Adverse health outcomes among survivors of childhood, teenage and young adult cancer

Sunguc, Ceren ORCID: 0000-0001-7831-960X (2023). Adverse health outcomes among survivors of childhood, teenage and young adult cancer. University of Birmingham. Ph.D.

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Abstract

As the incidence of cancer in childhood, teenage, and young adult (TYA) has increased, the survival rate from those cancers has improved; the overall rate is now over 80% in Europe. However, cancer experience at younger ages might manifest with various adverse health outcomes during the lifespan after cancer. The main goal of the thesis was to investigate the risk of developing adverse health outcomes following 5-year survival of cancer diagnosed before age 40 years in the cohort studies of survivors: i) in the Pancare Childhood and Adolescent Cancer Survivor Care and Follow-up studies (PanCareSurFup) for survivors of cancer diagnosed 0-19 years; ii) in the Teenage and Young Adult Cancer Survivor Study (TYACSS) for survivors of cancer diagnosed 15-39
years.
The Pan-European PanCareSurFup cohort consists of almost 70,000 at least five year childhood cancer survivors, and the TYACSS is a population-based cohort of over 200 000 at least five-year survivors of teenage and young adult (TYA) cancer diagnosed in England or Wales. Excess risks of developing adverse outcomes of interest –these outcomes were subsequent primary oral neoplasms, adverse obstetric outcomes, renal and other urinary tract diseases, and endocrine diseases– were investigated among cancer survivors using Standardised Incidence Ratios (SIRs), Absolute Excess Risks (AERs), and Relative Risks from multivariable Poisson regression models.
Specific groups of childhood cancer survivors were found to have substantial excessrisks of developing subsequent primary oral neoplasms and the risk stratification that this provides should be useful evidence for clinicians in long-term follow-up clinics. TYA female survivors overall produced only 68% of the expected births compared to the national English general population. The excess risks of inpatient hospitalisations due to renal and urinary tract disease were estimated, and elevated risks among specific TYA cancer survivor groups, particularly kidney and bladder cancer survivors, were found. For TYA survivors, excess risk of being hospitalised for an endocrine disease was found to vary substantially by specific type of endocrine dysfunction and by specific cancer
type experienced.
The thesis fills critical research gaps by conducting comprehensive epidemiological studies on the excess risks long-term adverse outcomes for childhood and TYA cancer survivors. Through accurate risk quantification, it contributes to risk stratification, supports the development of evidence-based clinical follow-up guidelines, and provides evidence for the development of survivorship care plans. The findings not only benefit healthcare professionals but also provide survivors with valuable information to guide their healthcare decisions.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):