Research Article

Assessment of selection bias in clinic-based populations of childhood cancer survivors: A report from the childhood cancer survivor study

  1. Kirsten K. Ness PhD1,*,
  2. Wendy Leisenring ScD2,
  3. Pam Goodman MS2,
  4. Toana Kawashima MS2,
  5. Ann C. Mertens PhD3,
  6. Kevin C. Oeffinger MD4,
  7. Gregory T. Armstrong MD1,
  8. Leslie L. Robison PhD1

Article first published online: 6 NOV 2008

DOI: 10.1002/pbc.21829

Issue

Pediatric Blood & Cancer

Pediatric Blood & Cancer

Volume 52, Issue 3, pages 379–386, March 2009

Additional Information

How to Cite

Ness, K. K., Leisenring, W., Goodman, P., Kawashima, T., Mertens, A. C., Oeffinger, K. C., Armstrong, G. T. and Robison, L. L. (2009), Assessment of selection bias in clinic-based populations of childhood cancer survivors: A report from the childhood cancer survivor study. Pediatric Blood & Cancer, 52: 379–386. doi: 10.1002/pbc.21829

Author Information

  1. 1

    Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee

  2. 2

    Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington

  3. 3

    Department of Pediatrics, Emory University, Atlanta, Georgia

  4. 4

    Departments of Pediatrics and Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

*Assistant Member, St. Jude Children's Research Hospital, Mail Stop 735, 262 Danny Thomas Place, Memphis, TN 38105.

Publication History

  1. Issue published online: 8 JAN 2009
  2. Article first published online: 6 NOV 2008
  3. Manuscript Accepted: 23 SEP 2008
  4. Manuscript Received: 15 JUL 2008

Funded by

  • National Cancer Institute. Grant Number: CA 55727
  • American Lebanese Syrian Associated Charities (ALSAC)

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Keywords:

  • epidemiology;
  • late effects;
  • long-term survival;
  • outcomes research;
  • pediatric oncology

Abstract

Background

It is not known to what extent prevalence estimates of late effects among childhood cancer survivors derived from clinic based samples represent the actual estimates that would be derived if the entire population of childhood cancer survivors was recruited and evaluated for a particular outcome.

Procedure

In a large retrospective cohort study of childhood cancer survivors, the Childhood Cancer Survivor Study (CCSS), the prevalence of chronic health conditions among participants who reported being seen in a cancer center or long-term follow-up clinic was compared to the prevalence of chronic conditions in the entire cohort.

Results

When compared to survivors who had no medical care in the previous 2 years, survivors accessing medical follow-up were significantly more likely to have chronic health conditions. Relative risks of reporting a chronic health condition were 1.4 (95% CI: 1.3–1.5) if seen in a cancer center or long-term follow-up clinic and 1.2 (95% CI: 1.1–1.3) if seen in a general medical care setting. Estimates derived from only those childhood cancer survivors who were seen in a cancer center or long-term follow-up clinic overestimate the prevalence of any chronic disease by 9.3% (95% CI: 7.0–11.6).

Conclusions

Applying chronic condition prevalence estimates from a clinical population to the general population of childhood cancer survivors must be undertaken with caution. Survivorship research must maintain a high level of scientific rigor to ensure that results reported in the literature are interpreted within the appropriate context. Pediatr Blood Cancer 2009;52:379–386. © 2008 Wiley-Liss, Inc.

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