Erice Statement on Survivorship Updated

It’s hard to believe it’s been over 10 years since the first Erice statement in 2016, which laid out 10 key points summarising the essential components of cure and care for childhood cancer survivors!

In Nov 2016, 65 pediatric cancer experts from 17 European countries and North America, including many members of the PanCareLIFE team, met in Erice as part of the semi-annual PanCare meeting to review the original statement. They have now published an updated version of the statement in the Journal of Cancer Survivorship (


New publication from our sister project PanCareSurFup

Check out the latest open access publication from our sister project PanCareSurFup in the European Journal of Epidemiology!



Related Publication: Audiological monitoring in Swiss childhood cancer patients

PanCareLIFE partners at UNIBE have published the results of their work on ‘Audiological monitoring in Swiss childhood cancer patients’ in Pediatric Blood & Cancer (A. Weiss et al. 2017;e26877,

Abstract Background: Full audiological monitoring is the best strategy to detect hearing loss early and to provide timely intervention in the absence of a clinical method of otoprotection. Full monitoring requires audiological evaluation before, and then during and after ototoxic cancer treatment. In a worldwide context of monitoring protocols that vary substantially, we analyzed the audiological monitoring of childhood cancer patients over the last decade across treatment centers in Switzerland.

Procedure: We retrospectively searched for audiological evaluations in all nine Swiss Pediatric Oncology Centers. We analyzed proportions of patients who had audiological monitoring and described type and timing of monitoring. We determined predictors of audiological monitoring using multivariable logistic regression and described time trends.

Results: We included 185 patients from the Swiss Childhood Cancer Registry diagnosed from 2005 to 2013 who had platinum chemotherapy and/or cranial radiation ≥30 Gray and who were alive at time of study. Less than half of children, 43%, had full audiological monitoring (before, during, and after treatment), while 72% were tested after cancer treatment. Nonstudy patients were less likely to have had monitoring in all phases of cancer treatment. Patients who received treatment with cisplatin or both platinum chemotherapy and cranial radiation were more likely to have had monitoring after treatment. Monitoring during and after treatment increased over the study period, but monitoring before treatment was insufficient in all time periods.

Conclusions: Our population-based study indicates that audiological monitoring is insufficient in Switzerland, particularly for nonstudy patients. Clinicians must become more aware of the importance of full audiological monitoring.

Related Publication: Long-term auditory complications after childhood cancer: A report from the Swiss Childhood Cancer Survivor Study

PanCareLIFE partners at UNIBE have published the results of their work on ‘Long-term auditory complications after childhood cancer: A report from the Swiss Childhood Cancer Survivor Study’ in Pediatric Blood & Cancer (A. Weiss et al. 2017 Feb;64(2):364-373. doi: 10.1002/pbc.26212).


Auditory complications are an adverse event of childhood cancer treatment, especially common in children treated with platinum chemotherapy or cranial radiation. Variation between diagnostic childhood cancer groups has rarely been studied, and we do not know if the burden of auditory complications has changed over the last decades.


Within the Swiss Childhood Cancer Survivor Study, we sent a questionnaire to all survivors who were diagnosed at age 16 years or less between 1976 and 2005. We compared prevalence of self-reported hearing loss and tinnitus between all diagnostic childhood cancer groups and siblings, used multivariable logistic regression to analyze the effect of treatment-related factors on hearing loss, and compared the cumulative incidence of hearing loss between different periods of cancer diagnosis.


Prevalence of self-reported hearing loss was higher in survivors (10%) than in siblings (3%, P < 0.001), and highest in survivors of central nervous system tumors (25%). Significant risk factors were treatment with platinum compounds (carboplatin: odds ratio [OR] 2.4; cisplatin: OR 9.4), cranial radiation (>29 Gy: OR >1.7), or brain surgery (OR 2.2). Children diagnosed in 1986-1995, when platinum compounds came into widespread use, had a significantly higher cumulative incidence of hearing loss than those diagnosed in 1976-1985. In the most recent period, 1996-2005, the risk decreased again, both for patients treated with platinum compounds and with cranial radiation.


Our data show that the burden of hearing loss has stabilized in recently treated survivors, suggesting that survivors have benefited from new treatment regimens that use less ototoxic radiation and more carefully dosed platinum compounds.

Related Publication from Denmark

Our Danish colleagues from KB are co-authors on the publication ‘Gastrointestinal and liver disease in Adult Life After Childhood Cancer in Scandinavia: A population-based cohort study’ in the International Journal of Cancer.

IJC Abst


Related publication: Childhood cancer survivors at heightened risk of several autoimmune diseases

The Danish Cancer Society Research Center, project partner in PanCareLIFE, have recently published the first large-scale study of the lifetime risk for autoimmune diseases after childhood cancer, with risk estimates for a broad range of well-defined, medically verified autoimmune diseases. in Annals of the Rheumatic Diseases (Autoimmune diseases in Adult Life after Childhood Cancer in Scandinavia (ALiCCS) – Ann Rheum Dis. 2015 Nov 10. pii: annrheumdis-2015-207659).

You can read the press release here.

The first author Anna S. Holmqvist, MD, PhD from Lund in Sweden has also been interviewed for a news story in The Lancet Oncology.

KB Pub Jan 2016

See our Publications page for other PanCareLIFE related publications.

PanCare Paper on Survivorship after Childhood Cancer

The PanCare network has been described in a paper published in the European Journal of Cancer. The PanCareLIFE project is presented alongside our sister project, PanCareSurFup. Both projects have arisen from work of the PanCare network and its collaborators.

Dynamics of fertility impairment in childhood brain tumour survivors.

This article can be accessed through this link.


Fertility impairment and recovery after chemo- and radiotherapy have been reported in both male and female childhood cancer survivors, but little is known about the dynamics. Our aim, therefore, was to describe the development of fertility impairment and possible recovery in childhood brain tumour survivors.


In this longitudinal study, we included 144 survivors, who were treated in two German paediatric oncology centres between 2000 and 2005. Fertility parameters were retrieved from medical records up to 12 years after diagnosis.


Participants with age ≥13 years and formerly cranial irradiation ≥30 Gray (n = 23), including 83 % (n = 19) with craniospinal irradiation ≥30 Gray, had a higher median FSH concentration compared to 29 patients without chemoradiotherapy: 8.3 IU/l (IQR 6.5-11.2) versus 4.1 IU/l (IQR 3.2-5.1) 2 years after initial treatment; 8.9 IU/l (IQR 8.5-10.8) versus 4.2 IU/l (IQR 2.4-6.7) after 8 years; and 7.1 IU/l (IQR 6.7-7.7) versus 3.5 IU/l (IQR 2.8-4.2) after 10 years. Altogether, 11/65 women reported the occurrence of amenorrhoea 6.0 years (range 1-10) after diagnosis. Five of these women later developed a regular menstrual cycle without hormone replacement therapy. Patients’ chance of recovery from fertility impairment was increased with time since diagnosis (p = 0.074).


Signs of fertility impairment such as amenorrhoea and elevated FSH levels were observed at variable time points between 1 and 12 years after chemoradiotherapy. Decreasing FSH levels were observed 1-7 years after elevation and were interpreted either as an atrophy of the pituitary gland or as recovery from fertility impairment.

Dynamics of fertility impairment and recovery after allogeneic haematopoietic stem cell transplantation in childhood and adolescence: results from a longitudinal study.

This article can be accessed through this link.


Fertility impairment and recovery after haematopoietic stem cell transplantation (HSCT) have been reported in both sexes, but little is known about how they develop over time. Our aim was to describe the dynamics of fertility impairment and recovery after HSCT.


We retrieved treatment and fertility data for up to 12 years of 361 paediatric patients with malignant and non-malignant diseases from seven European centres. The patients had been treated with allogeneic HSCT between 2000 and 2005.


Development of fertility impairment was observed in males (123/217, 56 %) after a median time of 2.6 years (range 0.1-11.4) and in females (82/144, 57 %) after 2.3 years (range 0.1-12.0) after HSCT. Different busulfan dosages had only a slight impact on the onset of fertility impairment (busulfan ≥16 mg/kg with a median time to fertility impairment of 2.9 vs. 3.9 years after busulfan <14 mg/kg). Recovery from fertility impairment was observed in 17 participants after a median time of 4.1 years (range 1-10.6) in females (10/144, 7 %) and 2.0 years (range 1-6.3) in males (7/217, 3 %) after fertility impairment first appeared.


In the light of the dynamics of fertility impairment and recovery in the HSCT patients reviewed, these patients should be counselled comprehensively regarding fertility preservation measures.

Related Publication: Understanding platinum-induced ototoxicity

Understanding Platinum-Induced Ototocity

Langer Tam Zehnhoff-Dinnesen ARadtke SMeitert JZolk O.

Trends Pharmacol Sci. 2013 Aug;34(8):458-69. doi: 10.1016/ Epub 2013 Jun 13.