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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Frobisher, C; Glaser, A; Levitt, GA; Cutter, DJ; Winter, DL; Lancashire, ER; Oeffinger, KC; Guha, J; Kelly, J; Reulen, RC; Hawkins, MM

Published Date

  • November 21, 2017

Published In

Volume / Issue

  • 117 / 11

Start / End Page

  • 1723 - 1731

PubMed ID

  • 29065109

Pubmed Central ID

  • PMC5729444

Electronic International Standard Serial Number (EISSN)

  • 1532-1827

Digital Object Identifier (DOI)

  • 10.1038/bjc.2017.347


  • eng

Conference Location

  • England