Risk stratification of childhood cancer survivors necessary for evidence-based clinical long-term follow-up
Research output: Contribution to journal › Article
Colleges, School and Institutes
- 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.
|Journal||British Journal of Cancer|
|Early online date||24 Oct 2017|
|Publication status||Published - 21 Nov 2017|
- Journal Article, clinical follow-up , childhood cancer , risk stratification , adverse health outcomes