Adverse health outcomes in survivors of childhood cancer

Reulen, Raoul (2009)
Ph.D. thesis, University of Birmingham.

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Abstract

This thesis concerns investigations into adverse health outcomes among survivors of childhood cancer using the British Childhood Cancer Survivor Study (BCCSS). The BCCSS is a large-scale population-based cohort of 17,981 survivors of childhood cancer who were diagnosed with childhood cancer (age 0-14 years) between 1940 and 1991, in Britain, and had survived for at least five years. The specific aims were to investigate, within the BCCSS cohort; (1) the psychometric properties of the SF-36 health-status questionnaire, (2) the self-reported health-status by using the SF-36, (3) the effect of therapeutic radiation on the offspring sex ratio, (4) the risks of adverse pregnancy outcomes, and (5) the risks of second primary breast cancer. This thesis demonstrates that the SF-36 questionnaire exhibits good validity and reliability when used in long-term survivors of childhood cancer. Survivors rate their physical and mental health similarly to those in the general population, apart from bone and central nervous system tumour survivors who rate their physical health below population norms. Therapeutic irradiation does not alter the sex ratio of offspring. Female survivors exposed to abdominal irradiation are at a three-fold risk of delivering premature and two-fold risk of producing low birth-weight offspring. Lastly, the risk of breast cancer among female survivors is two-fold that of the general population, but is not sustained into ages at which the risk of breast cancer in the general population becomes substantial.

Type of Work:	Ph.D. thesis.
Supervisor(s):	Hawkins, M M and Zeegers, M P
School/Faculty:	Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:	School of Health and Population Sciences
Additional Information:	Appendices 2 and 3 are not available in the digital version of this thesis. Research related to this thesis is published in the following papers: 1. Reulen RC, Zeegers MP, Wallace WHB, Frobisher C, Taylor AJ, Lancashire ER, Winter DL, Hawkins MM. Pregnancy outcomes among adult survivors of childhood cancer in the British Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2009:18:2239-47. 2. Reulen RC, Taylor AJ, Winter DL, Stiller CA, Frobisher C, Lancashire ER,McClanahan FM, Sugden EM, Hawkins MM. Long-term population-based risks of breast cancer after childhood cancer. Int J Cancer 2008;123:2156-63. 3. Reulen RC, Zeegers MP, Lancashire ER, Winter DL, Hawkins MM. Offspring sex ratio and gonadal irradiation in the British Childhood Cancer Survivor Study. Br J Cancer 2007;96:1439-41. 4. Reulen RC, Winter DL, Lancashire ER, Zeegers MP, Jenney ME, Walters SJ, Jenkinson C, Hawkins MM. Health-status of adult survivors of childhood cancer: A large-scale population-based study from the British childhood cancer survivor study. Int J Cancer 2007;121:633-40. 5. Reulen RC, Zeegers MP, Jenkinson C, Lancashire ER, Winter DL, Jenney ME, Hawkins MM. The use of the SF-36 questionnaire in adult survivors of childhood cancer: evaluation of data quality, scoring reliability, and scaling assumptions. Health Qual Life Outcomes 2006:4:77. 6. Hawkins MM, Lancashire ER, Winter DL, Frobisher C, Reulen RC, Taylor AJ, Stevens MC, Jenney M. The British Childhood Cancer Survivor Study: Objectives, methods, population structure, response rates and initial descriptive information. Pediatr Blood Cancer 2008:50:1018-25.
Keywords:	childhood cancer; survival; epidemiology; late effects; adverse health outcomes
Subjects:	RA0421 Public health. Hygiene. Preventive Medicine
Institution:	University of Birmingham
ID Code:	265

This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.

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