Late Effects: Who, When and Why

Genes  and depression in cancer patients

Depression is known to be one of the most serious and, in principle, life-threatening late effects in cancer patients. Earlier we have reported high rates of depression and use of antidepressants among survivors of cancer.

Compelling new research indicates that genetic factors influence how vulnerable a human is to develop depression when experiencing severe stress such as cancer. It is the aim of our study to use this new area of research in order to create new opportunities for screening, prevention, and treatment of depression in cancer patients.

We will base our study on the cohort “Diet, Cancer and Health” which holds information on more than 57,000 Danish participants. By 2011 more than 10,000 participants had been diagnosed with cancer. These 10,000 cancer patients will be followed for use of antidepressant medication as well as depression so severe that treatment at a hospital is initiated. We will examine if a specific gene should affect the use of antidepressant medication and development of severe depression.

Not only will our study provide new knowledge to the understanding of depression developed after cancer; it is our hope that the research will find use in the daily work with cancer patients, in order to prevent depression and its serious health related consequences.

Risk of hospital contacts for cardiovascular disease, pulmonary disease or depression in patients treated for breast, prostate or colorectal cancer, and evaluation of importance of selected pre-cancer lifestyle factors

In recent years a growing body of evidence has shown that cancer patients are at increased risk for developing serious late effects such as cardiovascular disease, pulmonary disease and depression after ended treatment. With this awareness of the adverse effects of cancer and its treatment, there is a growing need for identifying the underlying risk factors for late effects – among these are life style factors.

In this project, we have information on lifestyle and treatment in a large sample of more than 76,000 men and women aged 50-65 years at study enrollment from three large prospective cohort-studies, i.e. The Diet, Cancer and Health-study, the HPV-study and the LIVA-study. More than 5,400 of these individuals have been diagnosed with a cancer of the breast, prostate or colorectum during 1993-2003. This allows for a unique investigation of how pre-cancer lifestyle and cancer therapy affects the risk of developing late effects among cancer survivors compared to individuals without a history of cancer.

Our study is an important contribution within the field of late effects research, as we will be able to describe how differences in lifestyle and cancer treatment are related to the risk of being diagnosed with a chronic disease later in life.

This knowledge might enable clinicians to tailor future cancer therapy based on the individual patients' risk profile in order to secure the optimal but also least harmful treatment course. Further, this knowledge can help clinicans to identify high-risk cancer patients who needs to be followed more closely in order to prevent development of late effects.

The next step will be to include information on genotype as studies have shown that some patients might be genetically predisposed to and therefore at increased risk for developing late effects after cancer treatment.

SENECA - Cohort studies on late effects following treatment for gynecological cancers

Treatment of gynecological cancers potentially cause somatic and psychological symptoms leading to reduced functioning and quality of life. High-level evidence-based knowledge is sparse, giving us no chance to predict who is at high risk for late effects, and thereby prevent and treat these detrimental consequences of treatment.

We will investigate somatic, sexual, and psychological late effects and work-related issues in women treated for gynecological cancers using a combination of prospectively collected patient-reported data from 1,000 women diagnosed with gynecological cancers and nationwide register-based studies with 15-years of follow-up.

These studies will provide a comprehensive and unique overview of late effects and of high-risk patients. In perspective, results will inform cancer care guidelines on individually tailored prevention and treatment of late effects. Finally, establishing the prospective cohort will form the basis for further follow-up to understand the trajectory of late effects after treatment of gynecological cancers.

The study is not fully financed yet, but we hope to achieve full funding and initiate it during 2016. We have completed a pilot study in December 2015.

Testis cancer treatment results, risk of second cancer and risk of second germ cell cancer - a nationwide cohort study

Testicular cancer (TC) constitutes an important group of malignancies in young men during the second to fourth decades of life. While current treatment produces 15-year overall survival exceeding 90%, significant late morbidity and mortality is increasingly documented among TC survivors.

To study the quality of treatment and late toxicity among TC patients, especially those managed with surveillance, a large nationwide database including around 5000 TC patients has been conducted.

A world wide common prognostic classification for disseminated TC was established in 1997 describing a good, intermediate and poor prognostic group with a 5 year survival of 90%, 75% and 50%, respectively. There are no qualified data describing the survival of these three prognostic groups in unselected TC patients using chemotherapy, accepted as the best standard today, and with newer supportive treatment. Several studies have documented an increased risk of second cancer (SC) among TC survivors.

However, it is not clear whether patients treated on a surveillance program also have an increased risk SC. About half of Danish TC patients are followed on such a program, and this study will be able to clarify if having had a TC per se increases the risk of SC. The current study will also enable us to investigate the consequences of the carcinoma in situ screening program and answer the question whether performing biopsy from the contra lateral testis reduces the risk of developing a second germ cell cancer.