French Childhood Cancer Survivor Study

The main objectives of the FCCSS are to:

• estimate the relationship between doses received (radiotherapy, chemotherapy) at a given organ and risk of second malignancy tumors;

• help identify patients at higher risk;

• compare the mortality occurred among the survivors with the general population;

• investigate the consequences of various intensities of exposure to chemotherapy and/or radiation on health outcomes (such as cardiovascular, cerebrovascular and thyroid diseases, diabetes,…);

• characterize survivors with respect to socioeconomic status and quality of life.

The cohort will be ascertained using:

• the medical records from the treatment centers in order to characterize the childhood cancer, estimate doses of radiotherapy received by all organs and measure the chemotherapy administered;

• the French National Identification Registry and the French Death Registry in order to obtain the vital status and the causes of the deaths for the former patients

• a self-questionnaire that covers the entire future of the survivors (e.g. social status, family network, fertile offspring, access to care, access to bank loans, occupation,...);

• the French National Health Insurance Information System that contains data on all reimbursements for health expenditure including medicinal products as well as outpatient medical and nursing care, prescribed or performed by healthcare professionals.

In an initial cohort, we have already studied the iatrogenic effects of the cancer treatments. We have estimated the doses of ionising radiations delivered by radiotherapy to the target volume and by organs at distance. We found an important role of the radiotherapy and chemotherapy in the risk of a second cancer:

• the cancers occuring after childhood cancer are in excess compared to the general population,

• we studied the relationship between the brain radiation dose and the cerebrovascular mortality,

• there is a high risk of cardiac pathology after anthracyclines administration for a childhood cancer,

• cancer treatments increase the risk of second malignant neoplasms in digestive organs after a very long latency period,

• the risk of thyroid adenoma increased with the radiation dose received by the thyroid during childhood cancer treatment, and plateaued at high doses,

• there is a high long-term mortality risk for all types of second malignant neoplasms whatever the treatment received.