0000000000049692
AUTHOR
Peter Kaatsch
Zweitmalignome nach malignen Erkrankungen im Kindesalter
Since 1980 the German Registry of Childhood Malignancies has been established. In the framework of the long-term follow-up secondary malignancies are reported continually to the registry. An additional retrospective inquiry to all treating clinicians and principal investigators of clinical trials as well as a link to a previously existing pool of secondary malignancies (1) lead to a completion of the data. At the registry now 329 patients with second malignant neoplasms have been observed. 41.3% of them had been developed the first malignancy before the registry started its work in 1980. The most common primary malignancies are acute lymphoblastic leukaemia (ALL, 28.6%), brain tumours (12.2…
The Childhood Leukemia International Consortium
Abstract Background : Acute leukemia is the most common cancer in children under 15 years of age; 80% are acute lymphoblastic leukemia (ALL) and 17% are acute myeloid leukemia (AML). Childhood leukemia shows further diversity based on cytogenetic and molecular characteristics, which may relate to distinct etiologies. Case–control studies conducted worldwide, particularly of ALL, have collected a wealth of data on potential risk factors and in some studies, biospecimens. There is growing evidence for the role of infectious/immunologic factors, fetal growth, and several environmental factors in the etiology of childhood ALL. The risk of childhood leukemia, like other complex diseases, is like…
Early deaths from childhood cancer in Germany 1980-2016
Abstract Background Even though the survival of childhood cancer has improved over the last decades, there are still children dying shortly after diagnosis. The aim of the study is to add to understanding of the reasons for deaths shortly after date of diagnosis. Methods Using data of the population-based German Childhood Cancer Registry (cancer below 15 years of age diagnosed between 1980 and 2016), we compared characteristics of 671 children with cancer who died within 30 days of diagnosis to 53,649 patients with childhood cancer who survived longer. In addition to a descriptive analysis, we used logistic regression with multivariable fractional polynomials to describe the relationship be…
Health status, health-related quality of life, and socioeconomic outcome in childhood brain tumor survivors: a German cohort study
Abstract Background With rising numbers of childhood cancer survivors, somatic and socioeconomic outcome as well as health-related quality of life (QoL) gain increasing relevance. Based on the first nationwide German Survey on Life Situation, State of Health, and Quality of Life of Childhood Cancer Survivors, the VIVE survey, we report the outcome of survivors of childhood brain tumors localized in the posterior fossa. Methods Two hundred seventy participants with a median follow-up period of 21.9 years completed a questionnaire on socioeconomic and somatic late effects as well as a standardized QoL questionnaire (European Organisation for Research and Treatment of Cancer QLQ-C30). Comparis…
Maternal Supplementation with Folic Acid and Other Vitamins and Risk of Leukemia in Offspring
Maternal prenatal supplementation with folic acid and other vitamins has been inconsistently associated with a reduced risk of childhood acute lymphoblastic leukemia (ALL). Little is known regarding the association with acute myeloid leukemia (AML), a rarer subtype.We obtained original data on prenatal use of folic acid and vitamins from 12 case-control studies participating in the Childhood Leukemia International Consortium (enrollment period: 1980-2012), including 6,963 cases of ALL, 585 cases of AML, and 11,635 controls. Logistic regression was used to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for child's age, sex, ethnicity, parental education, and s…
Temporal trends in the incidence rate of childhood cancer in Germany 1987-2004.
The German Childhood Cancer Registry regularly presents graphs of childhood cancer incidence rates by period, but no systematic analysis. The Automated Childhood Cancer Information System-project found an increasing trend in Europe. Against this background we present the first detailed trend analysis of childhood (aged under 15) malignancies in Germany. We examined incidence rates separately in western Germany 1987-2004 and eastern Germany 1991-2004. We analyzed all malignancies, all main diagnostic groups and relevant subsets using an age-period-cohort model. Additionally we fitted fractional polynomials to assess the linearity of the drift. All malignancies combined (excluding Central Ner…
Epidemiologie, Ätiologie, Prävention
Welches sind die Ursachen von Krebserkrankungen im Kindes- und Jugendalter? Welche Rolle spielen Umweltfaktoren bei der Entstehung dieser Erkrankungen? Eine Grundlage zur Beantwortung dieser Fragen bilden epidemiologische Krebsregister, wie etwa das 1980 auf Initiative der deutschsprachigen padiatrischen Onkologen gegrundete Deutsche Kinderkrebsregister. Mit einem solchen Register kann z. B. beantwortet werden, wie haufig Krebserkrankungen auftreten, ob Veranderungen in der Auftretenshaufigkeit zu beobachten sind oder ob sich die Prognose generell verbessert hat. Dies ist dank der guten Zusammenarbeit der Krebsregister untereinander moglich und wird intensiv ge nutzt. Aufbauend auf der dami…
Childhood acute lymphoblastic leukaemia and birthweight: Insights from a pooled analysis of case–control data from Germany, the United Kingdom and the United States
Abstract Background Heavy birthweight is one of the few established risk factors for childhood acute lymphoblastic leukaemia (ALL). To provide new insight into this relationship, particularly at the extremes ( 4500 g), we pooled data from three of the largest childhood cancer case–control studies ever conducted. Methods Birthweight and gestational age on 4075 children with ALL and 12,065 controls were collected during the course of three studies conducted in the USA, the UK and Germany in the 1990s. Information was obtained from mothers at interview, and the impact of bias was evaluated using the UK study which accessed birth registrations of participants and non-participants. Odds ratios (…
Social outcomes of long-term survivors of adolescent cancer
Objectives: The study investigates psychosexual and family outcomes among German long-term survivors of adolescent cancer. Methods: Survivors of cancer during adolescence (n=820; age at onset of disease: M=15.8 years, SD=0.9, age at follow-up: M=30.4, SD=6.0 years) completed questionnaires on their family life and their psychosexual and autonomy development. Outcomes were compared to an age-matched sample (German Socio-Economic Panel, G-SOEP, n=820, age: M=30.4, SD=6.7 years) from the general population and to a control group of adults without cancer (n=1027, age: M=31.5, SD=7.0 years). Results: Compared to controls of the same sex, female survivors had achieved fewer developmental mileston…
Genetic determinants of ototoxicity during and after childhood cancer treatment: Protocol for the pancarelife study
BACKGROUND: Survival rates after childhood cancer now reach nearly 80% in developed countries. However, treatments that lead to survival and cure can cause serious adverse effects with lifelong negative impacts on survivor quality of life. Hearing impairment is a common adverse effect in children treated with cisplatin-based chemotherapy or cranial radiotherapy. Ototoxicity can extend from high-tone hearing impairment to involvement of speech frequencies. Hearing impairment can impede speech and language and neurocognitive development. Although treatment-related risk factors for hearing loss following childhood cancer treatment have been identified, the individual variability in toxicity of…
Pediatric Germ Cell Tumors From 1987 to 2011: Incidence Rates, Time Trends, and Survival
BACKGROUND: Malignant germ cell tumors (GCTs) are a rare and a heterogeneous group of pediatric cancers. The incidence rate has increased in some populations or subgroups. However, only a few recent publications on epidemiologic data showing the trends in incidence of pediatric GCTs are available. METHODS: We analyzed the incidence rates, time trends, and survival for 1366 GCTs in children 0 to 14 years old registered in the nationwide, population-based German Childhood Cancer Registry in 1987–2011. RESULTS: The incidence rate of GCTs was slightly higher in girls (age-standardized rate: girls, 5.3; boys, 4.4 per million). A bimodal age distribution was seen. In children aged <1 year…
Managing a Pan-European Consortium on Late Effects among Long-Term Survivors of Childhood and Adolescent Cancer—The PanCareLIFE Project
PanCareLIFE brought together European partners and is the largest study to have evaluated the issues of fertility impairment, hearing loss, and health-related quality of life in survivors of childhood and adolescent cancer. Successful delivery of the project aims did not evolve solely from scientific qualities. Organizational structure and careful information management were key components for its successful completion and are retrospectively assessed in this paper. PanCareLIFE used cohort studies, case-control studies, clinical evaluation of hearing, and genetic testing to study 32,000 survivors from 25 data providers. A management team implemented the organizational structures, was the de…
Educational and vocational achievement among long-term survivors of adolescent cancer in Germany
Background Adolescence involves graduating from school and preparing one's professional career. The accomplishment of these tasks may be hampered by the experience of cancer. This study investigates the educational and professional achievements of German long-term survivors of adolescent cancer. Procedure Adult survivors of cancer during adolescence (n = 820, age at onset between 15 and 18 years; M = 15.8, SD = 0.9 years; age at follow-up: M = 30.4, SD = 6.0 years) were recruited through the German Childhood Cancer Registry. They completed self-reports with standard items on their educational and vocational level and their current occupational situation. Outcomes were compared to an age-mat…
Untersuchung der Häufigkeit von Krebserkrankungen im Kindesalter in der Umgebung von Kernkraftwerken
Seit 1983 das Britische Fernsehen in der vielbeachteten Dokumentation „Windscale — The Nuclear Laundry“ uber eine Haufung kindlicher Leukamien in der Umgebung von Windscale berichtete, ist die Diskussion uber einen Zusammenhang zwischen Leukamieclustern und ionisierender Strahlung aus kerntechnischen Anlagen nicht abgebrochen. Grose Studien in England und Wales (2,3,6), in den USA (9) und in Frankreich (8), in denen die Krebsinzidenz bzw. Krebsmortalitat in der Umgebung kerntechnischer Anlagen ausgewahlten Vergleichsregionen gegenubergestellt wurde, sind zu unterschiedlichen Ergebnissen gekommen. Wahrend in den Vereinigten Staaten keine Erhohung der Krebsmortalitat in der Umgebung kerntechn…
Changing geographical patterns and trends in cancer incidence in children and adolescents in Europe, 1991–2010 (Automated Childhood Cancer Information System): a population-based study
List of ACCIS contributors = Monika Hackl, Anna Zborovskaya, Nadya Dimitrova, Zdravka Valerianova, Ladislav Dušek, Margit Mägi, Alain Monnereau, Jacqueline Clavel, Michel Velten, Anne-Valérie Guizard, Véronique Bouvier, Xavier Troussard, Anne-Sophie Woronoff, Emilie Marrer, Brigitte Trétarre, Marc Colonna, Olivier Ganry, Pascale Grosclaude, Berndt Holleczek, Zsuzsanna Jakab, Laufey Tryggvadóttir, Lucia Mangone, Franco Merletti, Stefano Ferretti, Bianca Caruso, Maria Michiara, Rosario Tumino, Fabio Falcini, Roberto Zanetti, Giovanna Tagliabue, Otto Visser, Giske Ursin, Ryszard Mężyk, Kamila Kepska, José Laranja Pontes, Maja Primic Žakelj, Rafael Fernández-Delgado, Marisa L Vicente Raneda, En…
PanCareLIFE
Aims: Survival after cancer diagnosed during childhood or adolescence continues to improve with new treatments and supportive therapies. Optimal long-term care requires that risks to vulnerable organs are clearly defined and translated into guidelines that are implemented into practice. PanCareLIFE is a pan-European consortium that addresses survivorship issues comprising fertility, hearing impairment and quality of life. This article describes the scientific basis of PanCareLIFE's studies.Methods: PanCareLIFE involves 17 partner institutions from eight European countries, with additional 11 data providers from five other countries. Study designs and methods include molecular genetic, cohor…
Case Control Study on Childhood Leukemia in Lower Saxony, Germany
In two municipalities in Lower Saxony statistically valid clusters were observed, which attracted great public interest. Committees were set up to initiate a large variety of on-the-spot-investigations. Finally, it was decided to conduct a case control study throughout Lower Saxony to explore potential risk factors which might explain the observed clusters. A limited number of already established and currently discussed hypotheses was chosen for investigation. The study was based on patients registrated at the German Children's Cancer Registry (GCCR). For each child with leukemia diseased between 1988 and 1993 two population-based controls (local and state controls) and one tumour control w…
erman case control study on childhood leukaemia - Basic considerations, methodology and summary of the results
In order to explore potential risk factors of childhood leukaemia, a case control study was performed including all incident cases from 1992 to 1994. The study was based on the German Childhood Cancer Registry. It was restricted to cases from West Germany and extended retrospectively until 1980 for children who were living in regions covered by a previous incidence study on nuclear installations (21). The study was conducted in close correspondence with a preceding case control study in Lower Saxony (13). Results of this study and of others published in the literature were used to define explicit hypotheses for the present study. This paper presents the methodology of the study and gives an…
Das Langzeit-Follow-up in der deutschen pädiatrischen Onkologie als Basis für die Durchführung von Studien mit Langzeitüberlebenden
BACKGROUND In recent years, the long-term survival of childhood cancer patients has increased considerably. While this is desirable, more patients with late effects are to be expected and studies thereof become increasingly important. We will need to be able to stay in touch with as many former patients as possible in order to make a systematic and comprehensive long-term follow-up possible. PATIENTS Childhood cancer patients under 15 years of age at diagnosis resident in Germany and registered at the German Childhood Cancer Registry (GCCR). METHODS The GCCR has established a 3-phase procedure for follow-up. We developed principles for the long-term follow up of these patients. They are bas…
Up-to-date monitoring of childhood cancer long-term survival in Europe: central nervous system tumours.
ABSTRACT Background Tumours of the central nervous system (CNS) account for 15–20% of all malignant childhood tumours in developed countries. Steady improvement of survival of children with CNS tumours has been reported for the past decades. However, these results, obtained by cohort analysis of survival, do not reflect the full extent of recent improvement. Methods Using selected registries from the database of the Automated Childhood Cancer Information System (ACCIS), we calculated period survival estimates for the years 1995–99 for children diagnosed with a malignant CNS tumour. Results The overall 10-year period survival estimate for the years 1995–99 was 59% for children with all CNS t…
Posttraumatic stress, depression and anxiety among adult long-term survivors of cancer in adolescence.
Abstract Background To determine the prevalence of posttraumatic stress, depression and anxiety in adults who have survived cancer (⩾5 years) diagnosed in adolescence, as compared to healthy controls. Patients and methods Survivors (n = 820) of cancer during adolescence (age M = 30.4 ± 6.0 years; M = 13.7 ± 6.0 years since diagnosis) and 1027 matched controls without history of cancer (age M = 31.5 ± 6.9 years) completed standardised questionnaires measuring posttraumatic stress, depression and anxiety. Additionally, sub-groups of 202 survivors and 140 controls with elevated scores received structured interviews to ascertain DSM-IV-diagnoses. Results A total of 22.4% of the survivors report…
Untersuchungen zur Entdeckung räumlicher Cluster im Kinderkrebsregister Mainz
Im Rahmen des Mainzer Kinderkrebsregisters beschaftigen wir uns mit der Frage, ob die Inzidenzen kindlicher Krebserkrankungen regional besonders hoch oder besonders niedrig sind. Nicht nur regionale Haufungen sind fur das Register von Interesse, sondern, als Hinweis auf systematische Erfassungslucken, auch regional besonders niedrige Inzidenzen. Dies fuhrt auf die Frage, ob die Inzidenzen von Krebserkrankungen bei Kindern raumliche Autokorrelation aufweisen. Ob man auf einer Landkarte Cluster visuell wahrnimmt und ob Tests auf raumliche Autokorrelation Cluster entdecken, hangt auch von der Klasseneinteilung der beobachteten Werte und von den verwendeten Verfahren ab. Wir haben daher mehrere…
Parental informed consent in pediatric cancer trials: A population-based survey in Germany
In Germany, nearly every child afflicted by a malignant dis-ease or a central nervous system tumor is enrolled in a clinicaltrial during treatment. Many of these children are under the age of5 years when they are first diagnosed [1]. The decision whether ornot to participate in a clinical trial is normally made by theparents on behalf of their child. Therefore, ensuring adequatelyinformed parental consent is essential to ethical practice in pedi-atric oncology.However, many empirical studies have revealed difficultieswith the informed consent process when parents are faced withthe decision to enroll their child in a clinical trial. Previous studyfindings have indicated that recalling signing th…
Effect of genetic variation in CYP450 on Gonadal impairment in a European cohort of female childhood cancer survivors, based on a candidate gene approach
Background: Female childhood cancer survivors (CCSs) carry a risk of therapy-related gonadal dysfunction. Alkylating agents (AA) are well-established risk factors, yet inter-individual variability in ovarian function is observed. Polymorphisms in CYP450 enzymes may explain this variability in AA-induced ovarian damage. We aimed to evaluate associations between previously identified genetic polymorphisms in CYP450 enzymes and AA-related ovarian function among adult CCSs. Methods: Anti-Müllerian hormone (AMH) levels served as a proxy for ovarian function in a discovery cohort of adult female CCSs, from the pan-European PanCareLIFE cohort (n = 743
Strategy for Long-Term Surveillance at the German Childhood Cancer Registry - an Update
Background The objective of this paper is to provide information about the quality (e.g. completeness, response) of long-term surveillance in German paediatric oncology and haematology based on the structures implemented by the German Childhood Cancer Registry (GCCR). Methods The GCCR contacts parents or patients to collect and update information on a minimal set of follow-up health status data (e.g. late relapses, subsequent neoplasms, current address) and exchanges this information regularly with the appropriate clinical trials. Results Between 2006 and 2010, GCCR approached a total of about 20,000 patients (contact at the age of 16 years, inquiry concerning the health status) in the cont…
Pediatric bone tumors in Germany from 1987 to 2011: incidence rates, time trends and survival
AbstractBackground: Malignant bone tumors are a rare group of childhood cancer.Materials and methods: This study describes incidence rates, survival probabilities, and time trends for 1831 children below 15 years of age with a bone tumor registered at the population-based German Childhood Cancer Registry between 1987 and 2011.Results: Overall age-standardized annual incidence rate (ASR) was 5.5 per million. Osteosarcomas (ASR 2.8) and Ewing tumors (ASR 2.6) were the most frequent diagnostic groups. The incidence of bone tumors overall tended to increase slightly over time by 0.7% each year on average. Thirty-nine of the bone tumor cases reported were subsequent primaries and not included in…
High-birth weight and other risk factors for Wilms tumour: results of a population-based case-control study.
Wilms tumour, or nephroblastoma, is one of the childhood cancers included in two recent population-based case-control studies in West Germany. Altogether, 177 children under the age of 10 years with Wilms tumour diagnosed between 1988 and 1994 and 2006 control children sampled from population registration files participated. Information on potential risk factors was obtained from the parents using a questionnaire and by subsequent telephone interview. We found an association with a high birth weight >4000 g (odds ratio 1.58; 95% confidence interval 1.01–2.48), which was somewhat stronger for children aged 2 years or older. Findings for young maternal age at birth and certain parental occupa…
Effective childhood cancer treatment: The impact of large scale clinical trials in Germany and Austria
In Germany and Austria, more than 90% of pediatric cancer patients are enrolled into nationwide disease-specific first-line clinical trials or interim registries. Essential components are a pediatric cancer registry and centralized reference laboratories, imaging review, and tumor board assistance. The five-year overall survival rate in countries where such infrastructures are established has improved from 80% since 1995. Today, treatment intensity is tailored to the individual patient's risk to provide the highest chances of survival while minimizing deleterious late effects. Multicenter clinical trials are internationalized and serve as platforms for further improvements by novel drugs an…
Second Malignancies Following Childhood Cancer Treatment in Germany From 1980 to 2014.
BACKGROUND Because of improvements in cancer treatment, more than 80% of all children with cancer now survive at least five years from the time of diagnosis. As a result, late sequelae of cancer and its treatment have become more common, particularly second malignancies. We studied the current incidence of second malignancies among childhood cancer survivors in Germany. METHODS This study is based on the cohort of the German Childhood Cancer Registry (Deutsches Kinderkrebsregister, DKKR). Persons given the diagnosis of a first malignancy at any time in the years 1980-2014 who were no more than 14 years old at the time of diagnosis and survived at least six months thereafter were included in…
Durchführung eines neuen Therapiekonzepts für Nephroblastome im Bereich der Gesellschaft für Pädiatrische Onkologie und Hämatologie SIOP 9/GPOH
Hintergrund: Die intensive Therapie der von der Gesellschaft fur Padiatrische Onkologie und Hamatologie (GPOH) ab 1980 durchgefuhrten Wilmstumorstudie sollte in der Folgestudie unter Wahrung der guten Ergebnisse reduziert werden. Methode: 1989 wurde das Therapiekonzept der International Society of Pediatric Oncology (SIOP) mit praoperativer Chemotherapie nach bildgebender Diagnose ubernommen, wobei der Tumor durch die Vorbehandlung verkleinert wird, damit er bei einem Grosteil der Kinder vollstandig entfernbar ist. Ergebnisse: Bei 505 in 5,25 Jahren aus 78 Kliniken gemeldeten Patienten hatten 486 ein Nephroblastom, 14 ein anderes Malignom und 5 eine benigne renale Lasion. Von 438 gemeldeten…
Cancer patterns among children of Turkish descent in Germany: A study at the German Childhood Cancer Registry
Abstract Background Cancer risks of migrants might differ from risks of the indigenous population due to differences in socioeconomic status, life style, or genetic factors. The aim of this study was to investigate cancer patterns among children of Turkish descent in Germany. Methods We identified cases with Turkish names (as a proxy of Turkish descent) among the 37,259 cases of childhood cancer registered in the German Childhood Cancer Registry (GCCR) during 1980–2005. As it is not possible to obtain reference population data for children of Turkish descent, the distribution of cancer diagnoses was compared between cases of Turkish descent and all remaining (mainly German) cases in the reg…
Contributing factors and outcomes of treatment refusal in pediatric oncology in Germany
Background In Germany, about 1,800 new cases of pediatric cancer under 15 years of age are diagnosed each year and survival rates approach 80%. Although treatment is covered by health insurance and is thus available for all patients at no cost, treatment refusal and treatment discontinuation have been observed. However, no data providing numbers and outcomes for developed countries have been published thus far. Procedure A questionnaire-based survey was performed among German pediatric oncology centers to ascertain the number of treatment refusals among pediatric patients who were diagnosed between January 2008 and December 2009 in Germany. Results Questionnaires from 70 of 73 centers were …
Childhood cancer predisposition syndromes-A concise review and recommendations by the Cancer Predisposition Working Group of the Society for Pediatric Oncology and Hematology.
Heritable predisposition is an important cause of cancer in children and adolescents. Although a large number of cancer predisposition genes and their associated syndromes and malignancies have already been described, it appears likely that there are more pediatric cancer patients in whom heritable cancer predisposition syndromes have yet to be recognized. In a consensus meeting in the beginning of 2016, we convened experts in Human Genetics and Pediatric Hematology/Oncology to review the available data, to categorize the large amount of information, and to develop recommendations regarding when a cancer predisposition syndrome should be suspected in a young oncology patient. This review su…
Regionale Analysen der Krebsinzidenz bei kleinen Fallzahlen
Seit 1980 dokumentiert das Mainzer Kinderkrebsregister bundesweit die malignen Erkrankungen bei Kindern unter 15 Jahren. Zu den registrierten Daten gehort neben Angaben wie Name, Alter, Diagnose und Erkrankungsdatum die Gemeinde, in der das erkrankte Kind bei Diagnosestellung wohnte. Diese Angabe dient als Grundlage zur kartographischen Aufbereitung der regionalen Inzidenzen, die eine wichtige Aufgabe von Krebsregistern darstellt (1).
Childhood Leukemia in the Vicinity of Nuclear Power Plants in Germany
SUMMARY The causes of leukemia are largely unclear. The question whether leukemia rates are increased near nuclear power plants is controversial. The German Childhood Cancer Registry has published an epidemiological case-control study on childhood cancer and nuclear power plants. Method: The study was based on the distance of children's residences from nuclear power plants and addressed the question whether children under age 5 with cancer live closer, on average, to nuclear power plants than randomly selected controls. Odds Ratios (OR) for distance categories and standardized incidence ratios (SIR) were calculated. Results: An association was found between the nearness of residence to nucl…
Leukemia and Non-Hodgkin's Lymphoma in Childhood and Exposure to Pesticides: Results of a Register-based Case-Control Study in Germany
Previous studies have suggested an association between exposure to pesticides and different types of childhood cancer. This paper presents results from a population-based case-control interview study of parents of children less than 15 years of age, which was conducted in the states of West Germany from 1993 to 1997. Cases were 1,184 children with leukemia, 234 with non-Hodgkin's lymphoma, and 940 with a solid tumor; 2,588 controls were also included. Parental occupational exposures were found to be related to childhood cancer regardless of the time period of exposure and the type of cancer. This finding might partially be explained by different recall of past exposures by the parents of ca…
Preradiation chemotherapy of children and young adults with malignant brain tumors: Results of the german pilot trial HIT'88/'89
Background Preradiation chemotherapy could be beneficial in malignant brain tumors, because the blood-brain tumor-barrier is disrupted after surgery, bone marrow recovery--essential for intense chemotherapy--is still intact, and CNS toxicity and ototoxicity of active drugs are lower before irradiation of a child's brain. Patients and methods A neoadjuvant phase 2 and a single arm pilot trial were initiated to investigate the efficacy and toxicity of an intense multidrug regimen before radiotherapy in 147 patients aged between 3 and 29; 9 years with medulloblastoma (94), malignant glioma (22), ependymoma (21), and stPNET (10). They were treated with one or two cycles consisting of procarbazi…
Childhood cancer and residential radon exposure - results of a population-based case-control study in Lower Saxony (Germany)
A population-based case-control study on risk factors for childhood malignancies was used to investigate a previously reported association between elevated indoor radon concentrations and childhood cancer, with special regard to leukaemia. The patients were all children suffering from leukaemia and common solid tumours (nephroblastoma, neuroblastoma, rhabdomyosarcoma, central nervous system (CNS) tumours) diagnosed between July 1988 and June 1993 in Lower Saxony (Germany) and aged less than 15 years. Two population-based control groups were matched by age and gender to the leukaemia patients. Long-term (1 year) radon measurements were performed in those homes where the children had been liv…
Return and Disclosure of Research Results: Parental Attitudes and Needs Over Time in Pediatric Oncology.
Objectives To explore parental attitudes regarding the return and disclosure of research findings in pediatric cancer trials over time. Study design Two surveys were set up to evaluate the stability of parental attitudes. One survey was carried out among 581 parents whose child was diagnosed recently (response rate, 53.5%). A second, population-based survey was set up with a time interval of 4 years between first cancer diagnosis and survey in which 1465 parents were included (response rate, 55.1%). Results Almost all surveyed parents stated a parental right to receive aggregate research results. Fifty-five percent of the parents who recently participated in trials and 62% of those asked af…
Burden of cardiovascular risk factors and cardiovascular disease in childhood cancer survivors: Data from the German CVSS-study.
Aims: The cardiac and vascular late sequelae in long-term survivors of childhood cancer (CVSS)-study aimed to quantify the prevalence of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD) in German childhood cancer survivors (CCS). Methods and results: In the CVSS-study (NCT02181049), 1002 CCS (age range 23-48 years) diagnosed with neoplasia prior to 15 years of age between 1980 and 1990 prospectively underwent a systematic, standardized clinical and laboratory cardiovascular screening, identical to the population-based Gutenberg Health Study (GHS) cohort. For 951 individuals, prevalences of CVRF and CVD were primarily compared to the GHS sample and to two further German po…
Atopic disease and childhood acute lymphoblastic leukemia
Our objective was to test the hypothesis that the risk of childhood leukemia is associated with allergies or a family history of allergy. We used a German population-based case-control study with self-reported information on allergies of the children and their first-degree relatives. Our study included a total of 1,130 cases of acute lymphoblastic leukemia (ALL), 164 cases of acute myeloid leukemia (AML) and 2,957 controls. A major finding of our study is that hay fever, neurodermatitis and contact eczema are underrepresented within the group of children with ALL, with respective odds ratios (OR) of 0.45 (95% confidence interval [CI] 0.31-0.66) for hay fever, of 0.49 (CI 0.34-0.71) for neur…
The Cohort of Long-term Survivors at the German Childhood Cancer Registry
Background With the increasing number of long-term survivors among patients diagnosed with cancer during childhood, questions concerning late effects have become a major research topic. To ascertain late effects, it is necessary to contact former patients. An essential requirement for such studies is a long-term surveillance (LTS) of former childhood cancer patients in their adolescence and their adulthood. The paper describes the role of the German Childhood Cancer Registry (GCCR) in LTS. A cohort of long-term survivors has been built up over the years. The characteristics of this LTS cohort and strategies for further improvement of LTS will be presented. Patients and methods Since 1980 th…
Long-Term Follow-Up of Children, Adolescents, and Young Adult Cancer Survivors.
<b><i>Background and Summary:</i></b> Thanks to increasing cure rates to currently &#x3e;80%, children, adolescents, and young adults (CAYA) survive their cancer much more frequently today than decades ago. Due to their long life expectancy, CAYA cancer survivors are at a particular risk of long-term sequelae from the cancer itself or the therapy applied; this requires specific follow-up, and preventative or even therapeutic interventions. Thus, compared to the normal population, morbidity and mortality may be significantly increased. In 2 of 3 survivors, the cancer and the respective treatment can lead to late effects, even after 30 years, which require specific…
Home pesticide exposures and risk of childhood leukemia: Findings from the childhood leukemia international consortium
Some previous studies have suggested that home pesticide exposure before birth and during a child's early years may increase the risk of childhood leukemia. To further investigate this, we pooled individual level data from 12 case-control studies in the Childhood Leukemia International Consortium. Exposure data were harmonized into compatible formats. Pooled analyses were undertaken using multivariable unconditional logistic regression. The odds ratio (ORs) for acute lymphoblastic leukemia (ALL) associated with any pesticide exposure shortly before conception, during pregnancy and after birth were 1.39 (95% confidence interval [CI]: 1.25, 1.55) (using 2,785 cases and 3,635 controls), 1.43 (…
Mental health and health-related quality of life in preschool-aged childhood cancer survivors. Results of the prospective cohort study ikidS-OEVA.
Objectives Long-term survivors of childhood cancer are at increased risk for sequelae such as poor mental health (MH) or impaired health-related quality of life (HrQoL). We aimed to evaluate early adverse effects on MH and HrQoL in young childhood cancer survivors (YCCS) before school entry. Methods In a nationwide prospective cohort study, children with cancer other than brain tumors diagnosed at preschool age and completed cancer treatments were identified from the German Childhood Cancer Registry. The comparison group was children of the same age without a cancer diagnosis who participated in the prospective population-based health survey ikidS. MH problems and HrQoL were assessed by par…
Complementary and alternative treatment methods in children with cancer. A population based retrospective survey on the prevalence of use in Germany
Introduction Few studies have been conducted to date on the prevalence of use of complementary and alternative treatment methods (CAM) in paediatric oncology and those that have been conducted are often not representative. We therefore decided to study a representative sample of children with cancer in the German population. Patients and methods The study took the form of a retrospective survey amongst all parents whose children were first diagnosed with a disease covered by the German Childhood Cancer Registry in 2001. The primary objectives of the survey were to establish the prevalence of use of CAM and the factors related to its use. Results Of the 1595 questionnaires sent out, 1063 (67…
Fetal growth and childhood acute lymphoblastic leukemia: Findings from the childhood leukemia international consortium
Positive associations have been reported between measures of accelerated fetal growth and risk of childhood acute lymphoblastic leukemia (ALL). We investigated this association by pooling individual-level data from 12 case-control studies participating in the Childhood Leukemia International Consortium. Two measures of fetal growth – weight-for-gestational-age and proportion of optimal birth weight (POBW) – were analysed. Study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression, and combined in fixed effects meta-analyses. Pooled analyses of all data were also undertaken using multivariable logistic regression. Subgroup analy…
Sero-epidemiological analysis of the risk of virus infections for childhood leukaemia.
Virus infections have been thought to be involved in the development of childhood leukaemia. In order to address this issue we determined, in a case-control study, the prevalence of antibodies to viruses infecting blood or bone-marrow cells [Epstein-Barr virsus (EBV), human herpes virus type 6 (HHV-6), parvovirus B19] as well as to the human virus known for its tumour-suppressive properties, the adeno-associated virus type 2 (AAV-2), in the sera of 121 children with leukaemia in Germany, and in 197 control individuals, hospitalized for other reasons, and matched for age and gender to the cases. In addition, we developed a questionnaire to be answered by the children's parents, in order to g…
Incidence, Trends, and Survival of Children With Embryonal Tumors.
BACKGROUND: Central nervous system (CNS) and non-CNS embryonal tumors occur principally in children and are rarely seen in adults. The incidence rates for rare entities such as atypical teratoid/rhabdoid tumors (AT/RT) or primitive neuroectodermal tumors in the CNS are rarely published. Incidence rates for certain subgroups, such as hepatoblastomas, have been increasing in some countries. METHODS: Data of 8337 embryonal tumors, registered in children (0–14 years) between 1991 and 2012 (for AT/RT 2000–2012) in the population-based German Childhood Cancer Registry with complete national coverage were analyzed for incidence rates, time trends, and survival. RESULTS: For most entities, the inc…
Electromagnetic Fields and Childhood Leukemia: Pooled Analyses of Two German Population-Based Case-Control Studies
From 1992 to 1995 we conducted a population-based case-control study on residential magnetic fields and childhood leukemia in Lower Saxony, a region in northwestern Germany with 7.4 million inhabitants.1,2 Because of the rural character of this area, we detected elevated magnetic fields in only 1.5% of all dwellings. We therefore expanded the EMF-measurements to an ongoing case-control study on childhood leukemia in the capital of Germany, Berlin. We applied the same methods of exposure assessment, intending to pool the data of the two studies and to calculate combined risk estimates.3
Incidence, time trends and regional variation of childhood leukaemia in Germany and Europe.
This paper presents data on the German and Europe-wide incidence, time trends and regional variations of childhood leukaemia. Data were provided by the German Childhood Cancer Registry (GCCR), a population-based cancer registry recording all cases of malignant diseases in children under 15 y of age residing in Germany and by the Automated Childhood Cancer Information System (ACCIS) co-ordinated at International Agency for Research on Cancer, Lyon, that combines and evaluates data from several European population-based cancer registries. The incidence of leukaemia (44.0 per million) has increased in Europe as well as in Germany in the last decades (0.6% annually on average). Germany shows no…
Risk factors for pediatric tumors of the central nervous system: Results from a German population-based case-control study
From 1993 to 1997 we conducted two population-based case-control studies on childhood cancer and a variety of potential risk factors in Germany. One case group involved children under the age of 15 years having a tumor of the central nervous system (CNS).For both studies, one conducted in the northwestern area of Germany, the other covering the whole of West Germany, incident cases were identified from the nationwide German Childhood Cancer Registry, and controls were randomly selected from complete population registration files.In total 466 pediatric CNS tumor cases and 2,458 controls were available for analyses. We observed only few positive associations, namely, between CNS tumors and lo…
Survival from childhood acute lymphoblastic leukaemia in West Germany: Does socio-demographic background matter?
Sex, age, immunophenotype and white blood cell count at diagnosis are well accepted predictors of survival from acute lymphoblastic leukaemia (ALL) in children. Less is known about the relationship between socio-economic determinants and survival from paediatric ALL, studied here for the first time in German children.ALL cases were diagnosed between 1992 and 1994 and their parents interviewed during a previous nationwide case-control study. Children were followed-up for 10 years after diagnosis by the German Childhood Cancer Registry. Cox proportional hazards models estimating hazard ratios (HRs) were calculated to assess the impact of selected socio-demographic characteristics on overall a…
Impact of era of diagnosis on cause-specific late mortality among 77 423 five-year European survivors of childhood and adolescent cancer:The PanCareSurFup consortium
Late mortality of European five-year survivors of childhood or adolescent cancer has dropped over the last 60 years, but excess mortality persists. There is little information concerning secular trends in cause-specific mortality among older European survivors. PanCareSurFup pooled data from 12 cancer registries and clinics in 11 European countries from 77 423 five-year survivors of cancer diagnosed before age 21 between 1940 to 2008 followed for an average age of 21 years and a total of 1.27 million person-years to determine their risk of death using cumulative mortality, standardized mortality ratios (SMR), absolute excess risks (AER), and multivariable proportional hazards regression ana…
Epidemiology of pediatric tumors of the central nervous system.
Tumors of the CNS are the second most frequent malignancy in childhood and the most common of the solid tumors. An increase in CNS tumor rates during the past decades has been observed in a number of countries. One possibility is that improvements in diagnostics of CNS tumors contributed to the increasing trend. Another concern is that changes in environmental exposures may be responsible for the increasing incidence rates and a number of epidemiologic studies investigated factors like exposure to ionizing radiation, electromagnetic fields, or pesticides. In addition, prenatal exposures, for example from maternal diet, or the role of infectious agents were of particular interest. In this re…
Health-related quality of life in European childhood cancer survivors: Protocol for a study within PanCareLIFE
Background Survival after childhood cancer has improved to more than 80% during the last few years, leading to an increased number of childhood cancer survivors. Cancer itself, or its treatment, may cause chronic health conditions, including somatic and mental sequelae, which may affect survivors’ health-related quality of life (HRQoL). Objective The project PanCareLIFE aims to establish a large database with comprehensive data on childhood cancer survivors from different European countries, including data on HRQoL. Within PanCareLIFE, this study aims to describe HRQoL in survivors, investigate predictors of HRQoL, and describe the association of HRQoL with hearing and female fertility imp…
Association of childhood leukaemia with factors related to the immune system
The childhood peak of common acute lymphoblastic leukaemia has been proposed as being a rare response to delayed exposure to a common infection. In this context, factors related to the child’s immune system are of special interest. Information on such factors was obtained in a recent German case-control study comprising more than 1000 children with acute leukaemia. Neither being the first-born child, nor a short duration of breastfeeding, indicators of a deficit in viral contacts during infancy or the number of infectious diseases, were significant risk factors. We observed a strong association with fewer routine immunizations with a 3.2-fold increase for those children getting less than fo…
Epidemiology of childhood cancer
The present contribution reports childhood cancer incidence and survival rates as well as time trends and geographical variation. The report is based on the databases of population-based cancer registries which joined forces in cooperative projects such as Automated Childhood Cancer Information System (ACCIS) and EUROCARE. According to these data, which refer to the International Classification of Childhood Cancer, leukemias, at 34%, brain tumors, at 23%, and lymphomas, at 12%, represent the largest diagnostic groups among the under 15-year-olds. The most frequent single diagnoses are: acute lymphoblastic leukemia, astrocytoma, neuroblastoma, non-Hodgkin lymphoma, and nephroblastoma. There …
Association of childhood cancer with factors related to pregnancy and birth
It has been hypothesized that risk factors of childhood cancers may already operate during the prenatal and neonatal period. Results of previous epidemiological studies have been inconsistent.During 1992-1997 a large case-control study on childhood cancers and a variety of potential risk factors was conducted in Germany. Cases were ascertained by the German Childhood Cancer Registry. Each case was matched to a population-based control of the same age and gender, sampled from the district where the case lived at the date of diagnosis. For the analyses, 2358 cases and 2588 controls were available.Risk of childhood acute leukaemia increased with maternal ageor =20 years at time of delivery (od…
Survival of European children and young adults with cancer diagnosed 1995-2002
This study analyses survival in 40,392 children (age 0-14 years) and 30,187 adolescents/young adults (age 15-24 years) diagnosed with cancer between 1995 and 2002. The cases were from 83 European population-based cancer registries in 23 countries participating in EUROCARE-4. Five-year survival in countries and in regional groupings of countries was compared for all cancers combined and for major cancers. Survival for 15 rare cancers in children was also analysed. Five-year survival for all cancers combined was 81% in children and 87% in adolescents/young adults. Between-country survival differences narrowed for both children and adolescents/young adults. Relative risk of death reduced signi…
Childhood cancer incidence patterns by race, sex and age for 2000-2006: A report from the South African National Cancer Registry
Higher childhood cancer incidence rates are generally reported for high income countries although high quality information on descriptive patterns of childhood cancer incidence for low or middle income countries is limited, particularly in Sub-Saharan Africa. There is a need to quantify global differences by cancer types, and to investigate whether they reflect true incidence differences or can be attributed to under-diagnosis or under-reporting. For the first time, we describe childhood cancer data reported to the pathology report-based National Cancer Registry of South Africa in 2000-2006 and compare our results to incidence data from Germany, a high income country. The overall age-standa…
Parental occupational pesticide exposure and the risk of childhood leukemia in the offspring: Findings from the childhood leukemia international consortium
Maternal occupational pesticide exposure during pregnancy and/or paternal occupational pesticide exposure around conception have been suggested to increase risk of leukemia in the offspring. With a view to providing insight in this area we pooled individual level data from 13 case-control studies participating in the Childhood Leukemia International Consortium (CLIC). Occupational data were harmonized to a compatible format. Pooled individual analyses were undertaken using unconditional logistic regression. Using exposure data from mothers of 8,236 cases, and 14,850 controls, and from fathers of 8,169 cases and 14,201 controls the odds ratio (OR) for maternal exposure during pregnancy and t…
Registration of childhood cancer: Moving towards pan-European coverage?
Cancer is relatively rare in childhood, but it contributes considerably to childhood mortality, years of life lost per person and late effects in survivors. Large populations need to be covered to set up meaningful studies of these rare conditions. Cancer registries ensure cancer surveillance, thus providing the basis for research as well as policy decisions. In this paper we examine coverage of childhood population by cancer registries in Europe and encourage national cancer registration. Over 200 cancer registries in various stages of development were identified as collecting data on childhood cancer patients in Europe. They cover 52% of the childhood population in the World Health Organi…
Association of candidate pharmacogenetic markers with platinum-induced ototoxicity
Genetic association studies suggest a genetic predisposition for cisplatin-induced ototoxicity. Among other candidate genes, thiopurine methyltransferase (TPMT) is considered a critical gene for susceptibility to cisplatin-induced hearing loss in a pharmacogenetic guideline. The PanCareLIFE cross-sectional cohort study evaluated the genetic associations in a large pan-European population and assessed the diagnostic accuracy of the genetic markers. 1,112 pediatric cancer survivors who had provided biomaterial for genotyping were screened for participation in the pharmacogenetic association study. 900 participants qualified for inclusion. Based on the assessment of original audiograms, patien…
Incidence and time trends of soft tissue sarcomas in German children 1985-2004 - a report from the population-based German Childhood Cancer Registry.
Abstract The incidence of soft tissue sarcoma (STS) in Europe is increasing, but it is unclear whether this increase can also be seen in Germany. We analysed the heterogeneous group of STS recorded to the German Childhood Cancer Registry (GCCR) between 1985 and 2004 with respect to incidence data. Age-specific, age-standardised and cumulative incidence rates were calculated. Additionally, the average annual percent change (AAPC), derived from a Poisson regression model, was estimated, using time in years as the explanatory, continuous variable. Two thousand sixty-one children were diagnosed at a median age of 72 months. Most common are rhabdomyosarcomas (RMS) (n = 1202) and fibrosarcomas (n…
Risk of digestive cancers in a cohort of 69 460 five-year survivors of childhood cancer in Europe: the PanCareSurFup study.
BackgroundSurvivors of childhood cancer are at risk of subsequent primary neoplasms (SPNs), but the risk of developing specific digestive SPNs beyond age 40 years remains uncertain. We investigated risks of specific digestive SPNs within the largest available cohort worldwide.MethodsThe PanCareSurFup cohort includes 69 460 five-year survivors of childhood cancer from 12 countries in Europe. Risks of digestive SPNs were quantified using standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence.Results427 digestive SPNs (214 colorectal, 62 liver, 48 stomach, 44 pancreas, 59 other) were diagnosed in 413 survivors. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors…
Usefulness of current candidate genetic markers to identify childhood cancer patients at risk for platinum-induced ototoxicity: Results of the European PanCareLIFE cohort study
Background Irreversible sensorineural hearing loss is a common side effect of platinum treatment with the potential to significantly impair the neurocognitive, social and educational development of childhood cancer survivors. Genetic association studies suggest a genetic predisposition for cisplatin-induced ototoxicity. Among other candidate genes, thiopurine methyltransferase (TPMT) is considered a critical gene for susceptibility to cisplatin-induced hearing loss in the FDA drug label and a pharmacogenetic guideline. The aim of this cross-sectional cohort study was to confirm the genetic associations in a large pan-European population and to evaluate the diagnostic accuracy of the genetic…
Risk factors for neuroblastoma at different stages of disease. Results from a population-based case-control study in Germany
Neuroblastoma is one of the childhood cancers included in two recent population-based case-control studies in West Germany. Altogether, 183 children under the age of 8 with neuroblastoma diagnosed in 1988-1994 and 1785 control children sampled from population registration files participated. Information on potential risk factors was obtained from the children's parents by a self-administered questionnaire and subsequent telephone interview. We observed positive associations with the use of oral contraceptives or other sex hormones during pregnancy (particularly with male offspring), a shorter gestational duration, lower birth weight, and maternal alcohol consumption during pregnancy. While …
Pediatric High-Grade Astrocytomas Show Chromosomal Imbalances Distinct from Adult Cases
We studied 23 pediatric high-grade astrocytomas by comparative genomic hybridization. Chromosomal imbalances were found in 10 of 10 anaplastic astrocytomas and 11 of 13 glioblastomas and consisted of +1q (43%), +3q (26%), +1p, +2q, +5q (22%), −22q (34%), −6q, −10q (30%), −9q, −11q, −13q, −16q, and −17p (22%). Anaplastic astrocytomas frequently showed +5q (40%), +1q (30%), −22q (50%), −6q, −9q (40%), and −12q (30%); glioblastomas +1q (54%), +3q (38%), +2q, +17q (23%), −6q, −8q, −10q, −13q, and −17p (31%). Minimal common regions mapped to +1q21-41, +3q27-qter, +2q31-32, +5q14-22, −22q12-qter, −10q23-25, −6q25-qter, −9q34.2, −11q14−22, −16q22-qter, and −17p. High-level gains were located on 1q…
Population-based epidemiologic data on brain tumors in German children.
BACKGROUND Brain tumors are the most common disease group of solid tumors in childhood, and children with brain tumors have a relatively poor survival rate. Epidemiologic data from a population-based cancer registry provide the necessary information to obtain a full picture of the frequency of this disease, which is a great challenge in pediatric oncology. METHODS The German Childhood Cancer Registry (GCCR) is a population-based registry. The level of completeness of patient registration is 95%, but it is somewhat lower for patients with brain tumors. More than 300 children with newly diagnosed brain tumors are reported every year. Analyses of GCCR data are performed according to the Intern…
Case Control Study of Neuroblastoma in West-Germany after the Chernobyl Accident
Background To explore possible causes of a 1988 incidence peak of infant neuroblastoma in west German regions which were contaminated with more than 6000 Bq/m2 Cs137 from the Chernobyl accident. The primary working hypothesis was that parents of the diseased children had been contaminated by an excessive intake of locally produced food, especially mushrooms or deer. Design Case control study with 1:2 (cases:controls) matching. Data were collected from the children's parents by questionnaires and telephone interviews. Setting Nation-wide study (former FRG) based on the German Childhood Cancer Registry. Subjects Cases born in 1988 and reported with a neuroblastoma to the registry until March …
Multiple primary neoplasms in childhood: data from the German children’s cancer registry
Abstract The German Children’s Cancer Registry (GCCR) has documented all malignancies during the first 15 years of life in Germany since 1980. In a series of 20 388 cancer cases to the end of 1995, 127 children with multiple primary neoplasms up to the age of 15 years were identified. The children were monitored for 82 591 person-years with a mean observation time of 4.1 years. Relative and cumulative risk for the occurrence of second malignant neoplasms were estimated only for the first 15 years of life, as follow-up data beyond childhood are incomplete and valid data on the incidence of cancer in adolescents and adults are not available in Germany. The overall standardised incidence ratio…
Complementary and alternative treatment methods in children with cancer: A population-based retrospective survey on the prevalence of use in Germany.
Abstract Introduction Few studies have been conducted to date on the prevalence of use of complementary and alternative treatment methods (CAMs) in paediatric oncology, and those that have been conducted are often not representative. We therefore decided to study a representative sample of children with cancer in the German population. Patients and methods The study took the form of a retrospective survey amongst all parents whose children were first diagnosed with a disease covered by the German Childhood Cancer Registry in 2001. The primary objectives of the survey were to establish the prevalence of use of CAM and the factors related to its use. Results Of the 1595 questionnaires sent ou…
Family circumstances and survival from childhood acute lymphoblastic leukaemia in West Germany
Little is known about the relationship between family characteristics and survival from childhood acute lymphoblastic leukaemia (ALL), which we studied for the first time in German children.ALL cases were diagnosed between 1992 and 1994 and information on family characteristics was collected during a previously conducted nationwide case-control study. Children were followed for 10 years after diagnosis, as few disease-related events occur afterwards. Cox proportional hazards models estimating hazard ratios (HR) were calculated using overall as well as event-free survival methods.Second born children showed statistically significant better survival compared to first or later born children, w…
Communication and ethical considerations for fertility preservation for patients with childhood, adolescent, and young adult cancer
Patients with childhood, adolescent, and young adult cancer who will be treated with gonadotoxic therapies are at increased risk for infertility. Many patients and their families desire biological children but effective communication about treatment-related infertility risk and procedures for fertility preservation does not always happen. The PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group reviewed the literature and developed a clinical practice guideline that provides recommendations for ongoing communication methods for fertility preservation for patients who were diagnosed with childhood, adolescent, and young adult cancer at a…