Risk stratification of childhood cancer survivors necessary for evidence-based clinical long-term follow-up

Clare Frobisher, Adam Glaser, Gill A. Levitt, David J. Cutter, David L. Winter, Emma R. Lancashire, Kevin C. Oeffinger, Joyeeta Guha, Julie Kelly, Raoul C. Reulen, Michael M. Hawkins*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    25 Citations (Scopus)


    Background:Reorganisation of clinical follow-up care in England was proposed by the National Cancer Survivorship Initiative (NCSI), based on cancer type and treatment, ranging from Level 1 (supported self-management) to Level 3 (consultant-led care). The objective of this study was to provide an investigation of the risks of serious adverse health-outcomes associated with NCSI Levels of clinical care using a large population-based cohort of childhood cancer survivors.Methods:The British Childhood Cancer Survivor Study (BCCSS) was used to investigate risks of specific causes of death, subsequent primary neoplasms (SPNs) and non-fatal non-neoplastic outcomes by NCSI Level.Results:Cumulative (excess) risks of specified adverse outcomes by 45 years from diagnosis among non-leukaemic survivors assigned to NCSI Levels 1, 2 and 3 were for: SPNs-5% (two-fold expected), 14% (four-fold expected) and 21% (eight-fold expected); non-neoplastic death-2% (two-fold expected), 4% (three-fold expected) and 8% (seven-fold expected); non-fatal non-neoplastic condition-14%, 27% and 40%, respectively. Consequently overall cumulative risks of any adverse health outcome were 21%, 45% and 69%, respectively.Conclusions:Despite its simplicity the risk stratification tool provides clear and strong discrimination between survivors assigned to different NCSI Levels in terms of long-term cumulative and excess risks of serious adverse outcomes.

    Original languageEnglish
    Pages (from-to)1723-1731
    Number of pages9
    JournalBritish Journal of Cancer
    Issue number11
    Publication statusPublished - 21 Nov 2017

    Bibliographical note

    Funding Information:
    The British Childhood Cancer Survivor Study (BCCSS) is a national collaborative undertaking guided by a Steering Group that comprises Professor Douglas Easton (chair), Professor Michael Hawkins, Dr Helen Jenkinson, Dr Meriel Jenney, Dr Raoul Reulen, Professor Kathryn Pritchard-Jones, Dr Elaine Sugden, Dr Andrew Toogood, and Professor Hamish Wallace. The BCCSS benefits from the contributions of the Officers, Centres, and individual members of the Children’s Cancer and Leukaemia Group and the Regional Paediatric Cancer Registries. The BCCSS acknowledges the collaboration of the Office for National Statistics, the General Register Office for Scotland, the National Health Service Information Centre, the regional cancer registries, health authorities, and area health boards for providing general practitioner names and addresses and the general practitioners nationwide who facilitated direct contact with survivors. We are particularly thankful to all survivors who completed a 40-page questionnaires and all General Practitioners who returned consent forms. The BCCSS would not have been possible without the support of our funders: University of Birmingham, Cancer Research UK, Kay Kendall Leukaemia Fund, Department of Health, England, and the European Commission to whom we offer our profound thanks. Finally thanks to all BCCSS staff who have given many years of dedicated work to bring the BCCSS to fruition.

    Funding Information:
    All authors have completed the ICMJE uniform disclosure form and declare: Dr Frobisher, Dr Lancashire, Dr Reulen, Professor Hawkins, Mr Winter and Ms Kelly reports grants from Department of Health, England, grants from Cancer Research UK, grants from Kay Kendall Leukaemia Fund, grants from PanCareSurFup, European 7th Framework Programme; Dr Glaser reports he was Clinical Director of the National Cancer Survivor Initiative at the Department of Health, England between 2010 and 2013; the remaining authors have no conflict of interest.

    Publisher Copyright:
    © 2017 Cancer Research UK. All rights reserved.


    • adverse health outcomes
    • childhood cancer
    • clinical follow-up
    • risk stratification


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