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Identifying causal ...
Identifying causal relationships of cancer treatment and long-term health effects among 5-year survivors of childhood cancer in Southern Sweden
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- Holst, Anders (author)
- Research Institutes of Sweden (RISE)
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- Ekman, Jan (author)
- Research Institutes of Sweden (RISE)
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- Petersson-Ahrholt, Magnus (author)
- Climber Sweden
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- Relander, Thomas (author)
- Lund University,Lunds universitet,Sena effekter efter barncancerbehandling,Forskargrupper vid Lunds universitet,Lymfom - Klinisk forskning,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Late effects after childhood cancer treatment,Lund University Research Groups,Lymphoma - Clinical Research,LUCC: Lund University Cancer Centre,Other Strong Research Environments,Skåne University Hospital
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- Wiebe, Thomas (author)
- Lund University,Lunds universitet,Sena effekter efter barncancerbehandling,Forskargrupper vid Lunds universitet,Late effects after childhood cancer treatment,Lund University Research Groups
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- Linge, Helena M (author)
- Lund University,Lunds universitet,Sena effekter efter barncancerbehandling,Forskargrupper vid Lunds universitet,Late effects after childhood cancer treatment,Lund University Research Groups
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(creator_code:org_t)
- 2022-03-02
- 2022
- English.
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In: Communications medicine. - : Springer Science and Business Media LLC. - 2730-664X. ; 2, s. 1-12
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Abstract
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- Background: Survivors of childhood cancer can develop adverse health events later in life. Infrequent occurrences and scarcity of structured information result in analytical and statistical challenges. Alternative statistical approaches are required to investigate the basis of late effects in smaller data sets.Methods: Here we describe sex-specific health care use, mortality and causal associations between primary diagnosis, treatment and outcomes in a small cohort ( n = 2315) of 5-year survivors of childhood cancer ( n = 2129) in southern Sweden and a control group ( n = 11,882; age-, sex- and region-matched from the general population). We developed a constraint-based method for causal inference based on Bayesian estimation of distributions, and used it to investigate health care use and causal associations between diagnoses, treatments and outcomes. Mortality was analyzed by the Kaplan-Meier method. Results: Our results confirm a significantly higher health care usage and premature mortality among childhood cancer survivors as compared to controls. The developed method for causal inference identifies 98 significant associations ( p < 0.0001) where most are well known ( n = 73; 74.5%). Hitherto undescribed associations are identified ( n = 5; 5.1%). These were between use of alkylating agents and eye conditions, topoisomerase inhibitors and viral infections; pituitary surgery and intestinal infections; and cervical cancer and endometritis. We discuss study-related biases ( n = 20; 20.4%) and limitations. Conclusions: The findings contribute to a broader understanding of the consequences of cancer treatment. The study shows relevance for small data sets and causal inference, and presents the method as a complement to traditional statistical approaches.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Publication and Content Type
- art (subject category)
- ref (subject category)
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