies included have been based on data from North America and may not be directly comparable to a European setting. The aim of our study was to critically evaluate and summarise the latest evidence on the QoL of childhood cancer survivors in Europe and to identify survivors at particular risk. The eligible studies were published between 2008 and 2022, conducted in Europe and included participants who had survived at least 5 years after diagnosis of a childhood cancer. The main outcome of interest was QoL of survivors which was measured with validated qualitative and quantitative QoL questionnaires. A systematic literature search conducted in PubMed, EMBASE, PsycINFO and CINALH resulted in inclusion of 36 articles with a total of 14 342 survivors of childhood cancer. The majority of included studies found that childhood cancer survivors reported poorer QoL than comparisons. Female gender, treatment with haematopoietic stem cell transplantation and a brain tumour diagnosis were associated with lower QoL. With a growing population of childhood cancer survivors with many years ahead of them, targeted interventions and optimal follow-up care are important to improve the QoL of survivors.
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Affiliation(s)
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Nermin Ghith
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Aarhus, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Camilla Pedersen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Aarhus, Denmark
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7
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Kyrönlahti A, Erdmann F, Feychting M, Frederiksen LE, Hirvonen E, Korhonen LM, Krøyer A, Mader L, Malila N, Mogensen H, Pedersen C, Talbäck M, Taskinen M, Winther JF, Madanat‐Harjuoja L, Pitkäniemi J. Income disparities between adult childhood cancer survivors and their peers-A register-based cohort study from the SALiCCS research programme. Cancer Med 2023; 12:16455-16468. [PMID: 37305982 PMCID: PMC10469706 DOI: 10.1002/cam4.6218] [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: 12/23/2022] [Revised: 04/20/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Childhood cancer survivors face various adverse consequences. This Nordic register-based cohort study aimed to assess whether survivors of childhood cancer are more likely to have low income than their peers. METHODS We identified 17,392 childhood cancer survivors diagnosed at ages 0 to 19 between 1971 and 2009 with 83,221 age-, sex-, and country-matched population comparisons. Annual disposable income at ages 20 to 50 years was retrieved from statistical offices (for 1990-2017) and categorized into low income and middle/high income. The number of transitions between income categories were assessed using binomial regression analyses. RESULTS The prevalence of annual low income among childhood cancer survivors was 18.1% and 15.6% among population comparisons (risk ratio [RR] 1.17; 95% confidence interval [CI] 1.16-1.18). Compared to population comparisons, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to transition from low to middle/high income and 12% (10%-15%) more likely to transition from middle/high to low income during follow-up. Among those initially in the low income category, survivors were 7% (95% CI 3%-11%) more likely to remain in the low income category. If the initial category was middle/high income, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to remain in the middle/high income and 45% (37%-53%) more likely to transition to the low income category permanently. CONCLUSIONS Childhood cancer survivors are at higher risk for low income in adulthood than their peers. These disparities might be reduced by continued career counseling along with support in managing within the social security system.
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Affiliation(s)
- Anniina Kyrönlahti
- Finnish Cancer RegistryHelsinkiFinland
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Friederike Erdmann
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Division of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University MainzGermany
- Department of Prevention and EvaluationLeibniz Institute for Prevention Research and Epidemiology – BIPSBremenGermany
| | - Maria Feychting
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | | | | | - Liisa Maria Korhonen
- Finnish Cancer RegistryHelsinkiFinland
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Anja Krøyer
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Luzius Mader
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Childhood Cancer Research GroupInstitute of Social and Preventive Medicine, University of BernBernSwitzerland
- Cancer Registry Bern‐SolothurnUniversity of BernBernSwitzerland
| | | | - Hanna Mogensen
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Camilla Pedersen
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Mats Talbäck
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Mervi Taskinen
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Division of Pediatric Hematology, Oncology, and Stem Cell TransplantationHelsinki University HospitalHelsinkiFinland
| | | | - Laura Madanat‐Harjuoja
- Finnish Cancer RegistryHelsinkiFinland
- Dana Farber/Boston Children's Cancer and Blood Disorders ClinicBostonMassachusettsUSA
| | - Janne Pitkäniemi
- Finnish Cancer RegistryHelsinkiFinland
- Health Sciences Unit, Faculty of Social SciencesTampere UniversityTampereFinland
- Department of Public Health, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
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8
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Bouwman E, Pluijm SMF, Stollman I, Araujo‐Soares V, Blijlevens NMA, Follin C, Falck Winther J, Hjorth L, Kepak T, Kepakova K, Kremer LCM, Muraca M, van der Pal HJH, Schneider C, Uyttebroeck A, Vercruysse G, Skinner R, Brown MC, Hermens RPMG, Loonen JJ. Healthcare professionals' perceived barriers and facilitators of health behavior support provision: A qualitative study. Cancer Med 2023; 12:7414-7426. [PMID: 36397667 PMCID: PMC10067039 DOI: 10.1002/cam4.5445] [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: 05/16/2022] [Revised: 10/27/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood cancer survivors (CCSs) have an increased risk of developing chronic health conditions. Evidence suggests that poor health behaviors further increase health risks. Healthcare professionals (HCPs) involved in survivorship care have a key role in providing health behavior support (HBS) but can feel limited in their ability to do so. This study aims to explore European HCPs perceived facilitators and barriers to providing HBS to CCSs. METHODS Five focus groups with 30 HCPs from survivorship care clinics across Europe were conducted. Topic guides were informed by the Theoretical Domains Framework (TDF) to capture domains that may influence provision of HBS. Focus groups were analyzed with thematic analysis. Transcripts were inductively coded, after which axial coding was applied to organize codes into categories. Finally, categories were mapped onto the TDF domains. RESULTS Nine TDF domains were identified in the data. The most commonly reported TDF domains were "Knowledge", "Skills", and "Environmental context and resources". HCPs indicated that their lack of knowledge of the association between late effects and health behaviors, besides time restrictions, were barriers to HBS. Facilitators for HBS included possession of skills needed to pass on health behavior information, good clinic organization, and an established network of HCPs. CONCLUSIONS This study identified education and training of HCPs as key opportunities to improve HBS. Survivorship care clinics should work towards establishing well-integrated structured care with internal and external networks including HBS being part of routine care. Proper understanding of facilitators and barriers should lead to better survivorship care for CCSs.
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Affiliation(s)
- Eline Bouwman
- Department of Hematology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Iridi Stollman
- Department of Hematology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Vera Araujo‐Soares
- Department of Health Technology & Services Research, Technical Medical CenterUniversity of TwenteEnschedeThe Netherlands
| | - Nicole M. A. Blijlevens
- Department of Hematology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Cecilia Follin
- Oncology, Department of Clinical Sciences LundLund University, Skåne University HospitalLundSweden
| | - Jeanette Falck Winther
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Department of Clinical MedicineAarhus University and Aarhus University HospitalAarhusDenmark
| | - Lars Hjorth
- Pediatrics, Department of Clinical Sciences LundLund University, Skåne University HospitalLundSweden
| | - Tomas Kepak
- International Clinical Research Center (FNUSA‐ICRC) at St. Anne's University HospitalMasaryk UniversityBrnoCzech Republic
| | - Katerina Kepakova
- International Clinical Research Center (FNUSA‐ICRC) at St. Anne's University HospitalMasaryk UniversityBrnoCzech Republic
| | - Leontien C. M. Kremer
- Princess Máxima Centre for Pediatric OncologyUtrechtThe Netherlands
- Department of Pediatrics, Emma Children's HospitalAmsterdam UMCAmsterdamThe Netherlands
- Faculty of MedicineUtrecht University and Utrecht Medical CenterUtrechtthe Netherlands
| | - Monica Muraca
- DOPO Clinic, Division of Pediatric Hematology and OncologyIRCCS Istituto Giannina GasliniGenoaItaly
| | | | | | - Anne Uyttebroeck
- Department of Oncology, Pediatric Oncology, KU Leuven, Department of Pediatric Hematology and OncologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Gertrui Vercruysse
- Department of Oncology, Pediatric Oncology, KU Leuven, Department of Pediatric Hematology and OncologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Roderick Skinner
- Wolfson Childhood Cancer Research Center, Newcastle University Centre for CancerNewcastle UniversityNewcastle upon TyneUK
- Great North Children's HospitalRoyal Victoria InfirmaryNewcastle upon TyneUK
- Wolfson Childhood Cancer Research Center, Translational and Clinical Research InstituteNewcastle UniverstiyNewcastle upon TyneUK
| | - Morven C. Brown
- Wolfson Childhood Cancer Research Center, Newcastle University Centre for CancerNewcastle UniversityNewcastle upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Rosella P. M. G. Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Jacqueline J. Loonen
- Department of Hematology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
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9
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Sørensen GV, Albieri V, Holmqvist AS, Erdmann F, Mogensen H, Talbäck M, Ifversen M, Lash TL, Feychting M, Schmiegelow K, Heyman MM, Winther JF, Hasle H. Long-Term Risk of Hospitalization for Somatic Diseases Among Survivors of Childhood Acute Lymphoblastic Leukemia. JNCI Cancer Spectr 2022; 6:6554212. [PMID: 35603856 PMCID: PMC9049267 DOI: 10.1093/jncics/pkac029] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 11/14/2022] Open
Abstract
Background Survivors of childhood acute lymphoblastic leukemia (ALL) may be at increased long-term risk of hospitalization for somatic diseases. However, large population-based cohort studies with risk estimates for survivors successfully cured without experiencing a relapse or requiring hematopoietic stem cell transplantation (HSCT) are lacking. Methods Danish and Swedish patients diagnosed with ALL before age 20 years in 1982-2008 were identified in the national cancer registries. Five-year survivors and matched population comparisons without childhood cancer were followed for hospitalization for 120 somatic disease categories in the national hospital registries from 5 years postdiagnosis until 2017, and disease-specific hospitalization rate ratios (RR) were calculated. The mean cumulative count method was used to estimate the mean number of multiple and recurrent disease-specific hospitalizations per individual. Results A total of 2024 5-year survivors and 9797 population comparisons were included. The overall hospitalization rate was more than twice as high compared with comparisons (RR = 2.30, 95% confidence interval [CI] = 2.09 to 2.52). At 30 years postdiagnosis, the mean cumulative hospitalization count was 1.69 (95% CI = 1.47 to 1.90) per survivor and 0.80 (95% CI = 0.73 to 0.86) per comparison. In the subcohort without relapse or HSCT (n = 1709), the RR was 1.41 (95% CI = 1.27 to 1.58). Conclusions Survivors of childhood ALL were at increased long-term risk for disease-specific hospitalizations; however, in survivors without relapse or HSCT, the rate was only modestly higher than in population comparisons without a childhood cancer. The absolute mean numbers of multiple and recurrent hospitalizations were generally low.
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Affiliation(s)
- Gitte Vrelits Sørensen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Vanna Albieri
- Unit of Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anna Sällfors Holmqvist
- Department of Clinical Sciences, Lund University, Pediatric Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Ifversen
- Department of Children and Adolescents Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Timothy Lee Lash
- Department of Epidemiology, Rollins School of Public Health, and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kjeld Schmiegelow
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mats Marshall Heyman
- Childhood Cancer Research Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Falck Winther
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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10
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von Heymann A, Alef-Defoe S, Salem H, Andersen EAW, Dalton SO, Schmiegelow K, Aw Wadt K, Falck Winther J, Johansen C, Bidstrup PE. Risk of somatic hospitalization in parents after cancer in a child, a nationwide cohort study. Psychooncology 2022; 31:1196-1203. [PMID: 35194898 DOI: 10.1002/pon.5909] [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: 10/15/2021] [Revised: 01/24/2022] [Accepted: 02/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The diagnosis of cancer in a child is a profoundly stressful experience. The impact on parents' somatic health, including lifestyle-related diseases, however, is unresolved. METHODS We conducted a nationwide population- and register-based study with parents of all children under age 20 diagnosed with cancer in Denmark between 1998 - 2013 and parents of cancer-free children, matched (1:10) on child's age and family type. We estimated hazard ratios (HR) with 95% confidence intervals (CI) in Cox proportional hazard models for thirteen major International Classification of Diseases-10 disease-groups, selected stress- and lifestyle-related disease-groups and investigated moderation by time since diagnosis, parental sex, and cancer type. RESULTS Among n=7797 parents of children with cancer compared with n=74,388 parents of cancer-free children (51% mothers, mean age 42), we found no overall pattern of increased risk for 13 broad disease-groups. We found increases in digestive system diseases (HR1.06, 95% CI1.01-1.12), genitourinary system diseases (HR 1.08, 95% CI 1.02-1.14), and neoplasms (HR 1.20, 95% CI 1.13-1.27), the latter attributable mostly to increased rates of tobacco-related cancers and mothers' diet-related cancers. CONCLUSIONS This is the first attempt to document the impact of childhood cancer on parents' somatic health. With the exception of increased risk for neoplasms, likely due to shared genetic or lifestyle factors, our findings offer the reassuring message, that the burden of caring for a child with cancer does not in general increase parents' risk for somatic diseases. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Annika von Heymann
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen.,Cancer Survivorship and Treatment Late Effects, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet
| | - Sierra Alef-Defoe
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen
| | - Hanin Salem
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen
| | | | | | - Kjeld Schmiegelow
- University Hospital Rigshospitalet, Institute of Clinical Medicine, Medical Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Karin Aw Wadt
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen.,Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen.,Cancer Survivorship and Treatment Late Effects, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet
| | - Pernille Envold Bidstrup
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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11
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Helligsoe ASL, Weile KS, Kenborg L, Henriksen LT, Lassen-Ramshad Y, Amidi A, Wu LM, Winther JF, Pickering L, Mathiasen R. Systematic Review: Sleep Disorders Based on Objective Data in Children and Adolescents Treated for a Brain Tumor. Front Neurosci 2022; 16:808398. [PMID: 35273474 PMCID: PMC8902496 DOI: 10.3389/fnins.2022.808398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Tumors of the central nervous system (CNS) are the most common solid childhood malignancy. Over the last decades, treatment developments have strongly contributed to the improved overall 5-year survival rate, which is now approaching 75%. However, children now face significant long-term morbidity with late-effects including sleep disorders that may have detrimental impact on everyday functioning and quality of life. The aims of this study were to (1) describe the symptoms that lead to polysomnographic evaluation; (2) describe the nature of sleep disorders diagnosed in survivors of childhood CNS tumor using polysomnography (PSG); and (3) explore the association between tumor location and diagnosed sleep disorder. Methods An extensive literature search following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA) was conducted. Inclusion criteria were children and adolescents diagnosed with a CNS tumor age <20 years having a PSG performed after end of tumor treatment. The primary outcome was sleep disorder confirmed by PSG. Results Of the 1,658 studies identified, 11 met the inclusion criteria. All the included articles were appraised for quality and included in the analysis. Analyses indicated that sleep disorders commonly occur among childhood CNS tumor survivors. Symptoms prior to referral for PSG were excessive daytime sleepiness (EDS), fatigue, irregular breathing during sleep and snoring. The most common sleep disorders diagnosed were sleep-related breathing disorders (i.e., obstructive sleep apnea) and central disorders of hypersomnolence (i.e., narcolepsy). Conclusion Our findings point to the potential benefit of systematically registering sleep disorder symptoms among CNS tumor patients together with tumor type and treatment information, so that at-risk patients can be identified early. Moreover, future rigorous and larger scale controlled observational studies that include possible modifiable confounders of sleep disorders such as fatigue and obesity are warranted. Clinical Trial Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021243866, identifier [CRD42021243866].
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Affiliation(s)
- Anne Sophie Lind Helligsoe
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kathrine Synne Weile
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise Tram Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lisa Maria Wu
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of AIAS, Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Jeanette Falck Winther
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Line Pickering
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
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12
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Byrne J, Schmidtmann I, Rashid H, Hagberg O, Bagnasco F, Bardi E, De Vathaire F, Essiaf S, Winther JF, Frey E, Gudmundsdottir T, Haupt R, Hawkins MM, Jakab Z, Jankovic M, Kaatsch P, Kremer LCM, Kuehni CE, Harila-Saari A, Levitt G, Reulen R, Ronckers CM, Maule M, Skinner R, Steliarova-Foucher E, Terenziani M, Zaletel LZ, Hjorth L, Garwicz S, Grabow D. Impact of era of diagnosis on cause-specific late mortality among 77 423 five-year European survivors of childhood and adolescent cancer: The PanCareSurFup consortium. Int J Cancer 2022; 150:406-419. [PMID: 34551126 DOI: 10.1002/ijc.33817] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 03/10/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 02/03/2023]
Abstract
Late mortality of European 5-year survivors of childhood or adolescent cancer has dropped over the last 60 years, but excess mortality persists. There is little information concerning secular trends in cause-specific mortality among older European survivors. PanCareSurFup pooled data from 12 cancer registries and clinics in 11 European countries from 77 423 five-year survivors of cancer diagnosed before age 21 between 1940 and 2008 followed for an average age of 21 years and a total of 1.27 million person-years to determine their risk of death using cumulative mortality, standardized mortality ratios (SMR), absolute excess risks (AER), and multivariable proportional hazards regression analyses. At the end of follow-up 9166 survivors (11.8%) had died compared to 927 expected (SMR 9.89, 95% confidence interval [95% CI] 9.69-10.09), AER 6.47 per 1000 person-years, (95% CI 6.32-6.62). At 60 to 68 years of attained age all-cause mortality was still higher than expected (SMR = 2.41, 95% CI 1.90-3.02). Overall cumulative mortality at 25 years from diagnosis dropped from 18.4% (95% CI 16.5-20.4) to 7.3% (95% CI 6.7-8.0) over the observation period. Compared to the diagnosis period 1960 to 1969, the mortality hazard ratio declined for first neoplasms (P for trend <.0001) and for infections (P < .0001); declines in relative mortality from second neoplasms and cardiovascular causes were less pronounced (P = .1105 and P = .0829, respectively). PanCareSurFup is the largest study with the longest follow-up of late mortality among European childhood and adolescent cancer 5-year survivors, and documents significant mortality declines among European survivors into modern eras. However, continuing excess mortality highlights survivors' long-term care needs.
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Affiliation(s)
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Humayra Rashid
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Edit Bardi
- St. Anna Children's Hospital, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital GmbH, Linz, Austria
| | - Florent De Vathaire
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Université Paris-Sud Orsay, Villejuif, France
- Department of Research, Gustave Roussy, Villejuif, France
| | - Samira Essiaf
- SIOPE, c/o BLSI, Clos Chapelle-aux-Champs 30, Brussels, Belgium
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Strandboulevarden, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Eva Frey
- St. Anna Children's Hospital, Vienna, Austria
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Strandboulevarden, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Foundation MBBM, Milan, Italy
- Italian Off-Therapy Register (OTR), Monza, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam UMC, 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
- Paediatric Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Arja Harila-Saari
- Department of Women and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gill Levitt
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Raoul Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cécile M Ronckers
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Milena Maule
- Childhood Cancer Registry of Piedmont, Department of Medical Science, University of Turin and Center for Cancer Prevention (CPO-Piemonte), Torino, Italy
| | - Roderick Skinner
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon Cedex, France
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Lars Hjorth
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
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13
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van Kalsbeek RJ, Mulder RL, Haupt R, Muraca M, Hjorth L, Follin C, Kepak T, Kepakova K, Uyttebroeck A, Mangelschots M, Winther JF, Loonen JJ, Michel G, Bardi E, Elmerdahl Frederiksen L, den Hartogh J, Mader L, Roser K, Schneider C, Brown MC, Brunhofer M, Göttgens I, Hermens RPMG, Kienesberger A, Korevaar JC, Skinner R, van der Pal HJH, Kremer LCM. The PanCareFollowUp Care Intervention: A European harmonised approach to person-centred guideline-based survivorship care after childhood, adolescent and young adult cancer. Eur J Cancer 2022; 162:34-44. [PMID: 34953441 DOI: 10.1016/j.ejca.2021.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term follow-up (LTFU) care, although endorsed, is not available for the majority of adult survivors of childhood, adolescence and young adult (CAYA) cancer. Barriers to implementation include lack of time, knowledge, personnel and funding. Sustainable solutions are urgently needed to address the needs of CAYA cancer survivors to improve the quality of life and reduce the burden of late effects on survivors, health care systems and society. The European Union-funded PanCareFollowUp project, initiated by the Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer, was established to facilitate the implementation of person-centred survivorship care across Europe. PATIENTS AND METHODS The PanCareFollowUp Care Intervention was co-developed with survivors as part of the PanCareFollowUp project. It is a person-centred approach to survivorship care, supported by guidelines and with flexibility to adapt to local health care settings. The Care Intervention consists of three steps: (1) previsit completion of a Survivor Questionnaire (by the survivor) and Treatment Summary (by the health care provider [HCP]), (2) a clinic visit including shared decision-making, and (3) a follow-up call to finalise the individualised Survivorship Care Plan. RESULTS We developed the key components of the PanCareFollowUp Care Intervention: a PanCareFollowUp Survivor Questionnaire, Treatment Summary template, Survivorship Care Plan template, and educational materials for HCPs and survivors. Wide implementation of the PanCareFollowUp Care Intervention will be supported with a freely distributed Replication Manual on completion of the PanCareFollowUp project. CONCLUSIONS The PanCareFollowUp Care Intervention will support the implementation of person-centred, guideline-based LTFU care in different health care settings across Europe to improve survivors' health and well-being.
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Affiliation(s)
| | - Renée L Mulder
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Monica Muraca
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lund, Sweden
| | - Cecilia Follin
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Oncology, Lund, Sweden
| | - Tomas Kepak
- International Clinical Research Centre (FNUSA-ICRC), St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Centre (FNUSA-ICRC), St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Anne Uyttebroeck
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marlies Mangelschots
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Jacqueline J Loonen
- Department of Haematology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Edit Bardi
- PanCare, Bussum, the Netherlands; St Anna Children's Hospital, Vienna, Austria; Department of Pediatric and Adolescent Medicine, Kepler University Clinic, Linz, Austria
| | | | - Jaap den Hartogh
- PanCare, Bussum, the Netherlands; Childhood Cancer International Europe, Vienna, Austria
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Copenhagen, Denmark; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Morven C Brown
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom
| | | | - Irene Göttgens
- Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
| | | | - Joke C Korevaar
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Roderick Skinner
- Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom; Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; Translational and Clinical Research Institute, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom
| | - Helena J H van der Pal
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands; PanCare, Bussum, the Netherlands.
| | - Leontine C M Kremer
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands; Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands; Faculty of Medicine, Utrecht University and Utrecht Medical Centre, Utrecht, the Netherlands
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14
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Frederiksen LE, Pedersen C, Mogensen H, Mader L, Bautz A, Talbäck M, Hirvonen E, Norsker FN, Hasle H, Malila N, Madanat-Harjuoja L, Feychting M, Erdmann F, Winther JF. Employment status and occupational positions of childhood cancer survivors from Denmark, Finland and Sweden: A Nordic register-based cohort study from the SALiCCS research programme. Lancet Reg Health Eur 2021; 12:100258. [PMID: 34901911 PMCID: PMC8640515 DOI: 10.1016/j.lanepe.2021.100258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A childhood cancer diagnosis and late effects of treatment may affect survivors' possibilities of employment or highly skilled occupations later in life. In this study, we compared the employment and occupational status of childhood cancer survivors with population comparisons and siblings. METHODS In a cohort study based on Nordic registers, we identified 10 461 survivors of childhood cancer diagnosed before age 20 years in Denmark, Finland and Sweden since 1971. Survivors were compared with 48 928 population comparisons matched to survivors by age, sex and geographical region and 12 605 siblings of survivors. Annual outcome information on employment, unemployment, health-related unemployment and occupational position was obtained from the statistical institutes between 1980-2017 and assessed in multivariate logistic regression analyses from age 30 onwards. FINDINGS By 30 years of age, 9.2% (95% CI, 8.6-9.9%) of survivors were unemployed for health reasons. Childhood cancer survivors had considerably higher odds of health-related unemployment at ages 30, 40 and 50 than population comparisons (ORage30, 2.57; 95% CI, 2.35-2.81) and siblings (ORage30, 2.50; 95% CI, 2.15-2.90). We observed no large difference in unemployment unrelated to health or in occupational position. Health-related unemployment was particularly pronounced among survivors of central nervous system tumours and survivors diagnosed below 15 years of age. INTERPRETATION Survivors at risk of health-related unemployment should be offered comprehensive survivorship care and interventions for obtaining and maintaining suitable employment. FUNDING NordForsk [76111], the Danish Childhood Cancer Foundation [2016-0293], Aarhus University [43239402], the Swedish Childhood Cancer Foundation [PR2020-0130] and [OB2019-0003], Tømrermester Jørgen Holm og Hustru Elisa F. Hansens Mindelegat [20088] and the Swiss National Science Foundation to LM [P2LUP3_175288].
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Affiliation(s)
- Line Elmerdahl Frederiksen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark,Corresponding author: Line Elmerdahl Frederiksen, PhD, Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen.
| | - Camilla Pedersen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Andrea Bautz
- The Danish Clinical Quality Program – National Clinical Registries, Frederiksberg, Denmark
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland,Dana Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark,Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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15
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Erdmann F, Frederiksen LE, Mogensen H, Pedersen C, Mader L, Talbäck M, Bautz A, Hirvonen E, Kyrönlahti A, Korhonen LM, Hasle H, Malila N, Madanat-Harjuoja LM, Feychting M, Winther JF. Cohort Profile: The Socioeconomic Consequences in Adult Life After Childhood Cancer in Scandinavia (SALiCCS) Research Programme. Front Oncol 2021; 11:752948. [PMID: 34900702 PMCID: PMC8662544 DOI: 10.3389/fonc.2021.752948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/26/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The growing number of survivors of childhood cancer, with many years of life ahead, demonstrates the increasing clinical and public health relevance of investigating the risks of social and socioeconomic impairment after a childhood cancer diagnosis and the life-saving treatment. To enrich understanding of the mental, social and socioeconomic difficulties that childhood cancer survivors may face during their life-course, identify particularly vulnerable survivors and overcome the limitations of previous research, we initiated the Socioeconomic Consequences in Adult Life after Childhood Cancer in Scandinavia (SALiCCS) research programme. METHODS This Nordic cross-border research programme is a collaboration between the Danish Cancer Society, the Finnish Cancer Registry and Karolinska Institutet to investigate a broad range of mental, social and socioeconomic conditions in long-term childhood cancer survivors in Denmark, Finland and Sweden. SALiCCS is based on a registry-based matched cohort design, comprising five-year survivors of cancer diagnosed at ages 0-19 years (1971-2008 in Denmark, 1971-2009 in Finland, 1971-2011 in Sweden), age-, sex- and country-matched population comparisons and sibling comparisons who were followed over time. Outcomes of interest included mental disorders, educational achievements, employment and profession, family life and the need of social security benefits. Individual-level data linkage among various national registries provided the data for the research programme. RESULTS The SALiCCS core population comprises 21,292 five-year survivors, 103,303 population comparisons and 29,644 siblings as a second comparison group. The most common diagnoses in survivors were central nervous system tumours, leukaemias and lymphomas. DISCUSSION SALiCCS is the largest, most comprehensive population-based research initiative in this field, based on high-quality registry data with minimal risk of bias. The findings will be informative for evidence-based survivorship care targeting not only somatic late effects but also psychosocial impairments.
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Affiliation(s)
- Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Pedersen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Bautz
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Elli Hirvonen
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Anniina Kyrönlahti
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
- New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Liisa Maria Korhonen
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
- New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Nea Malila
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Laura-Maria Madanat-Harjuoja
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
- Dana Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, United States
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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16
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Helligsoe ASL, Kenborg L, Henriksen LT, Udupi A, Hasle H, Winther JF. Incidence and survival of childhood central nervous system tumors in Denmark, 1997-2019. Cancer Med 2021; 11:245-256. [PMID: 34800006 PMCID: PMC8704152 DOI: 10.1002/cam4.4429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/24/2021] [Revised: 10/01/2021] [Accepted: 11/04/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Incidence rates in Denmark of central nervous system (CNS) tumors remain among the highest in the world. Survival rates, however, have improved in the past decades in high-income countries. METHODS We analyzed incidence and survival of childhood CNS tumors in Denmark diagnosed from 1997 to 2019 based on data from the Danish Childhood Cancer Registry and information on histological types, tumor localization, and treatment from medical records. RESULTS From 1997 to 2019, 949 children<15 years were diagnosed with a CNS tumor. Age-standardized incidence was 42.1 (95% CI, 39.4-44.6) per million person-years and stable during this period. Age-specific incidence for children aged 0-4 years was 47.7 per million. More than one-third (n = 374, 39.4%) were treated with surgery alone. Overall survival rates 5 and 10 years after diagnosis were 77.6% (95% CI, 74.7-80.2) and 74.7% (95% CI, 71.7-77.5). Five-year overall survival improved from 73.0% (95% CI, 68.9-76.7) in 1997-2008 to 83.2% (95% CI, 79.2-86.4) in 2009-2019 (p-value < 0.0001) in children aged 0-4 years (p = 0.0006). CONCLUSION Incidence rates are stable but remain among the highest in the world. Despite improved survival rates in recent years in younger children, some subtypes still have a poor prognosis.
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Affiliation(s)
- Anne Sophie Lind Helligsoe
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise Tram Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Aparna Udupi
- Biostatistical Advisory Service (BIAS), Faculty of Health, Aarhus University, Denmark
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jeanette Falck Winther
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
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17
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Pedersen LH, Erdmann F, Aalborg GL, Hjalgrim LL, Larsen HB, Schmiegelow K, Winther JF, Dalton SO. Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study. BMC Cancer 2021; 21:1104. [PMID: 34649500 PMCID: PMC8518314 DOI: 10.1186/s12885-021-08837-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background While underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark. Methods We identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage. Results We found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease. Conclusion Families with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08837-x.
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Affiliation(s)
- Line Hjøllund Pedersen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark. .,Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.
| | - Friederike Erdmann
- Division of Childhood Cancer Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gitte Lerche Aalborg
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Lisa Lyngsie Hjalgrim
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
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van der Perk MEM, Broer L, Yasui Y, Robison LL, Hudson MM, Laven JSE, van der Pal HJ, Tissing WJE, Versluys B, Bresters D, Kaspers GJL, de Vries ACH, Lambalk CB, Overbeek A, Loonen JJ, Beerendonk CCM, Byrne J, Berger C, Clemens E, Dirksen U, Falck Winther J, Fosså SD, Grabow D, Muraca M, Kaiser M, Kepák T, Kruseova J, Modan-Moses D, Spix C, Zolk O, Kaatsch P, Krijthe JH, Kremer LCM, Brooke RJ, Baedke JL, van Schaik RHN, van den Anker JN, Uitterlinden AG, Bos AME, van Leeuwen FE, van Dulmen-den Broeder E, van der Kooi ALLF, van den Heuvel-Eibrink MM. Effect of Genetic Variation in CYP450 on Gonadal Impairment in a European Cohort of Female Childhood Cancer Survivors, Based on a Candidate Gene Approach: Results from the PanCareLIFE Study. Cancers (Basel) 2021; 13:4598. [PMID: 34572825 PMCID: PMC8470074 DOI: 10.3390/cancers13184598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Female childhood cancer survivors (CCSs) carry a risk of therapy-related gonadal dysfunction. Alkylating agents (AA) are well-established risk factors, yet inter-individual variability in ovarian function is observed. Polymorphisms in CYP450 enzymes may explain this variability in AA-induced ovarian damage. We aimed to evaluate associations between previously identified genetic polymorphisms in CYP450 enzymes and AA-related ovarian function among adult CCSs. METHODS Anti-Müllerian hormone (AMH) levels served as a proxy for ovarian function in a discovery cohort of adult female CCSs, from the pan-European PanCareLIFE cohort (n = 743; age (years): median 25.8, interquartile range (IQR) 22.1-30.6). Using two additive genetic models in linear and logistic regression, nine genetic variants in three CYP450 enzymes were analyzed in relation to cyclophosphamide equivalent dose (CED) score and their impact on AMH levels. The main model evaluated the effect of the variant on AMH and the interaction model evaluated the modifying effect of the variant on the impact of CED score on log-transformed AMH levels. Results were validated, and meta-analysis performed, using the USA-based St. Jude Lifetime Cohort (n = 391; age (years): median 31.3, IQR 26.6-37.4). RESULTS CYP3A4*3 was significantly associated with AMH levels in the discovery and replication cohort. Meta-analysis revealed a significant main deleterious effect (Beta (95% CI): -0.706 (-1.11--0.298), p-value = 7 × 10-4) of CYP3A4*3 (rs4986910) on log-transformed AMH levels. CYP2B6*2 (rs8192709) showed a significant protective interaction effect (Beta (95% CI): 0.527 (0.126-0.928), p-value = 0.01) on log-transformed AMH levels in CCSs receiving more than 8000 mg/m2 CED. CONCLUSIONS Female CCSs CYP3A4*3 carriers had significantly lower AMH levels, and CYP2B6*2 may have a protective effect on AMH levels. Identification of risk-contributing variants may improve individualized counselling regarding the treatment-related risk of infertility and fertility preservation options.
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Affiliation(s)
- M. E. Madeleine van der Perk
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Linda Broer
- Department of Internal Medicine, Rotterdam, ErasmusMC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.B.); (A.G.U.)
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
- Department of Oncology, Division of Survivorship, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Joop S. E. Laven
- Department of Obstetrics and Gynecology, Erasmus MC–University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Helena J. van der Pal
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Gertjan J. L. Kaspers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
- Department of Pediatric Oncology-Haematology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Cornelis B. Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (C.B.L.); (A.O.)
| | - Annelies Overbeek
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (C.B.L.); (A.O.)
| | - Jacqueline J. Loonen
- Department of Haematology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Catharina C. M. Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Julianne Byrne
- Boyne Research Institute, 5 Bolton Square, East, Drogheda, A92 RY6K Co. Louth, Ireland;
| | - Claire Berger
- Department of Paediatric Oncology, University Hospital, 42 055 Saint-Etienne, France;
- Lyon University, Jean Monnet University, INSERM, U 1059, Sainbiose, 42023 Saint-Etienne, France
| | - Eva Clemens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Uta Dirksen
- University Hospital Essen, Pediatrics III, West German Cancer Centre, 45147 Essen, Germany;
- German Cancer Research Centre, DKTK, Site Essen, 45147 Essen, Germany
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, 8200 Aarhus, Denmark
| | - Sophie D. Fosså
- Department of Oncology, Oslo University Hospital, 0372 Oslo, Norway;
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Monica Muraca
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Melanie Kaiser
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Tomáš Kepák
- University Hospital Brno, International Clinical Research Center (FNUSA-ICRC), Masaryk University, 656 91 Brno, Czech Republic;
| | | | - Dalit Modan-Moses
- The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Oliver Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 16816 Neuruppin, Germany;
| | - Peter Kaatsch
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Jesse H. Krijthe
- Department of Intelligent Systems, Delft University of Technology, 2628 BL Delft, The Netherlands;
| | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Russell J. Brooke
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Jessica L. Baedke
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Ron H. N. van Schaik
- Department of clinical chemistry, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - John N. van den Anker
- Division of Clinical Pharmacology, Children’s National Hospital, Washington, DC 20010, USA;
| | - André G. Uitterlinden
- Department of Internal Medicine, Rotterdam, ErasmusMC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.B.); (A.G.U.)
| | - Annelies M. E. Bos
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, 3584 CS Utrecht, The Netherlands;
| | - Flora E. van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Anne-Lotte L. F. van der Kooi
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
- Department of Obstetrics and Gynecology, Erasmus MC–University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
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19
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Pedersen C, Rechnitzer C, Andersen EAW, Kenborg L, Norsker FN, Bautz A, Baad-Hansen T, Tryggvadottir L, Madanat-Harjuoja LM, Holmqvist AS, Hjorth L, Hasle H, Winther JF. Somatic Disease in Survivors of Childhood Malignant Bone Tumors in the Nordic Countries. Cancers (Basel) 2021; 13:cancers13184505. [PMID: 34572734 PMCID: PMC8467516 DOI: 10.3390/cancers13184505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/10/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 01/18/2023] Open
Abstract
Simple Summary The treatment of osteosarcoma and Ewing sarcoma, the two major types of malignant bone tumors in children, has progressed considerably during the last decades, with more patients becoming long-term survivors. This improvement has resulted in an increasing number of patients with long-term adverse health consequences from the life-saving treatment. The aim of this study was to provide a detailed, comprehensive overview of somatic diseases that require hospitalization in long-term survivors of osteosarcoma and Ewing sarcoma. This study contributes new insights into the risk of somatic late effects in survivors of osteosarcoma and Ewing sarcoma which are urgently requested by pediatric oncologists, researchers, and by survivors and their families. The study provides an essential basis for the development of preventive intervention strategies and for optimal patient counseling and follow-up care, which all contribute to improving the health and quality of life in survivors. Abstract Survivors of malignant bone tumors in childhood are at risk of long-term adverse health effects. We comprehensively reviewed cases of somatic diseases that required a hospital contact in survivors of osteosarcoma and Ewing sarcoma. In a population-based cohort study, 620 five-year survivors of osteosarcoma (n = 440) or Ewing sarcoma (n = 180), diagnosed before the age of 20 years in Denmark, Finland, Iceland, and Sweden during 1943–2008, were followed in the national hospital registers. Overall rates of hospital contacts for any somatic disease and for 12 main diagnostic groups and 120 specific disease categories were compared with those in a matched comparison cohort (n = 3049) randomly selected from the national population registers. The rate of hospital contact for any somatic disease was 80% higher in survivors of malignant bone tumors than in comparisons and remained elevated up to 30 years after diagnosis. The rate of hospital contacts was higher after Ewing sarcoma (rate ratio (RR) 2.24; 95% confidence interval (CI) 1.76–2.85) than after osteosarcoma (RR 1.67; 95% CI 1.41–1.98). Elevated rates were observed for 11 main diagnostic groups, including infections, second malignant neoplasms, and diseases of the skin, bones, and circulatory, digestive, endocrine, and urinary systems. Survivors of malignant bone tumors in childhood are at increased risk of somatic diseases many years after diagnosis. This comprehensive study contributes new insight into the risk of late effects in survivors of osteosarcoma and Ewing sarcoma, which is an essential basis for optimal patient counseling and follow-up care.
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Affiliation(s)
- Camilla Pedersen
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; (E.A.W.A.); (L.K.); (F.N.N.); (A.B.); (J.F.W.)
- Correspondence:
| | - Catherine Rechnitzer
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
| | | | - Line Kenborg
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; (E.A.W.A.); (L.K.); (F.N.N.); (A.B.); (J.F.W.)
| | - Filippa Nyboe Norsker
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; (E.A.W.A.); (L.K.); (F.N.N.); (A.B.); (J.F.W.)
| | - Andrea Bautz
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; (E.A.W.A.); (L.K.); (F.N.N.); (A.B.); (J.F.W.)
| | - Thomas Baad-Hansen
- Department of Orthopedic Surgery, Sarcoma Centre of Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Laufey Tryggvadottir
- The Icelandic Cancer Registry, 105 Reykjavik, Iceland;
- Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland
| | | | - Anna Sällfors Holmqvist
- Department of Clinical Sciences Lund, Lund University, 222 41 Lund, Sweden; (A.S.H.); (L.H.)
- Department of Pediatric Hematology and Oncology, Skane University Hospital, 221 85 Lund, Sweden
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Lund University, 222 41 Lund, Sweden; (A.S.H.); (L.H.)
- Department of Pediatric Hematology and Oncology, Skane University Hospital, 221 85 Lund, Sweden
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; (E.A.W.A.); (L.K.); (F.N.N.); (A.B.); (J.F.W.)
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, 8200 Aarhus, Denmark
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20
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Helligsoe ASL, Henriksen LT, Kenborg L, Dehlendorff C, Winther JF, Hasle H. Factors influencing participation rates in clinical late-effect studies of childhood cancer survivors. Pediatr Blood Cancer 2021; 68:e29098. [PMID: 34022113 DOI: 10.1002/pbc.29098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/14/2021] [Revised: 03/17/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022]
Abstract
To ensure external validation of a study population in clinical late-effect studies of childhood cancer, the participation rate must be high. This study investigated demographic data in Nordic late-effect studies and potential factors impacting participation rates such as cancer type, time since diagnosis, and duration of clinical examinations. We found 80 published studies originating from 16 cohorts, with median follow-up of 6.0 years (range 3-14). The overall participation rates ranged from 27% to 100%. The highest participation rates were seen in studies of survivors with solid tumors (92%) and the lowest in hematologic malignancies (67%) and central nervous system tumors (73%). The clinical examination in 10 studies (62.5%) lasted for more than 3 hours. Neither duration of the clinical examination nor time since diagnosis seemed to affect the participation rate. We encourage future studies to describe the recruitment process more thoroughly to improve understanding of the factors influencing participation rates.
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Affiliation(s)
- Anne Sophie Lind Helligsoe
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Louise Tram Henriksen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Survivorship Research Group, Danish Cancer Society Research Center, Aarhus, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Aarhus, Denmark
| | - Jeanette Falck Winther
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Childhood Cancer Survivorship Research Group, Danish Cancer Society Research Center, Aarhus, Denmark
| | - Henrik Hasle
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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21
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Oskarsson T, Duun-Henriksen AK, Bautz A, Montgomery S, Harila-Saari A, Petersen C, Niinimäki R, Madanat-Harjuoja L, Tryggvadóttir L, Holmqvist AS, Hasle H, Heyman M, Winther JF. Skeletal adverse events in childhood cancer survivors: An Adult Life after Childhood Cancer in Scandinavia cohort study. Int J Cancer 2021; 149:1863-1876. [PMID: 34278568 DOI: 10.1002/ijc.33741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/14/2021] [Revised: 06/04/2021] [Accepted: 06/18/2021] [Indexed: 12/22/2022]
Abstract
The dynamic growth of the skeleton during childhood and adolescence renders it vulnerable to adverse effects of cancer treatment. The lifetime risk and patterns of skeletal morbidity have not been described in a population-based cohort of childhood cancer survivors. A cohort of 26 334 1-year cancer survivors diagnosed before 20 years of age was identified from the national cancer registries of Denmark, Finland, Iceland and Sweden as well as a cohort of 127 531 age- and sex-matched comparison subjects randomly selected from the national population registries in each country. The two cohorts were linked with data from the national hospital registries and the observed numbers of first-time hospital admissions for adverse skeletal outcomes among childhood cancer survivors were compared to the expected numbers derived from the comparison cohort. In total, 1987 childhood cancer survivors had at least one hospital admission with a skeletal adverse event as discharge diagnosis, yielding a rate ratio (RR) of 1.35 (95% confidence interval, 1.29-1.42). Among the survivors, we observed an increased risk for osteonecrosis with a RR of 25.9 (15.0-44.5), osteoporosis, RR 4.53 (3.28-6.27), fractures, RR 1.27 (1.20-1.34), osteochondropathies, RR 1.57 (1.28-1.92) and osteoarthrosis, RR 1.48 (1.28-1.72). The hospitalization risk for any skeletal adverse event was higher among survivors up to the age of 60 years, but the lifetime pattern was different for each type of skeletal adverse event. Understanding the different lifetime patterns and identification of high-risk groups is crucial for developing strategies to optimize skeletal health in childhood cancer survivors.
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Affiliation(s)
- Trausti Oskarsson
- Department of Paediatric Oncology, Astrid Lindgren Children's Hospital, Stockholm, Sweden.,Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Andrea Bautz
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Arja Harila-Saari
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Cecilia Petersen
- Department of Paediatric Oncology, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Riitta Niinimäki
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Laura Madanat-Harjuoja
- Finnish Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland.,Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laufey Tryggvadóttir
- The Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anna Sällfors Holmqvist
- Division of Paediatric Oncology and Haematology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Mats Heyman
- Department of Paediatric Oncology, Astrid Lindgren Children's Hospital, Stockholm, Sweden.,Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Falck 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
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22
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Meijer AJM, Diepstraten FA, Langer T, Broer L, Domingo IK, Clemens E, Uitterlinden AG, de Vries ACH, van Grotel M, Vermeij WP, Ozinga RA, Binder H, Byrne J, van Dulmen-den Broeder E, Garrè ML, Grabow D, Kaatsch P, Kaiser M, Kenborg L, Winther JF, Rechnitzer C, Hasle H, Kepak T, Kepakova K, Tissing WJE, van der Kooi ALF, Kremer LCM, Kruseova J, Pluijm SMF, Kuehni CE, van der Pal HJH, Parfitt R, Spix C, Tillmanns A, Deuster D, Matulat P, Calaminus G, Hoetink AE, Elsner S, Gebauer J, Haupt R, Lackner H, Blattmann C, Neggers SJCMM, Rassekh SR, Wright GEB, Brooks B, Nagtegaal AP, Drögemöller BI, Ross CJD, Bhavsar AP, Am Zehnhoff-Dinnesen AG, Carleton BC, Zolk O, van den Heuvel-Eibrink MM. TCERG1L allelic variation is associated with cisplatin-induced hearing loss in childhood cancer, a PanCareLIFE study. NPJ Precis Oncol 2021; 5:64. [PMID: 34262104 PMCID: PMC8280110 DOI: 10.1038/s41698-021-00178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/08/2020] [Accepted: 04/16/2021] [Indexed: 12/24/2022] Open
Abstract
In children with cancer, the heterogeneity in ototoxicity occurrence after similar treatment suggests a role for genetic susceptibility. Using a genome-wide association study (GWAS) approach, we identified a genetic variant in TCERG1L (rs893507) to be associated with hearing loss in 390 non-cranial irradiated, cisplatin-treated children with cancer. These results were replicated in two independent, similarly treated cohorts (n = 192 and 188, respectively) (combined cohort: P = 5.3 × 10-10, OR 3.11, 95% CI 2.2-4.5). Modulating TCERG1L expression in cultured human cells revealed significantly altered cellular responses to cisplatin-induced cytokine secretion and toxicity. These results contribute to insights into the genetic and pathophysiological basis of cisplatin-induced ototoxicity.
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Affiliation(s)
- A J M Meijer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - F A Diepstraten
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - T Langer
- Department of Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, Lübeck, Germany
| | - L Broer
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - I K Domingo
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| | - E Clemens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M van Grotel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - W P Vermeij
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - R A Ozinga
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - H Binder
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - J Byrne
- Boyne Research Institute, Drogheda, Ireland
| | - E van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- VU Medical Center, Amsterdam, The Netherlands
| | - M L Garrè
- Department of Neurooncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - D Grabow
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - P Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - M Kaiser
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - L Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - J 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
| | - C Rechnitzer
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - H Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - T Kepak
- University Hospital Brno, Brno, Czech Republic
- International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - K Kepakova
- University Hospital Brno, Brno, Czech Republic
- International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A L F van der Kooi
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - J Kruseova
- Department of Children Hemato-Oncology, Motol University Hospital Prague, Prague, Czech Republic
| | - S M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - H J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - R Parfitt
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - C Spix
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - A Tillmanns
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - D Deuster
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - P Matulat
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - G Calaminus
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - A E Hoetink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Utrecht, Utrecht, The Netherlands
| | - S Elsner
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - J Gebauer
- Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - R Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - H Lackner
- Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - C Blattmann
- Department of Pediatric Oncology/Hematology/Immunology, Stuttgart Cancer Center, Olgahospital, Stuttgart, Germany
| | - S J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S R Rassekh
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - G E B Wright
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - B Brooks
- Audiology and Speech Pathology Department, BC Children's Hospital, Vancouver, BC, Canada
| | - A P Nagtegaal
- Departement of Otorhinolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - B I Drögemöller
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - C J D Ross
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - A P Bhavsar
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - A G Am Zehnhoff-Dinnesen
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - B C Carleton
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - O Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School, Rüdersdorf, Germany
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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23
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Kieran MW, Caron H, Winther JF, Henderson TO, Haupt R, Hjorth L, Hudson MM, Kremer LCM, van der Pal HJ, Pearson ADJ, Pereira L, Reaman G, Skinner R, Vassal G, Weiner SL, Horton Taylor D. A global approach to long-term follow-up of targeted and immune-based therapy in childhood and adolescence. Pediatr Blood Cancer 2021; 68:e29047. [PMID: 33860611 DOI: 10.1002/pbc.29047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/02/2021] [Revised: 03/05/2021] [Accepted: 03/18/2021] [Indexed: 11/08/2022]
Abstract
While considerable efforts and progress in our understanding of the long-term toxicities of surgery, radiation and chemotherapy in children with cancer have been made over the last 5 decades, there continues to be a wide gap in our knowledge of the long-term health impact of most novel targeted and immunotherapy agents. To address this gap, ACCELERATE, a multi-stakeholder collaboration of clinical and translational academics, regulators from the EMA and FDA, patient/family advocates and members spanning small biotechnology through to large pharmaceutical companies have initiated the development of an international long-term follow-up data registry to collect this important information prospectively. Providing critical safety data on the long-term use of these approved and investigational therapies in children will support the regulatory requirements and labeling information. It will also provide the necessary insight to help guide physicians and families on the appropriateness of a targeted or immune therapy for their child and inform survivorship planning.
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Affiliation(s)
- Mark W Kieran
- ACCELERATE Platform LTFU Working Group Co-Chair, ACCELERATE, Brussels, Belgium.,Pediatric Oncology, Bristol Meyers Squibb, Lawrenceville, New Jersey, USA
| | - Hubert Caron
- Global Development Leader for Pediatric Oncology, Hoffmann-La Roche AG, Basel, Switzerland
| | - Jeanette Falck 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
| | - Tara O Henderson
- Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | - Riccardo Haupt
- PanCare, Bussum, The Netherlands.,Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Lars Hjorth
- PanCare, Bussum, The Netherlands.,Skane University Hospital, Lund University, Lund, Sweden
| | - Melissa M Hudson
- Cancer Survivorship Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Leontien C M Kremer
- Princess Máxima Center for pediatric oncology, Heidelberglaan 25, 3584 CS, and Wilhemina Children's Hospital, UMC, Utrecht, The Netherlands.,PanCare, Bussum, The Netherlands
| | - Helena J van der Pal
- Princess Máxima Center for pediatric oncology, Heidelberglaan 25, 3584 CS, and Wilhemina Children's Hospital, UMC, Utrecht, The Netherlands.,PanCare, Bussum, The Netherlands
| | | | | | - Gregory Reaman
- Pediatric Oncology Program, Oncology Center of Excellence and Office of Oncologic Diseases, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Roderick Skinner
- PanCare, Bussum, The Netherlands.,Department of Paediatric and Adolescent Haematology/Oncology, Translational and Clinical Research Institute, Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Gilles Vassal
- ACCELERATE, Brussels, Belgium.,Paediatric Oncology Department, Institut Gustave Roussy, Paris-Sud University, Villejuif, France
| | - Susan L Weiner
- Children's Cancer Cause, Washington, District of Columbia, USA
| | - Danielle Horton Taylor
- ACCELERATE Platform LTFU Working Group Co-Chair, ACCELERATE, Brussels, Belgium.,ACCELERATE, Brussels, Belgium.,Paediatric Oncology Reference Team (PORT), London, England
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- ACCELERATE Platform LTFU Working Group Co-Chair, ACCELERATE, Brussels, Belgium
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24
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van den Berg MH, van Dijk M, Byrne J, Berger C, Dirksen U, Winther JF, Fossa SD, Grabow D, Grandage VL, Haupt R, van den Heuvel-Eibrink MM, Kaiser M, Kepak T, van der Kooi ALF, Kremer LCM, Kruseova J, Lambalk CB, van Leeuwen FE, Leiper A, Modan-Moses D, Spix C, Twisk JWR, Ronckers CM, Kaatsch P, van Dulmen-den Broeder E. Treatment-related fertility impairment in long-term female childhood, adolescent and young adult cancer survivors: investigating dose-effect relationships in a European case-control study (PanCareLIFE). Hum Reprod 2021; 36:1561-1573. [PMID: 33744927 DOI: 10.1093/humrep/deab035] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/29/2019] [Revised: 01/21/2021] [Indexed: 02/02/2023] Open
Abstract
STUDY QUESTION Which chemotherapeutic agents and body site-specific radiation fields are dose-dependently associated with an increased risk of fertility impairment in long-term female childhood, adolescent and young adulthood (CAYA) cancer survivors? SUMMARY ANSWER Busulfan, lower abdominal radiotherapy (RT) and total body irradiation (TBI) seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively. WHAT IS KNOWN ALREADY Several treatment-related fertility deficits, as assessed by both self-reported outcomes and hormonal markers are known to occur following treatment of CAYA cancer. However, knowledge regarding precise dose-related estimates of these treatment-related risks are scarce. STUDY DESIGN, SIZE, DURATION The current case-control study was nested within the PanCareLIFE cohort study. In total, 1332 CAYA survivors from 8 countries, 9 institutions and 11 cohorts, participated in and contributed data to the study. PARTICIPANTS/MATERIALS, SETTING, METHODS All participants were female 5-year CAYA cancer survivors. In total, 450 cases (fertility impaired survivors) and 882 matched controls (not fertility impaired survivors) were included. Fertility impairment was defined using both questionnaire data (primary or secondary amenorrhea; use of artificial reproductive techniques; unfulfilled wish to conceive) and hormonal data (FSH and anti-Müllerian hormone (AMH)). Multivariable logistic regression models were used to investigate the effect of (i) alkylating agent exposure, and (ii) dose categories for individual chemotherapeutic agents and for RT-exposed body sites. MAIN RESULTS AND THE ROLE OF CHANCE A positive dose-effect relationship between cyclophosphamide equivalent dose (CED) score and fertility impairment was found, with survivors with a CED score > 7121 mg/m2 being at a significantly increased risk of fertility impairment (odds ratio (95% CI) = 2.6 (1.9-3.6) P < 0.001). Moreover, cumulative dose variables of the following treatments were significantly associated with fertility impairment: busulfan, carmustine, cyclophosphamide, melphalan, procarbazine, lower abdominal RT and TBI. Busulfan, lower abdominal RT and TBI seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively. LIMITATIONS, REASONS FOR CAUTION Our study may have been subject to selection bias since data from about half of the original base cohorts were available for the current study. This could impact the generalizability of our study results. WIDER IMPLICATIONS OF THE FINDINGS We identified survivors at high risk for fertility impairment and, consequently, for a reduced or even absent reproductive life span. Both girls and young women who are about to start anti-cancer treatment, as well as adult female survivors, should be counselled about future parenthood and referred to a reproductive specialist for fertility preservation, if desired. STUDY FUNDING/COMPETING INTEREST(S) This study has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 602030. There are no competing interests. TRIAL REGISTRATION NUMBER n/a.
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Affiliation(s)
- M H van den Berg
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M van Dijk
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Byrne
- Boyne Research Institute, Department of Epidemiology, Drogheda, Ireland
| | - C Berger
- Department of Pediatric Hematology and Oncology, University-Hospital, Saint-Etienne, France
| | - U Dirksen
- Department of Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - J 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
| | - S D Fossa
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - D Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | | | - R Haupt
- Gaslini Children Hospital, Epidemiology and Biostatistics Section, Genova, Italy
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Paediatric Oncology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - T Kepak
- University Hospital Brno, Brno, Czech Republic.,International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - A L F van der Kooi
- Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J Kruseova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - C B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam
| | - F E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Leiper
- Great Ormond Street Children's Hospital, London, UK
| | - D Modan-Moses
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - C Spix
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, THE Netherlands
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Institute for Biostatistics and Registry Research, Medical University Brandenburg, Neuruppin, Germany
| | - P Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - E van Dulmen-den Broeder
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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25
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Høgsholt S, Asdahl PH, Bonnesen TG, Holmqvist AS, Madanat-Harjuoja L, Tryggvadottir L, Bautz A, Albieri V, Green D, Winther JF, Hasle H. Disease-specific hospitalizations among 5-year survivors of Wilms tumor: A Nordic population-based cohort study. Pediatr Blood Cancer 2021; 68:e28905. [PMID: 33484071 DOI: 10.1002/pbc.28905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/28/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND With modern therapy, over 90% of Wilms tumor patients can expect to become long-term survivors, and focus on morbidity and late effects become increasingly important. We provide a novel evaluation and insight to subsequent hospitalizations in 5-year survivors of Wilms tumor. METHODS As part of the Adult Life after Childhood Cancer in Scandinavia (ALiCCS) study, we identified 5-year survivors of Wilms tumor. Based on stratified random sampling, we constructed a population comparison cohort. Outcomes of interest were overall hospitalizations; hospitalizations for specific organ systems and disease-specific categories. Standardized hospitalization rate ratios (SHRR) and absolute excess risks (AER) were calculated. RESULTS We included 913, 5-year survivors of Wilms tumor and 152 231 population comparisons. Survivors of Wilms tumor had an increased overall risk of being hospitalized (SHRR 1.8; 95% confidence interval (CI) 1.7-2.0). The hospitalization risk was increased within all major organ systems: urinary and genital organs (SHRR 2.5; 95% CI 2.1-3.0), endocrine (SHRR 2.5; 95% CI 1.9-3.3), cardiovascular (SHRR 2.2; 95% CI 1.7-2.9), and gastrointestinal (SHRR 1.5; 95% CI 1.3-1.8). Risks for specific diseases are reported in the study. CONCLUSIONS Survivors of Wilms tumor had higher risks than population comparisons for a wide range of diseases, with the highest risks seen for urinary, endocrine, and cardiovascular disorders. Five to 20 years after the Wilms tumor diagnosis, 43% of survivors had been hospitalized at least once versus 29% of population comparisons. The overall AER was 2.3, which translates into 0.2 extra hospitalizations in 10 years for every Wilms tumor survivor.
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Affiliation(s)
- Stine Høgsholt
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Peter Haubjerg Asdahl
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Trine Gade Bonnesen
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anna Sällfors Holmqvist
- Pediatric Oncology and Hematology, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland.,Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laufey Tryggvadottir
- The Icelandic Cancer Registry, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Andrea Bautz
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Vanna Albieri
- Unit of Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Daniel Green
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Henrik Hasle
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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26
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Mader L, Frederiksen LE, Bidstrup PE, Hargreave M, Kjær SK, Kuehni CE, Nielsen TT, Krøyer A, Winther JF, Erdmann F. Hospital Contacts for Psychiatric Disorders in Parents of Children With Cancer in Denmark. JNCI Cancer Spectr 2021; 5:pkab036. [PMID: 34085001 PMCID: PMC8164824 DOI: 10.1093/jncics/pkab036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/26/2020] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Having a child diagnosed with cancer is a devastating experience that may affect parents' mental health. We aimed to assess the risk of hospital contacts for psychiatric disorders in parents of children with cancer. Methods We conducted a nationwide population-based cohort study using Danish registry data. Parents of children diagnosed with cancer between 1982 and 2014 (n = 6689 mothers, n = 5509 fathers) were matched with comparison parents of cancer-free children (n = 67 544 mothers, n = 55 756 fathers). We used Cox proportional hazards models to estimate the risk of hospital contacts for any psychiatric disorder and specific disorders. Cox models were also used to investigate sociodemographic and cancer-related risk factors for psychiatric disorders. Results Incidence rates of hospital contacts for any psychiatric disorder were 426 per 100 000 person-years in mothers of children with cancer and 345 per 100 000 person-years in comparison mothers. For fathers, the respective incidence rates were 260 and 262 cases per 100 000 person-years. Compared with parents of cancer-free children, mothers of children with cancer were at an increased risk of hospital contacts for any psychiatric disorder (hazard ratio = 1.23, 95% confidence interval = 1.12 to 1.36), whereas no elevated risk was seen in fathers (hazard ratio = 0.99, 95% confidence interval = 0.87 to 1.13). Among mothers, risks were particularly elevated for affective and stress-related disorders. Parents of deceased children and children diagnosed at a younger age were at particular risk of hospital contacts for psychiatric disorders. Conclusion Hospital contacts for psychiatric disorders were overall rare. Health-care professionals should draw attention to subgroups of vulnerable parents to meet their needs of support and adequate treatment.
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Affiliation(s)
- Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Marie Hargreave
- Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjær
- Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | | | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Falck 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
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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27
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van der Kooi ALLF, van Dijk M, Broer L, van den Berg MH, Laven JSE, van Leeuwen FE, Lambalk CB, Overbeek A, Loonen JJ, van der Pal HJ, Tissing WJ, Versluys B, Bresters D, Beerendonk CCM, Ronckers CR, van der Heiden-van der Loo M, Kaspers GL, de Vries ACH, Robison LL, Hudson MM, Chemaitilly W, Byrne J, Berger C, Clemens E, Dirksen U, Falck Winther J, Fosså SD, Grabow D, Haupt R, Kaiser M, Kepak T, Kruseova J, Modan-Moses D, Pluijm SMF, Spix C, Zolk O, Kaatsch P, Krijthe JH, Kremer LC, Yasui Y, Brooke RJ, Uitterlinden AG, van den Heuvel-Eibrink MM, van Dulmen-den Broeder E. Possible modification of BRSK1 on the risk of alkylating chemotherapy-related reduced ovarian function. Hum Reprod 2021; 36:1120-1133. [PMID: 33582778 PMCID: PMC7970730 DOI: 10.1093/humrep/deaa342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/24/2020] [Revised: 11/05/2020] [Indexed: 01/23/2023] Open
Abstract
STUDY QUESTION Do genetic variations in the DNA damage response pathway modify the adverse effect of alkylating agents on ovarian function in female childhood cancer survivors (CCS)? SUMMARY ANSWER Female CCS carrying a common BR serine/threonine kinase 1 (BRSK1) gene variant appear to be at 2.5-fold increased odds of reduced ovarian function after treatment with high doses of alkylating chemotherapy. WHAT IS KNOWN ALREADY Female CCS show large inter-individual variability in the impact of DNA-damaging alkylating chemotherapy, given as treatment of childhood cancer, on adult ovarian function. Genetic variants in DNA repair genes affecting ovarian function might explain this variability. STUDY DESIGN, SIZE, DURATION CCS for the discovery cohort were identified from the Dutch Childhood Oncology Group (DCOG) LATER VEVO-study, a multi-centre retrospective cohort study evaluating fertility, ovarian reserve and risk of premature menopause among adult female 5-year survivors of childhood cancer. Female 5-year CCS, diagnosed with cancer and treated with chemotherapy before the age of 25 years, and aged 18 years or older at time of study were enrolled in the current study. Results from the discovery Dutch DCOG-LATER VEVO cohort (n = 285) were validated in the pan-European PanCareLIFE (n = 465) and the USA-based St. Jude Lifetime Cohort (n = 391). PARTICIPANTS/MATERIALS, SETTING, METHODS To evaluate ovarian function, anti-Müllerian hormone (AMH) levels were assessed in both the discovery cohort and the replication cohorts. Using additive genetic models in linear and logistic regression, five genetic variants involved in DNA damage response were analysed in relation to cyclophosphamide equivalent dose (CED) score and their impact on ovarian function. Results were then examined using fixed-effect meta-analysis. MAIN RESULTS AND THE ROLE OF CHANCE Meta-analysis across the three independent cohorts showed a significant interaction effect (P = 3.0 × 10-4) between rs11668344 of BRSK1 (allele frequency = 0.34) among CCS treated with high-dose alkylating agents (CED score ≥8000 mg/m2), resulting in a 2.5-fold increased odds of a reduced ovarian function (lowest AMH tertile) for CCS carrying one G allele compared to CCS without this allele (odds ratio genotype AA: 2.01 vs AG: 5.00). LIMITATIONS, REASONS FOR CAUTION While low AMH levels can also identify poor responders in assisted reproductive technology, it needs to be emphasized that AMH remains a surrogate marker of ovarian function. WIDER IMPLICATIONS OF THE FINDINGS Further research, validating our findings and identifying additional risk-contributing genetic variants, may enable individualized counselling regarding treatment-related risks and necessity of fertility preservation procedures in girls with cancer. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the PanCareLIFE project that has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no 602030. In addition, the DCOG-LATER VEVO study was funded by the Dutch Cancer Society (Grant no. VU 2006-3622) and by the Children Cancer Free Foundation (Project no. 20) and the St Jude Lifetime cohort study by NCI U01 CA195547. The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Anne-Lotte L F van der Kooi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marloes van Dijk
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Paediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marleen H van den Berg
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Paediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cornelis B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annelies Overbeek
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline J Loonen
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Wim J Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatric Oncology/Haematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatric Oncology, Wilhelmina Children’s Hospital/University Medical Center, Utrecht, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Willem-Alexander Children’s Hospital/Leiden University Medical Center, Leiden, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cécile R Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Brandenburg Medical School, Neuruppin, Germany
| | | | - Gertjan L Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Paediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric oncology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Leslie L Robison
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Wassim Chemaitilly
- Division of Endocrinology, Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Claire Berger
- Department of Paediatric Oncology, University Hospital, St-Etienne, France
- Epidemiology of Childhood and Adolescent Cancers, CRESS, INSERM, UMR 1153, Paris Descartes University, Villejuif, France
| | - Eva Clemens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Uta Dirksen
- University Hospital Essen, Pediatrics III, West German Cancer Centre, Essen, Germany
- German Cancer Consortium, DKTK, Site Essen, Essen, Germany
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Sophie D Fosså
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Desiree Grabow
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
- DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Melanie Kaiser
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Tomas Kepak
- University Hospital Brno, International Clinical Research Center (FNUSA-ICRC), Masaryk University, Brno, Czech Republic
| | | | - Dalit Modan-Moses
- The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Claudia Spix
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Oliver Zolk
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, University Hospital Ulm, Ulm, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Jesse H Krijthe
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Yutaka Yasui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Russell J Brooke
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric oncology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Paediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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28
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Salem H, Kazak AE, Andersen EW, Belmonte F, Johansen C, Schmiegelow K, Winther JF, Wehner PS, Hasle H, Rosthøj S, Bidstrup PE. Home-based cognitive behavioural therapy for families of young children with cancer (FAMOS): A nationwide randomised controlled trial. Pediatr Blood Cancer 2021; 68:e28853. [PMID: 33369038 DOI: 10.1002/pbc.28853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/29/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Evidence-based knowledge is needed to reduce psychological symptoms in families of young children with cancer after treatment ends. OBJECTIVE To evaluate the effect of a psychotherapeutic intervention, FAMily-Oriented Support (FAMOS) on parents of young children after cancer treatment. METHODS All families of children aged 0-6 years who had been treated for cancer at one of the four paediatric oncology departments in Denmark were invited to participate after ending intensive medical treatment. The families were randomly assigned 1:1 to up to seven sessions of FAMOS, a cognitive-behavioural manualised home intervention, for 6 months or to usual psychosocial care. The primary outcome was parents' symptoms of posttraumatic stress disorder (PTSD) at 6 and 12 months after enrolment. The secondary outcomes were parents' symptoms of depression and anxiety. RESULTS We enrolled 109 families (204 parents). Parents in the intervention group did not show a statistically significant decrease in symptoms of PTSD as compared with the control group at 6 months (predicted mean difference, -0.10; 95% confidence interval [CI] -0.19, 0.01), but a statistically significant decrease was seen at 12 months (predicted mean difference, -0.15; 95% CI -0.28, -0.02), and they had significantly lower symptoms of depression at both 6 and 12 months. Differences in reductions in symptoms of anxiety were not statistically significant. CONCLUSIONS The FAMOS intervention reduced parents' symptoms of PTSD and depression. Next step is to also report on psychological effects in the children and siblings (clinicaltrials.gov: NCT02200731).
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Affiliation(s)
- Hanin Salem
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne E Kazak
- Nemours Children's Health System, Wilmington, Delaware
| | | | - Federica Belmonte
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Late Effect Research Unit, Oncology Clinic, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Institute of Clinical Medicine, Medical Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, and Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
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29
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Wilhelmsson M, Jahnukainen K, Winiarski J, Abrahamsson J, Bautz A, Gudmundsdottir T, Madanat‐Harjuoja L, Holmqvist AS, Winther JF, Hasle H. Hospitalizations in long-term survivors of childhood AML treated with allogeneic HCT-An Adult Life after Childhood Cancer in Scandinavia (ALiCCS) study. Am J Hematol 2021; 96:E74-E77. [PMID: 33326137 DOI: 10.1002/ajh.26071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/07/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Mari Wilhelmsson
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Department of Pediatrics Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
| | - Kirsi Jahnukainen
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Division of Haematology‐Oncology and Stem Cell Transplantation Children's Hospital, University of Helsinki, Helsinki University Central Hospital Helsinki Finland
| | - Jacek Winiarski
- Department of Pediatrics Astrid Lindgren Children's Hospital, Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention, and Technology Karolinska Institutet Stockholm Sweden
| | - Jonas Abrahamsson
- Department of Pediatrics Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Andrea Bautz
- Childhood Cancer Research Group Danish Cancer Society Research Center Copenhagen Denmark
| | | | - Laura‐Maria Madanat‐Harjuoja
- Finnish Cancer Registry Institute for Statistical and Epidemiological Cancer Research Helsinki Finland
- Department of Pediatrics Dana‐Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center Boston Massachusetts USA
| | - Anna Sällfors Holmqvist
- Pediatric Oncology and Hematology, Skåne University Hospital, Department of Clinical Sciences Lund University Lund Sweden
| | - Jeanette Falck 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
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine Aarhus University Hospital Skejby Aarhus Denmark
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30
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Lund LW, Winther JF, Cederkvist L, Rechnitzer C, Dalton SO, Appel CW, Schmiegelow K, Johansen C. Antidepressant Use in Siblings of Children With Cancer: A Danish Population-Based Cohort Study. JNCI Cancer Spectr 2020; 4:pkaa046. [PMID: 33134828 PMCID: PMC7583159 DOI: 10.1093/jncics/pkaa046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/27/2019] [Revised: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022] Open
Abstract
Siblings of children with cancer experience severe stress early in life. Most studies of mental health problems in these siblings are limited by being small, cross-sectional, or self-reporting. In a population-based cohort study, we investigated the risk for antidepressant use by linking several nationwide, population-based registries comparing 6644 siblings of children diagnosed with cancer from 1991-2009 with 128 436 population-based sibling comparisons using the Cox proportional hazards model. Irrespective of cancer type, no increased risk of antidepressant use in siblings of children with cancer was found (hazard ratio = 1.00, 95% confidence interval = 0.91 to 1.11). However, data suggested that siblings being young at cancer diagnosis had an increased risk (2-sided Ptrend = .01). Interaction analyses showed no modifying effect of parental socioeconomic position or antidepressant use. Findings from this study with a very low risk of bias are reassuring and important for families facing childhood cancer and for clinicians counseling these families.
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Affiliation(s)
- Lasse Wegener Lund
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark.,Paediatric and Adolescent Medicine, Juliane Marie Centre, University Hospital Rigshospitalet, Pediatric Clinics, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Luise Cederkvist
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
| | - Catherine Rechnitzer
- Paediatric and Adolescent Medicine, Juliane Marie Centre, University Hospital Rigshospitalet, Pediatric Clinics, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | | | - Kjeld Schmiegelow
- Paediatric and Adolescent Medicine, Juliane Marie Centre, University Hospital Rigshospitalet, Pediatric Clinics, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.,Cancer Late Effect Research, Oncology Clinic, Center for Surgery and Cancer, Rigshospitalet, Copenhagen, Denmark
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31
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Norsker FN, Boschini C, Rechnitzer C, Holmqvist AS, Tryggvadottir L, Madanat-Harjuoja LM, Schrøder H, Scheike TH, Hasle H, Winther JF, Andersen KK. Risk of late health effects after soft-tissue sarcomas in childhood - a population-based cohort study within the Adult Life after Childhood Cancer in Scandinavia research programme. Acta Oncol 2020; 59:1246-1256. [PMID: 32692292 DOI: 10.1080/0284186x.2020.1794031] [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: 11/12/2022]
Abstract
BACKGROUND In the 1960s only 1/3 of children with soft-tissue sarcomas survived, however with improved treatments survival today has reached 70%. Given the previous poor survival and the rarity of soft-tissue sarcomas, the risk of somatic late effects in a large cohort of Nordic soft-tissue sarcoma survivors has not yet been assessed. METHODS In this population-based cohort study we identified 985 five-year soft-tissue sarcoma survivors in Nordic nationwide cancer registries and late effects in national hospital registries covering the period 1964-2012. Information on tumour site and radiotherapy was available for Danish and Finnish survivors (N = 531). Using disease-specific rates of first-time hospital contacts for somatic diseases in survivors and in 4,830 matched comparisons we calculated relative rates (RR) and rate differences (RD). RESULTS Survivors had a RR of 1.5 (95% CI 1.4-1.7) and an absolute RD of 23.5 (17.7-29.2) for a first hospital contact per 1,000 person-years. The highest risks in both relative and absolute terms were of endocrine disorders (RR = 2.5; RD = 7.6), and diseases of the nervous system (RR = 1.9; RD = 6.6), digestive organs (RR = 1.7; RD = 5.4) and urinary system (RR = 1.7; RD = 5.6). By tumour site, excess risk was lower after extremity tumours. Irradiated survivors had a 2.6 (1.2-5.9) times higher risk than non-irradiated. CONCLUSIONS Soft-tissue sarcoma survivors have an increased risk of somatic late effects in 5 out of 10 main diagnostic groups of diseases, and the risk remains increased up to 40 years after cancer diagnosis. Risks were slightly lower for those treated for tumours in the extremities, and radiotherapy increased the risk by more than two-fold.
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Affiliation(s)
- Filippa Nyboe Norsker
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Cristina Boschini
- Unit of Statistics and Pharmaco-epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Catherine Rechnitzer
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Sällfors Holmqvist
- Division of Paediatric Oncology and Hematology, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Laufey Tryggvadottir
- The Icelandic Cancer Registry, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Henrik Schrøder
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas H. Scheike
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Hasle
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jeanette Falck 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
| | - Klaus Kaae Andersen
- Unit of Statistics and Pharmaco-epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
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32
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Sørensen GV, Winther JF, de Fine Licht S, Andersen KK, Holmqvist AS, Madanat-Harjuoja L, Tryggvadottir L, Bautz A, Lash TL, Hasle H. Long-Term Risk of Hospitalization Among Five-Year Survivors of Childhood Leukemia in the Nordic Countries. J Natl Cancer Inst 2020; 111:943-951. [PMID: 30753563 DOI: 10.1093/jnci/djz016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/15/2018] [Accepted: 02/05/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Adverse effects from childhood leukemia treatment may persist or present years after cure from cancer. We provide a comprehensive evaluation of subsequent hospitalization in five-year survivors of childhood acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML). METHODS In the Adult Life after Childhood Cancer in Scandinavia Study, we identified 4003 five-year survivors diagnosed with childhood leukemia 1970-2008 in Denmark, Sweden, Iceland, and Finland. Survivors and 129 828 population comparisons were followed for first-time nonpsychiatric hospitalizations for 120 disease categories in the hospital registries. Standardized hospitalization rate ratios and absolute excess rates were calculated. All statistical tests were two-sided. RESULTS Survivors of ALL (n = 3391), AML (n = 389), and CML (n = 92) had an increased overall hospitalization rate compared with population comparisons. The rate ratio for any hospitalization was 1.95 (95% confidence interval [CI] = 1.83 to 2.07) in ALL, 3.09 (95% CI = 2.53 to 3.65) in AML, and 4.51 (95% CI = 3.03 to 6.00) in CML survivors and remained increased even 20 years from leukemia diagnosis. Corresponding absolute excess rates per 1000 person-years were 28.48 (95% CI = 24.96 to 32.00), 62.75 (95% CI = 46.00 to 79.50), and 105.31 (95% CI = 60.90 to 149.72). CONCLUSION Leukemia survivors have an increased rate of hospitalization for medical conditions. We provide novel insight into the relative and absolute rate of hospitalization for 120 disease categories in survivors of ALL, AML, and CML, which are likely to be informative for both survivors and healthcare providers.
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33
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Doser K, Andersen EW, Kenborg L, Dalton SO, Jepsen JRM, Krøyer A, Østergaard J, Hove H, Sørensen SA, Johansen C, Mulvihill J, Winther JF, Bidstrup PE. Clinical characteristics and quality of life, depression, and anxiety in adults with neurofibromatosis type 1: A nationwide study. Am J Med Genet A 2020; 182:1704-1715. [PMID: 32484306 DOI: 10.1002/ajmg.a.61627] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 10/31/2019] [Revised: 03/20/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a genetic condition characterized by numerous somatic manifestations. The psychosocial burden in adults has rarely been studied. We examined the prevalence of self-reported impairment of quality of life (QoL), symptoms of anxiety and depression and need for support, associated with disease severity and visibility. We conducted a nationwide cross-sectional study of all 467 adults with NF1 diagnosed between 1977 and 2016 at one of the two national centers for rare diseases in Denmark. A total of 244 (56% response rate) completed a questionnaire that included standard measures of QoL, symptoms of depression and anxiety, indicators of disease-related severity, visibility, and need for professional support. Associations between disease severity and visibility and psychosocial burden were analyzed in descriptive and multivariate models. We observed impaired QoL (mean = 81.3; 95% CI, 76.2; 86.4); 19% reported symptoms of depression (mean = 5.7; SD = 5.4), and 15% reported anxiety (mean = 5.1; SD = 5.2) at a clinical level. Adults with NF1 also reported requiring professional support for physical, psychological, and work-related problems. Disease severity and (partly) visibility were significantly (p < .0001) associated with psychosocial well-being and a requirement for support. This study provides new understanding of the factors associated with impaired QoL, indicating that follow-up care should be optimized into adult life.
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Affiliation(s)
- Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research and Center for Neuropsychiatric Schizophrenia Research, Mental Health Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Center, Mental Health Services Capital Region Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - John Østergaard
- Center for Rare Disease, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Hove
- The RAREDIS Database, Center for Rare Diseases, Copenhagen University Hospital and Aarhus University, Copenhagen, Denmark
| | - Sven Asger Sørensen
- Department of Neurogenetics, Institute of Cellular and Molecular Medicine, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Oncology Clinic, Finsen Center, Copenhagen, Denmark
| | - John Mulvihill
- Department of Pediatrics, University of Oklahoma, Norman, Oklahoma, USA
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Faculty of Health, Department of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Mader L, Hargreave M, Frederiksen LE, Bidstrup PE, Dalton SO, Kjaer SK, Nielsen TT, Kroyer A, Winther JF, Erdmann F. The impact of childhood cancer on parental separation, divorce, and family planning in Denmark. Cancer 2020; 126:3330-3340. [PMID: 32449155 DOI: 10.1002/cncr.32901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/22/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Childhood cancer is a devastating experience for the family. The objective of the current study was to assess the impact of having a child with cancer on parental separation, divorce, and future family planning among families residing in Denmark. METHODS The authors conducted a nationwide cohort study using Danish registry data. Parents of children diagnosed with cancer between 1982 and 2014 (7066 children and 12,418 case parents) were matched with 10 comparison parents of cancer-free children per case parent (69,993 children and 125,014 comparison parents). We used discrete-time Cox regression models to compare the risk of separation (end of cohabitation) and divorce between case and comparison parents, and to identify risk factors for separation and divorce among case parents only. Descriptive statistics were used to compare family planning between case and comparison parents. RESULTS Case parents were found to have a slightly lower risk of separation (hazard ratio, 0.96; 95% confidence interval, 0.93-0.99) and divorce (hazard ratio, 0.92; 95% confidence interval, 0.87-0.97) than comparison parents. The authors found that case parents who were aged <45 years, with short education (an International Standard Classification of Education code indicating early childhood education, primary education, and lower secondary education), and who were unemployed were at an increased risk of separation and divorce. Moreover, the parents of children diagnosed with cancer at a young age (aged <15 years) were more likely to separate or divorce. No differences with regard to the total number of children and time to a next child after the cancer diagnosis were observed between case and comparison parents. CONCLUSIONS Having a child with cancer was not associated with an overall adverse impact on parents' risk of separation or divorce and future family planning. These encouraging findings should be communicated to parents to support them along their child's cancer trajectory.
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Affiliation(s)
- Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marie Hargreave
- Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Services, Zealand University Hospital, Naestved, Denmark
| | - Susanne K Kjaer
- Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Anja Kroyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Falck 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
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
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Erdmann F, Frederiksen LE, Bonaventure A, Mader L, Hasle H, Robison LL, Winther JF. Childhood cancer: Survival, treatment modalities, late effects and improvements over time. Cancer Epidemiol 2020; 71:101733. [PMID: 32461035 DOI: 10.1016/j.canep.2020.101733] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [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: 11/27/2019] [Revised: 04/01/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022]
Abstract
Since the 1960s, paediatric oncologists have gradually become better organised in large study groups and participation in clinical trials is today considered as the standard of care, with most children with cancer in Europe and North America being enrolled on available treatment protocols. Chemotherapy is nowadays the main element of therapy, but irradiation is still required for some patients. With the advent of multimodality therapy and supportive care, five-year cancer survival exceeds 80 % in most European and North American countries today. The substantial improvements in survival led to a constantly growing population of childhood cancer survivors. Concerns regarding the risk of late effects of the intensive cancer treatment at a young age, together with increasing numbers of survivors, have directed attention towards survivorship research. Survivors of childhood cancer are at longstanding risk of various severe somatic and mental health conditions attributable to the cancer and its treatment, as well as adverse social and socioeconomic consequences, and diminished psychological well-being and quality of life. It is, however, important to stress that some survivors have no or very mild adverse health conditions. Nevertheless, joint efforts are warranted for the care and long-term follow-up of childhood cancer patients. With this article, we provide a comprehensive overview of improvements in survival and treatment modalities over time, as well as the related somatic and mental late effects, and social and socioeconomic difficulties that these children might encounter later in life.
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Affiliation(s)
- Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Denmark; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Germany.
| | | | - Audrey Bonaventure
- Epidemiology of Childhood and Adolescent Cancer Team, Centre of Research in Epidemiology and Statistics, University of Paris, UMR 1153 INSERM, France
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Denmark; Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital, Denmark
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, 38105, United States
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Denmark
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Kenborg L, Winther JF, Linnet KM, Krøyer A, Albieri V, Holmqvist AS, Tryggvadottir L, Madanat-Harjuoja LM, Stovall M, Hasle H, Olsen JH. Neurologic disorders in 4858 survivors of central nervous system tumors in childhood-an Adult Life after Childhood Cancer in Scandinavia (ALiCCS) study. Neuro Oncol 2020; 21:125-136. [PMID: 29850875 DOI: 10.1093/neuonc/noy094] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background A comprehensive overview of neurologic complications among survivors of central nervous system (CNS) tumors in childhood is lacking. We aimed to investigate the risk for these disorders in a large, population-based study with outcome measures from nationwide hospital registries. Methods We identified 4858 five-year survivors with diagnoses of CNS tumor in childhood in Denmark, Iceland, Finland, and Sweden in 1943-2007, and 166658 matched population comparison subjects. Inpatient discharge diagnoses of neurologic disorders were used to calculate relative risks (RRs) and absolute excess risks (AERs). Results A neurologic disorder was verified in 1309 survivors, while 92.4 were expected, yielding an overall RR of 14.2 (95% confidence interval [CI]: 13.3-15.1) and an AER of 20 hospitalizations per 1000 persons per year. The risks remained increased more than 20 years after diagnosis (RR: 6.3, 95% CI: 5.6-7.2; AER: 11, 9-12). The most frequent diagnoses were epilepsy (affecting 14.1% of all survivors) followed by hydrocephalus (9.5%) and paralytic syndromes (4.2%), with RRs of 28.7 (95% CI: 26.0-31.6), 243 (95% CI: 190-311), and 40.3 (95% CI: 33.1-49.2), respectively. Of these outcomes, 30%-40% were diagnosed prior to or synchronously with the CNS tumor. The survivors had highly increased RRs for infectious diseases of the CNS, disorders of cranial nerves, and degenerative diseases of the nervous system. Conclusions Survivors of childhood CNS tumors are at markedly increased risk for neurologic disorders throughout their lives. Health care professionals must be aware of survivors who might benefit from preventive interventions and intensive follow-up.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Vanna Albieri
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anna Sällfors Holmqvist
- Department of Clinical Sciences, Lund University, Pediatric Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Laufey Tryggvadottir
- The Icelandic Cancer Registry, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Marilyn Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Texas, Houston, USA
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen H Olsen
- Research Management and Administration, Danish Cancer Society Research Center, Copenhagen, Denmark
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Grabas MR, Kjaer SK, Frederiksen MH, Winther JF, Erdmann F, Dehlendorff C, Hargreave M. Incidence and time trends of childhood cancer in Denmark, 1943-2014. Acta Oncol 2020; 59:588-595. [PMID: 32048526 DOI: 10.1080/0284186x.2020.1725239] [Citation(s) in RCA: 17] [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] [Indexed: 12/16/2022]
Abstract
Background: Surveillance of childhood cancer incidence is informative for etiologic research and health policy. However, high-quality data covering several decades of virtually complete cancer diagnosis in children is sparse.Methods: Incident cases of childhood cancer (0-19 years at diagnosis), classified according to Birch and Marsden's International Classification of Childhood Cancer, first edition (ICCC-1), were identified in the Danish Cancer Registry and used to calculate age-standardized incidence rates (ASRs) and estimated annual percentage change (EAPC) separately for 1943-1977 (early period) and 1977-2014 (recent period).Results: During 1943-2014, 15,184 childhood cancer cases were reported. The ASR for any cancer was 13.0 per 100 000 person-years in the early period (EAPC 0.55%; 95% CI 0.30-0.80) and 17.7 per 100 000 person-years in the recent period (EAPC 1.16%; 95% CI 0.96-1.36). In both periods, the increasing trend was seen in both boys (EAPC 0.69%; 95% CI 0.43-0.96/EAPC 0.96%; 95% CI 0.75-1.17) and girls (EAPC 0.37%; 95% CI -0.01-0.75/EAPC 1.41%; 95% CI 1.11-1.72) and in children aged 0-14 years (EAPC 0.53%; 95% CI 0.26-0.80/EAPC 0.86%; 95% CI 0.64-1.08) and 15-19 years (EAPC 0.60%; 95% CI 0.19-1.02/EAPC 1.97%; 95% CI 1.67-2.28). Increasing trends were observed for all main diagnostic groups.Conclusions: The incidence of childhood cancer in Denmark has increased since the 1940s, especially since 1977 and in older children. In recent years the increase has been most pronounced among girls.
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Affiliation(s)
- Mads Ravn Grabas
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K. Kjaer
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Marie Hoffmann Frederiksen
- Department of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Dehlendorff
- Department of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marie Hargreave
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
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Kjaer TK, Andersen EAW, Winther JF, Bidstrup PE, Borre M, Møller H, Larsen SB, Johansen C, Dalton SO. Long-term Somatic Disease Risk in Adult Danish Cancer Survivors. JAMA Oncol 2020; 5:537-545. [PMID: 30844031 DOI: 10.1001/jamaoncol.2018.7192] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Long-term health effects of cancer in adult survivors are a major concern; however, it is difficult to differentiate between the consequences of cancer and cancer treatment and those of normal aging or comorbidity. Objectives To provide an overview and investigate the temporal pattern of hospitalizations for medically verified incident somatic disease in adult survivors compared with cancer-free comparison people, taking into consideration pretreatment comorbidity and the socioeconomic position of the participants. Design, Setting, and Participants In this nationwide, population-based cohort-cohort study, 458 646 survivors of the 12 most frequent first primary cancers listed in the Danish Cancer Registry between January 1, 1997, and December 31, 2014, and 2 121 567 matched cancer-free comparison people were identified from the Danish Central Population Registry. Hospitalizations for somatic diseases after cancer diagnosis or study entry were identified from the National Patient Register and stratified according to the 11 main diagnostic groups in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. A cohort of cancer survivors was formed for each combination of cancer type and diagnostic group, with a corresponding group of cancer-free people, resulting in 132 unique cohorts. Data analysis was performed from September 1, 2017, to January 15, 2018. Main Outcomes and Measures Risk of hospitalization and the temporal pattern of incidence were analyzed in Cox proportional hazards regression models. Cumulative incidence proportions were calculated by the pseudo-observation method. Results A total of 2 580 213 people were investigated, of whom 458 646 were cancer survivors (mean [SD] age, 69 [11.6] years; 230 793 [50.3%] male and 227 853 [49.7%] female) and 2 121 567 were comparison people (mean [SD] age, 69 [11.5] years; 1 054 465 [49.7%] male and 1 067 102 [50.3%] female). More cancer survivors vs comparison people had comorbid conditions at the time of cancer diagnosis or study entry (Charlson Comorbidity Index ≥1: 19% vs 13%). Overall, the risk of hospitalizations for somatic diseases was significantly higher for cancer survivors in almost all diagnostic groups (eg, diseases in the nervous system among breast cancer survivors: hazard ratio, 1.20; 95% CI, 1.17-1.22; diseases in the respiratory system in lung cancer survivors: hazard ratio, 5.85; 95% CI, 5.63-6.07; and diseases in blood and blood-forming organs in prostate cancer survivors: hazard ratio, 2.60; 95% CI, 2.50-2.71). Conclusions and Relevance The findings suggest that adult survivors of the 12 most common cancers are at significantly higher risk for a broad range of somatic diseases that require hospitalization compared with matched cancer-free comparison people. The results of this study suggest the importance of close, targeted monitoring for new somatic disease during follow-up care of cancer survivors.
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Affiliation(s)
| | | | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Møller
- Cancer Epidemiology & Population Health, King's College London, London, England.,The Danish Clinical Registries, Aarhus, Denmark
| | - Signe Benzon Larsen
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
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Norsker FN, Rechnitzer C, Andersen EW, Linnet KM, Kenborg L, Holmqvist AS, Tryggvadottir L, Madanat-Harjuoja LM, Øra I, Thorarinsdottir HK, Vettenranta K, Bautz A, Schrøder H, Hasle H, Winther JF. Neurologic disorders in long-term survivors of neuroblastoma - a population-based cohort study within the Adult Life after Childhood Cancer in Scandinavia (ALiCCS) research program. Acta Oncol 2020; 59:134-140. [PMID: 31591921 DOI: 10.1080/0284186x.2019.1672892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Neuroblastoma is the commonest extracranial solid tumor of childhood, yet rare, and with poor survival before 1990, especially for high-risk disease; thus, information on late effects is sparse. With great advances in cancer treatment, survival has reached 80% in the Nordic countries. The aim of the study was to investigate the risk of developing neurologic disorders after neuroblastoma.Material and methods: Through population-based cancer registries of four Nordic countries we identified 654 5-year survivors of neuroblastoma (diagnosed 1959-2008) and 133,668 matched population comparisons. We grouped neurologic diagnoses from national hospital registries into 11 main diagnostic categories and 56 disease-specific sub-categories and calculated relative risks (RRs), absolute excess risks (AERs), cumulative incidence and mean cumulative count (MCC). Information on cancer treatment was available for 49% of survivors.Results: A hospital contact for a neurologic disorder was observed in 181 survivors 5 years or more from cancer diagnosis with 59 expected, yielding a RR of 3.1 (95% CI 2.7-3.6) and an AER of 16 per 1,000 person-years (95% CI 12-19). The most frequent disorders included epilepsy, paralytic syndromes, diseases of the eyes and ears and hearing loss. The cumulative incidence of any neurologic disorder was 31% in survivors 20 years after cancer diagnosis with a MCC of 0.5 unique diagnoses. All risks were highest in survivors of high-risk neuroblastoma.Conclusion: Neuroblastoma survivors represent a population with a high risk of developing neurologic disorders. Our results should contribute to improving health care planning and underscores the need for systematic follow-up care of this vulnerable group of survivors.
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Affiliation(s)
- Filippa Nyboe Norsker
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
| | - Catherine Rechnitzer
- Rigshospitalet, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Karen Markussen Linnet
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Line Kenborg
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
| | - Anna Sällfors Holmqvist
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Division of Paediatric Oncology and Haematology, Skane University Hospital, Lund, Sweden
| | - Laufey Tryggvadottir
- The Icelandic Cancer Registry, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Ingrid Øra
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Division of Paediatric Oncology and Haematology, Skane University Hospital, Lund, Sweden
| | | | - Kim Vettenranta
- University of Helsinki Hospital for Children and Adolescents, Helsinki, Finland
| | - Andrea Bautz
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
| | - Henrik Schrøder
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Hasle
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jeanette Falck 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
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Frederiksen LE, Erdmann F, Wesseling C, Winther JF, Mora AM. Parental tobacco smoking and risk of childhood leukemia in Costa Rica: A population-based case-control study. Environ Res 2020; 180:108827. [PMID: 31655332 DOI: 10.1016/j.envres.2019.108827] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The role of environmental and behavioral exposures on childhood leukemia etiology is poorly understood. We examined the association of maternal and paternal tobacco smoking at different time points with the risk of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) in Costa Rican children. MATERIALS AND METHODS We conducted a population-based case-control study on childhood leukemia in Costa Rica. Cases (n ALL = 252; n AML = 40) were diagnosed between 1995 and 2000 (aged <15 years at diagnosis) and identified from the Costa Rican Cancer Registry and the National Children's Hospital. A total of 578 frequency-matched population controls were sampled from the National Birth Registry. Parental tobacco smoking was assessed via face-to-face interviews. We used logistic regression models to examine the association of paternal and maternal tobacco smoking before conception, during pregnancy, and after birth with childhood ALL and AML risk, adjusted for child sex, birth year, maternal/paternal age, and parental education. RESULTS Paternal smoking before conception, during pregnancy, and after birth was associated with an increased risk of childhood AML (Odds Ratio (OR): 2.51, 95% CI: 1.21-5.17; OR: 3.21, 95% CI: 1.56-6.60; and OR: 2.83, 95% CI: 1.36-5.90, respectively). Maternal smoking during pregnancy was also associated with a modest, but imprecise increase in AML risk. We observed null associations of maternal and paternal smoking with ALL in the offspring. CONCLUSION Our results suggest an association between parental smoking and risk of AML, but not ALL, in Costa Rican children. These findings add to the established evidence of numerous health risks associated with smoking and highlight the potential harm of smoking during sensitive windows of the development of fetus and child.
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Affiliation(s)
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Catharina Wesseling
- Department of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Falck 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
| | - Ana M Mora
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica; Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, CA, USA.
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Abstract
IMPORTANCE An increasing number of children worldwide are born after the use of fertility treatment, although it remains unclear whether the treatment affects the risk of childhood cancer and whether any associations observed are due to the use of specific drugs, the use of specific procedures, or the underlying infertility. OBJECTIVE To examine the association between different types of fertility treatments and cancer risk in children. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study based on Danish population-based registry data and the Danish Infertility Cohort (individual record linkage) that included 1 085 172 children born in Denmark between January 1, 1996, and December 31, 2012, linked with parental information. There were a total of 2217 children diagnosed with cancer (follow-up occurred during 1996-2015). EXPOSURES Maternal fertility treatment during the index pregnancy, including the use of fertility drugs (clomiphene [n = 33 835], gonadotropins [n = 57 136], gonadotropin-releasing hormone analogs [n = 38 653], human chorionic gonadotropin [n = 68 181], progesterone [n = 41 628], and estrogen [n = 16 948]) and assisted reproductive technology (in vitro fertilization [n = 19 448], intracytoplasmic sperm injection [n = 13 417], and frozen embryo transfer [n = 3356]). Each exposure was examined separately and compared with children born to fertile women. MAIN OUTCOMES AND MEASURES Hazard ratios and incidence rate differences for childhood cancer. RESULTS After 12.2 million person-years of follow-up (mean, 11.3 years), the incidence rate of childhood cancer was 17.5 per 100 000 for children born to fertile women (n = 910 291) and 44.4 per 100 000 for children born after the use of frozen embryo transfer (n = 3356). Compared with children born to fertile women, the use of frozen embryo transfer was associated with an elevated risk of childhood cancer (14 cancer cases; hazard ratio, 2.43 [95% CI, 1.44 to 4.11]; incidence rate difference, 26.9 [95% CI, 2.8 to 51.0] per 100 000), mainly due to an increased risk of leukemia (5 cancer cases; incidence rate, 14.4 per 100 000; hazard ratio, 2.87 [95% CI, 1.19 to 6.93]; incidence rate difference, 10.1 [95% CI, -4.0 to 24.2] per 100 000) and sympathetic nervous system tumors (<5 cancer cases; hazard ratio, 7.82 [95% CI, 2.47 to 24.70]). There were no statistically significant associations with the use of the other types of fertility treatment examined. CONCLUSIONS AND RELEVANCE Among children born in Denmark, the use of frozen embryo transfer, compared with children born to fertile women, was associated with a small but statistically significant increased risk of childhood cancer; this association was not found for the use of other types of fertility treatment examined.
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Affiliation(s)
- Marie Hargreave
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Merete Kjær Hansen
- Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Falck 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
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K. Kjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Korhonen LM, Taskinen M, Rantanen M, Erdmann F, Winther JF, Bautz A, Feychting M, Mogensen H, Talbäck M, Malila N, Ryynänen H, Madanat-Harjuoja L. Suicides and deaths linked to risky health behavior in childhood cancer patients: A Nordic population-based register study. Cancer 2019; 125:3631-3638. [PMID: 31287570 DOI: 10.1002/cncr.32373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/08/2019] [Revised: 05/27/2019] [Accepted: 06/09/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Childhood cancer survivors have been reported to be vulnerable to psychiatric morbidities and risky health behavior. Suicides, substance abuse, accidents, and violence as causes of death can be regarded as an extreme manifestation of risky health behavior. In the current study, the authors studied the risk of suicide and other risky health behavior-related deaths among childhood cancer patients in Denmark, Finland, and Sweden. METHODS Using linkage between national cancer, population, and cause-of-death registries, the authors investigated the causes of death in 29,285 patients diagnosed with cancer before age 20 years between 1971 and 2009 compared with a cohort of 146,282 age-matched, sex-matched, and country-matched population comparisons. Rate ratios (RRs) with 95% CIs were estimated using Poisson regression models, adjusting for demographic factors. RESULTS The overall risk of dying of a risky health behavior was found to be increased among childhood cancer patients (RR, 1.25; 95% CI, 1.06-1.47) when compared with population comparisons. The elevated risk was statistically significant among patients with central nervous system tumors (RR, 1.49; 95% CI, 1.08-2.05) and patients diagnosed at ages 5 to 9 years and 15 to 19 years (RR, 1.50 [95% CI, 1.01-2.24] and RR, 1.31 [95% CI, 1.03-1.67], respectively). The overall risk of suicide was found to be increased (RR, 1.37; 95% CI, 1.02-1.83), and statistically significantly so when patients were diagnosed between ages 15 and 19 years (RR, 1.61; 95% CI, 1.09-2.39). CONCLUSIONS Childhood cancer patients appear to have an increased risk of risky health behavior-related causes of death compared with the general population. The results of the current study suggest the importance of integrating psychosocial support into the follow-up care of these individuals.
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Affiliation(s)
- Liisa M Korhonen
- Finnish Cancer Registry, Helsinki, Finland.,Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mervi Taskinen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Andrea Bautz
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | | | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland.,Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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43
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Nielsen BF, Schmidt AA, Mulvihill JJ, Frederiksen K, Tawn EJ, Stovall M, Johansen C, Boice JD, Winther JF. Chromosomal Abnormalities in Offspring of Young Cancer Survivors: A Population-Based Cohort Study in Denmark. J Natl Cancer Inst 2019; 110:534-538. [PMID: 29228263 DOI: 10.1093/jnci/djx248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/27/2017] [Indexed: 12/18/2022] Open
Abstract
To examine whether cancer survivors diagnosed before age 35 years are more likely to have offspring with chromosomal abnormalities than their siblings, chromosomal abnormalities were determined in a population-based cohort of 14 611 offspring (14 580 live-born children and 31 fetuses) of 8945 Danish cancer survivors and 40 859 offspring (40 794 live-born children and 65 fetuses) of 19 536 siblings. Chromosomal abnormalities include numeric and structural abnormalities. Odds ratios were estimated by multiple logistic regression models comparing the risk of chromosomal abnormalities among survivors' offspring with that in siblings' offspring. In a subgroup of survivors with gonadal radiation doses (mean = 0.95 Gy for males and 0.91 Gy for females), no indication of a dose response was found. Overall, no increased risk of chromosomal abnormalities among survivors' offspring was observed compared with their siblings' offspring (odds ratio = 0.99, 95% confidence interval = 0.67 to 1.44, two-sided P = .94), with similar risk between male and female survivors. Cancer survivors were not more likely than their siblings to have children with a chromosomal abnormality.
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Affiliation(s)
| | | | - John J Mulvihill
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - E Janet Tawn
- Institute of Population Health, The University of Manchester, Manchester, UK
| | - Marilyn Stovall
- The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | | | - John D Boice
- School of Medicine and Vanderbilt-Ingram Cancer Centre, Vanderbilt University, Nashville, TN.,National Council for Radiation Protection and Measurements, Bethesda, MD
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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44
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Roser K, Erdmann F, Michel G, Winther JF, Mader L. The impact of childhood cancer on parents' socio‐economic situation—A systematic review. Psychooncology 2019; 28:1207-1226. [DOI: 10.1002/pon.5088] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/25/2019] [Accepted: 04/05/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Katharina Roser
- Department of Health Sciences and Health PolicyUniversity of Lucerne Lucerne Switzerland
| | - Friederike Erdmann
- Childhood Cancer Research GroupDanish Cancer Society Research Center Copenhagen Denmark
| | - Gisela Michel
- Department of Health Sciences and Health PolicyUniversity of Lucerne Lucerne Switzerland
| | - Jeanette Falck Winther
- Childhood Cancer Research GroupDanish Cancer Society Research Center Copenhagen Denmark
- Department of Clinical Medicine, Faculty of HealthAarhus University Aarhus Denmark
| | - Luzius Mader
- Childhood Cancer Research GroupDanish Cancer Society Research Center Copenhagen Denmark
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45
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Salem H, Andersen EW, Dalton SO, Schmiegelow K, Winther JF, Lichtenthal WG, Johansen C, Bidstrup PE. Psychotropic Medication Use in Parents of Children Diagnosed With Cancer. Pediatrics 2019; 143:peds.2018-2605. [PMID: 30944153 PMCID: PMC7548106 DOI: 10.1542/peds.2018-2605] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Accepted: 01/29/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Objective measures on parental distress after a child's cancer diagnosis are sparse. We examined the risk for first prescription of psychotropic medicine among parents of children with cancer compared with parents of children who were cancer free. In addition, we examined if sociodemographic and clinical characteristics are associated with risk of first prescription of psychotropic medication in parents of children with cancer. METHODS We followed all parents of children with cancer (N = 6744) from the Danish Cancer Registry (1998-2014) using parents of matched children who were cancer free (N = 65 747) as a comparison. To identify vulnerable subgroups among parents of children with cancer, we followed all parents of children with cancer from the Childhood Cancer Registry (2003-2015; N = 3290 parents). In Cox proportional hazard models, we estimated hazard ratios (HRs) for a first prescription of psychotropic medication according to cancer status of the child and sociodemographic and clinical risk factors. RESULTS Parents of children with cancer were at increased risk for a first prescription of psychotropic medication compared with parents of children who were cancer free up to 2 years after the diagnosis, the risk being highest in the first year (HR, 1.83 [95% confidence interval (CI), 1.66-2.01]). Parents of children with cancer, especially parents who lost their child, had an increased risk for a first prescription of hypnotics (HR, 6.91; 95% CI, 3.50-13.66) and anxiolytics (HR, 4.55, 95% CI, 1.57-13.17) in the first year after diagnosis. CONCLUSIONS Efforts should be made to ensure that medical teams are adequately educated to address stress responses in the parents.
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Affiliation(s)
| | | | - Susanne O. Dalton
- Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- University Hospital Rigshospitalet; Institute of Clinical Medicine, Medical Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark;,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Wendy G. Lichtenthal
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Christoffer Johansen
- Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark;,Department of Oncology, Finsen Centre, University Hospital Rigshospitalet
| | - Pernille E. Bidstrup
- Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
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46
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Holmqvist AS, Chen Y, Wu J, Battles K, Francisco L, Hageman L, Kung M, Ness E, Parman M, Winther JF, Rosenthal J, Arora M, Armenian SH, Bhatia S. Late Mortality after Allogeneic Bone Marrow Transplantation in Childhood for Bone Marrow Failure Syndromes and Severe Aplastic Anemia. Biol Blood Marrow Transplant 2019; 25:749-755. [PMID: 30578940 PMCID: PMC9990882 DOI: 10.1016/j.bbmt.2018.12.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/07/2018] [Accepted: 12/11/2018] [Indexed: 12/23/2022]
Abstract
Children with bone marrow failure syndromes and severe aplastic anemia (SAA) are treated with allogeneic blood or marrow transplantation (BMT). However, there is a paucity of studies examining late mortality risk after allogeneic BMT performed in childhood for bone marrow failure syndromes and SAA and evaluating how this risk differs between these diseases. We investigated cause-specific late mortality in 2-year survivors of allogeneic BMT for bone marrow failure syndromes and SAA performed before age 22years between 1974 and 2010 at 2 US transplantation centers. Vital status information was collected from medical records, the National Death Index, and Accurint databases. Overall survival was calculated using Kaplan-Meier techniques. The standardized mortality ratio (SMR) was calculated using age- sex-, and calendar-specific mortality rates from the Centers for Disease Control and Prevention. Among the 2-year survivors of bone marrow failure syndromes (n = 120) and SAA (n = 147), there were 15 and 19 deaths, respectively, yielding an overall survival of 86.4% for bone marrow failure syndromes and 93.1% for SAA at 15years post-BMT. Compared with the general population, patients with bone marrow failure syndromes were at a higher risk for premature death (SMR, 22.7; 95% CI, 13.1 to 36.2) compared with those with SAA (SMR, 4.5; 95% CI, 2.8 to 7.0) (P < .0001). The elevated relative risk persisted at ≥15years after BMT for both diseases. The hazard of all-cause late mortality was 2.9-fold (95% CI, 1.1 to 7.3) higher in patients with bone marrow failure syndromes compared with those with SAA. The high late mortality risk in recipients of allogeneic BMT in childhood for bone marrow failure syndromes calls for intensified life-long follow-up.
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Affiliation(s)
- Anna Sällfors Holmqvist
- Pediatric Oncology and Hematology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica Wu
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kevin Battles
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lindsey Hageman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle Kung
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Emily Ness
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mariel Parman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Saro H Armenian
- Pediatric Hematology/Oncology, City of Hope, Duarte, California
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama; Division of Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
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47
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Doser K, Kenborg L, Andersen EW, Bidstrup PE, Kroyer A, Hove H, Østergaard J, Sørensen SA, Johansen C, Mulvihill J, Winther JF, Dalton SO. Educational delay and attainment in persons with neurofibromatosis 1 in Denmark. Eur J Hum Genet 2019; 27:857-868. [PMID: 30820037 DOI: 10.1038/s41431-019-0359-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/20/2018] [Accepted: 01/24/2019] [Indexed: 01/17/2023] Open
Abstract
Most research on psychosocial consequences of neurofibromatosis type 1 (NF1) has focused on the relationship between disease factors and cognitive functioning. NF1 may impair domains of learning and attention, resulting in low academic performance. This study is the first nationwide population-based cohort study to investigate educational attainment and delay in completing mandatory school by persons with NF1. Educational information was collected from 550 persons at the age of 30 (born 1965-1984). They were diagnosed with NF1 in Denmark and compared to a cohort of NF1-free persons matched on gender and age (n = 4295). Multinomial logistic models were applied to estimate odds ratios (ORs) for obtaining short (≤9 years) or medium (10-12 years) education compared to long education (>12 years) by the age of 30 years. We calculated the probability of graduating 9th year of mandatory school at different ages in 932 persons with NF1 and 7962 NF1-free persons (born 1965-2000) using quantile regression. The OR of educational completion for short- and medium-term education was three fold (95% CI 2.55-3.99) and 1.29 fold (95% CI 0.99-1.69) higher, respectively, for persons with NF1 than NF1-free persons after adjusting for birth year, gender, psychiatric and somatic morbidity and mother's education. Persons with NF1 were significantly delayed in graduating mandatory school education compared to NF1-free persons. When 90% of persons have graduated, persons with NF1 were 1.2 times older than the NF1-free persons. Experiencing delays in mandatory school likely affect further educational achievements and may impair employment and entering work force.
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Affiliation(s)
- Karoline Doser
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Anja Kroyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Hanne Hove
- The RAREDIS Database, Centre for Rare Diseases, Copenhagen University Hospital and Aarhus University, Aarhus, Denmark
| | - John Østergaard
- Center for Rare Disease, Aarhus University Hospital, Aarhus, Denmark
| | | | - Christoffer Johansen
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Oncology Clinic, Finsen Center, Rigshospitalet, 5073, Copenhagen, Denmark
| | - John Mulvihill
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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48
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Holmqvist AS, Chen Y, Wu J, Battles K, Bhatia R, Francisco L, Hageman L, Kung M, Ness E, Parman M, Salzman D, Wadhwa A, Winther JF, Rosenthal J, Forman SJ, Weisdorf DJ, Armenian SH, Arora M, Bhatia S. Assessment of Late Mortality Risk After Allogeneic Blood or Marrow Transplantation Performed in Childhood. JAMA Oncol 2018; 4:e182453. [PMID: 30054602 DOI: 10.1001/jamaoncol.2018.2453] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Allogeneic blood or marrow transplantation (BMT) is a curative option for malignant and nonmalignant diseases of childhood. However, little is known about trends in cause-specific late mortality in this population during the past 3 decades. Objectives To examine cause-specific late mortality among individuals who have lived 2 years or more after allogeneic BMT performed in childhood and whether rates of late mortality have changed over time. Design, Setting, and Participants A retrospective cohort study was conducted of individuals who lived 2 years or more after undergoing allogeneic BMT performed in childhood between January 1, 1974, and December 31, 2010. The end of follow-up was December 31, 2016. Exposure Allogeneic BMT performed in childhood. Main Outcomes and Measures All-cause mortality, relapse-related mortality, and non-relapse-related mortality. Data on vital status and causes of death were collected using medical records, the National Death Index Plus Program, and Accurint databases. Results Among 1388 individuals (559 females and 829 males) who lived 2 years or more after allogeneic BMT performed in childhood, the median age at transplantation was 14.6 years (range, 0-21 years). In this cohort, there was a total of 295 deaths, yielding an overall survival rate of 79.3% at 20 years after BMT. The leading causes of death were infection and/or chronic graft-vs-host disease (121 of 244 [49.6%]), primary disease (60 of 244 [24.6%]), and subsequent malignant neoplasms (45 of 244 [18.4%]). Overall, the cohort had a 14.4-fold increased risk for death (95% CI, 12.8-16.1) compared with the general population (292 deaths observed; 20.3 deaths expected). Relative mortality remained elevated at 25 years or more after BMT (standardized mortality ratio, 2.9; 95% CI, 2.0-4.1). The absolute excess risk for death from any cause was 12.0 per 1000 person-years (95% CI, 10.5-13.5). The cumulative incidence of non-relapse-related mortality exceeded that of relapse-related mortality throughout follow-up. The 10-year cumulative incidence of late mortality decreased over time (before 1990, 18.9%; 1990-1999, 12.8%; 2000-2010, 10.9%; P = .002); this decrease remained statistically significant after adjusting for demographic and clinical factors (referent group: <1990; 1990-1999: hazard ratio, 0.64; 95% CI, 0.47-0.89; P = .007; 2000-2010: hazard ratio, 0.49; 95% CI, 0.31-0.76; P = .002; P < .001 for trend). Conclusions and Relevance Late mortality among children undergoing allogeneic BMT has decreased during the past 3 decades. However, these patients remain at an elevated risk of late mortality even 25 years or more after transplantation when compared with the general population, necessitating lifelong follow-up.
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Affiliation(s)
- Anna Sällfors Holmqvist
- Pediatric Oncology and Hematology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Jessica Wu
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Kevin Battles
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Ravi Bhatia
- Division of Hematology, Oncology and Bone Marrow Transplantation, University of Alabama at Birmingham
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Lindsey Hageman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Michelle Kung
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Emily Ness
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Mariel Parman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Donna Salzman
- Division of Hematology, Oncology and Bone Marrow Transplantation, University of Alabama at Birmingham
| | - Aman Wadhwa
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | | | - Daniel J Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis
| | - Saro H Armenian
- Pediatric Hematology/Oncology, City of Hope, Duarte, California
| | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham.,Department of Pediatrics, School of Medicine, University of Alabama at Birmingham
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49
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Mader L, Roser K, Baenziger J, Vetsch J, Winther JF, Scheinemann K, Michel G. Relationship status and quality of the partner relationship in parents of long-term childhood cancer survivors: The Swiss Childhood Cancer Survivor Study-Parents. Psychooncology 2018; 28:309-316. [PMID: 30421855 DOI: 10.1002/pon.4941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/31/2018] [Revised: 10/08/2018] [Accepted: 11/08/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The intensive and long-lasting experience of childhood cancer is a tremendous stressor for the parental relationship. We aimed to (1) compare civil status and partner relationship of parents of long-term childhood cancer survivors with population-based comparisons, (2) identify cancer-related characteristics associated with not being married, and (3) evaluate the quality of the partner relationship. METHODS We sent questionnaires to parents of survivors aged ≤16 years at diagnosis and ≥20 years at study. Population-based comparisons were derived from a random sample of the general population (≥1 child aged ≥20 years) and standardized by sociodemographic characteristics of survivor parents. We used logistic regression to identify cancer-related characteristics associated with not being married. The quality of the partner relationship was evaluated using the relationship-specific attachment scale for adults assessing the dimensions security (secure-fearful) and dependency (dependent-independent). RESULTS A total of 784 parents (58.9% mothers) of 512 survivors (response rate: 44.0%) and 471 comparison parents completed the questionnaire. Parents of survivors were less often divorced/separated (9.0% vs 17.5%, P < 0.001) and more often in a partner relationship (89.9% vs 85.0%, P = 0.010) than comparisons. Not being married was not associated with cancer-related characteristics. Parents of survivors reported similar security (P = 0.444) but higher dependency (P = 0.032) within the partner relationship than comparisons. In both populations, fathers indicated higher security and dependency than mothers. CONCLUSIONS Long after the diagnosis of cancer in their child, parents' relationship appears similar as in parents of the general population. The increased dependency reported by parents of survivors suggests that they managed their child's disease as a team.
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Affiliation(s)
- Luzius Mader
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.,Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Katharina Roser
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Julia Baenziger
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Janine Vetsch
- School of Women's and Children's Health, UNSW, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Katrin Scheinemann
- Division of Hematology/Oncology, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pediatrics, McMaster Children's Hospital & McMaster University, Hamilton, Canada.,Division of Hematology/Oncology, Hospital for Children and Adolescents, Kantonsspital Aarau, Aarau, Switzerland
| | - Gisela Michel
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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50
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Frederiksen LE, Mader L, Feychting M, Mogensen H, Madanat-Harjuoja L, Malila N, Tolkkinen A, Hasle H, Winther JF, Erdmann F. Surviving childhood cancer: a systematic review of studies on risk and determinants of adverse socioeconomic outcomes. Int J Cancer 2018; 144:1796-1823. [PMID: 30098012 DOI: 10.1002/ijc.31789] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/20/2018] [Accepted: 07/27/2018] [Indexed: 01/03/2023]
Abstract
Substantial improvements in childhood cancer survival have resulted in a steadily increasing population of childhood cancer survivors. Whereas somatic late effects have been assessed in many studies, less is known about the impact of childhood cancer on socioeconomic outcomes in survivors. The aim of this article was to evaluate and summarise the evidence on the socioeconomic conditions of childhood cancer survivors and to identify survivors at particular risk of adverse socioeconomic outcomes. An extensive literature search of three electronic databases was conducted. Of 419 articles identified, 52 met the inclusion criteria. All the selected articles were appraised for quality, and findings were summarised in a narrative synthesis. Childhood cancer survivors were at higher risk of adverse socioeconomic outcomes with regard to educational achievement, income and social security benefits than the general population or a sibling comparison group. The risks for unemployment and a lower occupational position were significantly increased only for survivors of a central nervous system tumour. Notably, survivors of central nervous system tumours, survivors treated with cranial radiotherapy and those diagnosed at younger age independent of cancer type were determinants of particular adverse socioeconomic outcomes. Given the increasing population of childhood cancer survivors, targeted follow-up interventions and support strategies addressing not only the somatic and psychiatric late effects but also the socioeconomic difficulties that some childhood cancer survivors face is of high importance to reduce social inequity, and ensure a high quality of life after childhood cancer.
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Affiliation(s)
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Anniina Tolkkinen
- Finnish Cancer Registry, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
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