Risk stratification of childhood cancer survivors necessary for evidence-based clinical long-term follow-up

Research output: Contribution to journalArticle


  • Clare Frobisher
  • Adam Glaser
  • Gill A. Levitt
  • David J. Cutter
  • David L. Winter
  • Kevin C. Oeffinger
  • Joyeeta Guha
  • Julie Kelly

Colleges, School and Institutes

External organisations

  • University of Leeds
  • Department of Haematology/Oncology, Great Ormond Street Hospital for Children NHS Trust
  • Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford
  • Departments of Paediatrics and Medicine, Memorial Sloan-Kettering Cancer Centre
  • Public Health England, Birmingham And The Black Country Area Team


BACKGROUND: Reorganisation of clinical follow-up care in England was proposed by the National Cancer Survivorship Initiative (NCSI), based on cancer type and treatment, ranging from Level 1 (supported self-management) to Level 3 (consultant-led care). The objective of this study was to provide an investigation of the risks of serious adverse health-outcomes associated with NCSI Levels of clinical care using a large population-based cohort of childhood cancer survivors.

METHODS: The British Childhood Cancer Survivor Study (BCCSS) was used to investigate risks of specific causes of death, subsequent primary neoplasms (SPNs) and non-fatal non-neoplastic outcomes by NCSI Level.

RESULTS: Cumulative (excess) risks of specified adverse outcomes by 45 years from diagnosis among non-leukaemic survivors assigned to NCSI Levels 1, 2 and 3 were for: SPNs-5% (two-fold expected), 14% (four-fold expected) and 21% (eight-fold expected); non-neoplastic death-2% (two-fold expected), 4% (three-fold expected) and 8% (seven-fold expected); non-fatal non-neoplastic condition-14%, 27% and 40%, respectively. Consequently overall cumulative risks of any adverse health outcome were 21%, 45% and 69%, respectively.

CONCLUSIONS: Despite its simplicity the risk stratification tool provides clear and strong discrimination between survivors assigned to different NCSI Levels in terms of long-term cumulative and excess risks of serious adverse outcomes.British Journal of Cancer advance online publication, 24 October 2017; doi:10.1038/bjc.2017.347 www.bjcancer.com.


Original languageEnglish
Pages (from-to)1723–1731
JournalBritish Journal of Cancer
Early online date24 Oct 2017
Publication statusPublished - 21 Nov 2017


  • Journal Article, clinical follow-up , childhood cancer , risk stratification , adverse health outcomes