Long-term adverse health outcomes among survivors of childhood, teenage and young adult cancer

Plant, Emma Josephine ORCID: 0000-0001-5115-0293 (2024). Long-term adverse health outcomes among survivors of childhood, teenage and young adult cancer. University of Birmingham. Ph.D.

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Abstract

Background: Childhood, teenage and young adult (TYA) cancer survivors are at increased risk of many long-term health complications. This thesis aims to address specific gaps in the existing research regarding the risk of subsequent primary neoplasms (SPNs) and antidepressant and antipsychotic prescriptions dispensed in primary care.

Methods: The PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies (PCSF) includes 69,460 survivors of cancer diagnosed before age 20, across 12 European countries. This data was used to calculate standardized incidence ratios (SIRs) and cumulative incidence of subsequent glioma and meningioma. A nested case-control study, comprising 143 CRC cases and 143 controls, was then used to calculate odds ratios (ORs) for subsequent colorectal cancer (CRC), and cumulative absolute risks (CARs) by attained age and abdominal radiotherapy treatment. The British Childhood Cancer Survivor Study (BCCSS) includes 34,488 British survivors of cancer diagnosed before age 15. The Teenage and Young Adult Cancer Survivor Study (TYACSS) includes 200,945 British survivors of cancer diagnosed between age 15 and 39. Both of these datasets were linked to NHS primary care prescription records for the years 2015-2021, and the data was then used to estimate SIRs and absolute excess risks (AERs).

Results: Within the PCSF cohort, central nervous system tumour and leukaemia survivors were at the highest risk of developing subsequent gliomas and meningiomas, especially following cranial irradiation, and cancer survivors treated with abdominopelvic region radiotherapy were at the most increased risk of a subsequent colorectal cancer. Within the BCCSS and TYACSS cohorts, survivors were at significantly increased risk of being prescribed both antidepressants and antipsychotics, particularly survivors of childhood bone cancer and survivors of TYA cervical and other genitourinary tract cancers.

Conclusions: Survivors of cancer diagnosed before age 40 are at increased risk of a variety of long-term adverse health outcomes. This thesis provides new evidence which should be used by both clinicians and survivors, and in the development and revision of clinical follow-up guidelines.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):