Childhood Cancer Survivorship and Long-Term Outcomes

Medical Journal of Australia

Baade

Green

et al. 2019

Objective To investigate the incidence of second primary cancers in people diagnosed with cancer during childhood. Design, setting Retrospective, population‐based study; analysis of Australian Childhood Cancer Registry data. Participants People alive at least two months after being diagnosed before the age of 15 years with a primary cancer, 1983–2013, followed until 31 December 2015 (2–33 years' follow‐up). Main outcome measures Risks of second primary cancer compared with the general population, expressed as standardised incidence ratios (SIRs). Results Among 18 230 people diagnosed with cancer during childhood, 388 (2%) were later diagnosed with second primary cancers; the estimated 30‐year cumulative incidence of second cancers was 4.4% (95% CI, 3.8–5.0%). The risk of a new primary cancer was five times as high as for the general population (SIR, 5.13; 95% CI, 4.65–5.67). Relative risk of a second primary cancer was greatest for people who had childhood rhabdomyosarcoma (SIR, 19.9; 95% CI, 14.4–27.6). Relative risk was particularly high for children who had undergone both chemotherapy and radiotherapy (SIR, 9.80; 95% CI, 8.35–11.5). Relative risk peaked during the 5 years following the first diagnosis (2 to less than 5 years: SIR, 10.3; 95% CI, 8.20–13.0), but was still significant at 20–33 years (SIR, 2.58; 95% CI, 2.02–3.30). The most frequent second primary cancers were thyroid carcinomas (65 of 388, 17%) and acute myeloid leukaemias (57, 15%). Conclusions Survivors of childhood cancer remain at increased risk of a second primary cancer well into adulthood. As the late effects of cancer treatment probably contribute to this risk, treatments need to be refined and their toxicity reduced, without reducing their benefit for survival.

Section: Researchmentioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Second primary cancers in people who had cancer as children: an Australian Childhood Cancer Registry population‐based study

Medical Journal of Australia

Baade

Green

et al. 2019

“…3,6 Five-year relative survival for children between 2009 and 2013 was 80% in the United States (USA). 7 Improved survival, however, means that a growing number of children have a lifelong increased risk of adverse health effects following treatment, notably hearing loss and cardiac toxicity associated with standard platinum-based liver cancer chemotherapy regimens, 8,9 substantial morbidity following liver transplantation for high-risk cases, 9,10 and late-effect adverse psychosocial outcomes. 8,11 The most common malignant liver tumour in younger children aged 0-4 years is embryonal tumour hepatoblastoma (HB).…”

Section: Introductionmentioning

confidence: 99%

“…7 Improved survival, however, means that a growing number of children have a lifelong increased risk of adverse health effects following treatment, notably hearing loss and cardiac toxicity associated with standard platinum-based liver cancer chemotherapy regimens, 8,9 substantial morbidity following liver transplantation for high-risk cases, 9,10 and late-effect adverse psychosocial outcomes. 8,11 The most common malignant liver tumour in younger children aged 0-4 years is embryonal tumour hepatoblastoma (HB). 12,13 While preterm birth, 14 very low birthweight 15 and various genetic disorders including Beckwith-Wiedemann Syndrome (BWS) 9,12 have been associated with HB; most cases are sporadic with unknown aetiology.…”

Section: Introductionmentioning

confidence: 99%

Global trends in incidence rates of childhood liver cancers: A systematic review and meta‐analysis

Dasgupta

Henshaw

Paediatric Perinatal Epid

et al. 2020

Background Childhood liver cancers are relatively rare, hence inferences on incidence trends over time are limited by lack of precision in most studies. Objective To conduct a systematic review and meta‐analysis of published contemporary trends on childhood liver cancer incidence rates worldwide. Data sources PubMed, EMBASE, CINAHL, Web of Science. Study selection and data extraction English‐language peer‐reviewed articles published from 1 January 2008 to 1 December 2019 that presented quantitative estimates of incidence trends for childhood liver cancer and diagnostic subgroups. Review was conducted per PRISMA guidelines. Two authors independently extracted data and critically assessed studies. Synthesis Random effects meta‐analysis models were used to estimate pooled incidence trends by diagnostic subgroups. Heterogeneity was measured using the Q and I2 statistics and publication bias evaluated using Egger’s test. Results Eighteen studies were included, all based on population‐based cancer registries. Trends were reported on average for 18 years. Overall pooled estimates of the annual percentage change (APC) were 1.4 (95% confidence interval [CI] 0.5, 2.3) for childhood liver cancers, 2.8 (95% CI 1.8, 3.8) for hepatoblastoma and −3.0 (95% CI −11.0, 4.9) for hepatocellular carcinoma. Sub‐group analysis by region indicated increasing trends for childhood liver cancers in North America/Europe/Australia (APC 1.7, 95% CI 0.7, 2.8) whereas corresponding trends were stable in Asia (APC 1.4, 95%CI −0.3, 2.7). Publication bias was not detected for any of these analyses. The I2 statistic indicated that the heterogeneity among included studies was low for combined liver cancers, moderate for hepatoblastoma and high for hepatocellular carcinoma. Conclusions Incidence is increasing for childhood liver cancers and the most commonly diagnosed subgroup hepatoblastoma. Lack of knowledge of the etiology of childhood liver cancers limited the ability to understand the reasons for observed incidence trends. This review highlighted the need for ongoing monitoring of incidence trends and etiological studies.

Late mortality from other diseases following childhood cancer in Australia and the impact of intensity of treatment

Pediatric Blood & Cancer

Walwyn

Cohn

et al. 2020

Background People who receive treatment for cancer during childhood often experience subsequent complications of therapy, known as late effects, which can lead to an increased risk of death. Procedure Using deidentified population‐based data from the Australian Childhood Cancer Registry for children aged 0‐14 diagnosed with cancer during the period 1983‐2011 and who survived for a minimum of 5 years, we examined disease‐related deaths (other than cancer recurrence or second primary cancers) that occurred up to 31 December 2016. Risk of death relative to the general population was approximated using standardised mortality ratios (SMRs). Treatment received was stratified according to the intensity of treatment rating, version 3 (ITR‐3). Results During the study period, 82 noncancer disease‐related deaths were recorded among 13 432 childhood cancer survivors, four times higher than expected (SMR = 4.43, 95% CI = 3.57‐5.50). A clear link to treatment intensity was observed, with the relative risk of noncancer disease‐related mortality being twice as high for children who underwent ‘most intensive’ treatment (SMR = 5.94, 95% CI = 3.69‐9.55) compared to the ‘least intensive’ treatment group (SMR = 2.98, 95% CI = 1.42‐6.24; Ptrend = .01). Thirty‐year cumulative mortality from noncancer disease‐related deaths was estimated at 1.4% (95% CI = 1.1‐1.9) after adjusting for competing causes of death such as cancer, accidents, or injuries. Conclusions Although childhood cancer survivors are at increased relative risk of death from noncancer diseases, particularly those who undergo more intensive treatment, the cumulative mortality within 30 years of diagnosis remains small. Knowledge of late effects can guide surveillance of survivors and treatment modification, without wanting to compromise the high rates of survival.