adolescent; cohort study; second malignancies; childhood cancer; mortality; epidemiology; survivor
Schindler Matthias, Belle Fabiën N, Grotzer Michael A, von der Weid Nicolas X, Kuehni Claudia E, Kuehni Claudia E (2017), Childhood cancer survival in Switzerland (1976-2013): Time-trends and predictors., in International journal of cancer
, 140(1), 62-74.
Wengenroth Laura, Sommer Grit, Schindler Matthias, Spycher Ben, von der Weid Nicolas, Stutz-Grunder Eveline, Michel Gisela, Kuehni Claudia (2016), Income in Adult Survivors of Childhood Cancer, in PLOS One
, 11(5), :e0155546.
Winther JF, Kenborg L, Byrne J, Hjorth L, Kaatsch P, Kremer LC, Kuehni CE, Auquier P, Michel G, de Vathaire F, Haupt R, Skinner R, Madanat-Harjuoja LM, Tryggvadottir L, Wesenberg F, Reulen RC, Grabow D, Ronckers CM, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, Schindler M, Berbis J, Holmqvist AS, Gudmundsdottir T, de Fine Licht S (2015), Childhood cancer survivor cohorts in Europe, in acta oncologica
Schindler Matthias (2015), Death certificate notifications in the Swiss Childhood Cancer Registry: assessing completeness and registration procedures, in Swiss Medical Weekly
Schindler M, Spycher BD, Ammann RA, Ansari M, Michel G, Kuehni CE, Cause-Specific Long-Term Mortality in Survivors of Childhood Cancer in Switzerland: A Population Based Study, in International Journal of Cancer
, Epub ahead.
Background: Cancer is the second most important cause of death in childhood. With improving therapy, overall survival of childhood cancer increased dramatically and 5-year survival rates now exceed 80%. However, as a consequence of the cancer and its therapy, two thirds of survivors develop chronic conditions and all-cause mortality is several times higher than in the general population. In the first 10 years after diagnosis the main cause of death is recurrence of the primary cancer, but thereafter deaths from second primary cancers predominate. This underlines the need to identify avoidable risk factors for these late consequences. The existence of a national registry for cancer in childhood and adolescence (Swiss Childhood Cancer Registry, SCCR) with on-going long-term follow-up provides a unique opportunity to study mortality and second primary cancers in an unbiased representative population.Aims: This PhD project will focus on long-term outcomes of childhood and adolescent cancer in Switzerland. In particular, it aims to analyse incidence and risk factors for: (i) total and cause-specific mortality, including late mortality (>5 years after diagnosis of cancer) and (ii) second primary cancers.Methods: Study population: The student will analyse the dataset of the SCCR, which registers since 1976 all children and adolescents diagnosed with cancer in Switzerland before age 21 years. It contains data on cancer diagnosis, treatment and mortality for 6442 children (aged 0-15 years) and 1544 adolescents (aged 16-21 years at diagnosis). Of these, 1653 children and 338 adolescents have died (251 and 66 respectively more than 5 years after diagnosis). Available data: For all participants, current address, live status and date of death has been assessed via community registries. Cause of death has been obtained via linkage with the Swiss mortality statistics. Incidence of second primary cancers is currently being assessed via four independent approaches: a) direct notification from treatment centres to the SCCR; b) data linkage with cantonal cancer registries; c) mortality records (for participants deceased because of a second primary cancer) and d) a questionnaire survey among all survivors (the Swiss Childhood Cancer Survivor Study). Patient-reported secondary cancers from the questionnaire will be validated with medical records. Information on socio-economic status is available for most participants via data linkage with the Swiss National Cohort. Work steps: The PhD student will: (i) participate in the on-going data collection, data validation and cleaning of the cohort dataset; (ii) calculate standardised mortality ratios, standardized cancer incidence ratios and absolute excess risks of death and second primary cancer in the study population compared to expected numbers in the general population; (iii) determine risk factors for total and late mortality and for second primary cancers using multivariable Cox models. This study will have 80% and higher power to detect risk factors associated with a hazard ratio of at least 1.5 for late mortality.Research environment: The student will participate in the PhD training of the University of Bern and the Swiss School of Public Health (SSPH+). The project will be performed in close collaboration with the Swiss Paediatric Oncology Group and is embedded in on-going research, particularly the Swiss Childhood Cancer Survivor Study and PanCareSurFup, a EU-FP7-funded international project on long-term outcomes of childhood cancer. Significance: This project will provide the first data on long-term mortality and second primary cancers after childhood cancer in Switzerland. It provides a unique opportunity to study long-term outcomes of childhood and adolescent cancer in a national setting with international collaboration, maximising statistical power and generalisability of results. The identification of avoidable causes for second primary cancers and premature deaths will allow adapting treatment in new patients, aiming at maximal cure rates with minimal long-term side effects.