Temporal changes in treatment exposures in the Childhood Cancer Survivor Study (CCSS).
Bibliographic record
Abstract
10074 Background: Well-designed epidemiologic investigations of pediatric cancer survivors inform clinical practice guidelines and future clinical trials. Expansion of the CCSS cohort to include survivors diagnosed across three decades (1970-99) affords the opportunity to evaluate associations between key temporal changes in survivor and treatment characteristics and risk for subsequent adverse health outcomes. Methods: We analyzed cancer and treatment characteristics of 24,000 CCSS participants. Treatment exposures were abstracted from medical records. Trends across 5 year intervals were evaluated using logistic regression models with weights to account for sampling probabilities. Results: Within the expanded CCSS, the use of chemotherapy significantly increased overall (Table, T1-T6) for all diagnoses except leukemia which was always 100%. Exposure to radiation (RT) decreased overall and for all diagnoses except soft tissue sarcoma. Overall, chest RT exposure was reduced and notably, exposures of ≥ 30 Gy declined from 85% to 6% (T1 to T6) for Hodgkin lymphoma. Alkylating agent use increased by 15% overall, and among leukemia, lymphoma and sarcoma patients proportions were on the order of 40% higher at T6 than at T1. Use of anthracyclines (ANT) increased significantly, predominantly for doses lower than 250 mg/m2. Conclusions: The expansion of the CCSS cohort provides a unique resource to evaluate the impact of historical changes in primary cancer therapy, including reduction of therapeutic intensity for low- and standard-risk populations, as well as intensification of specific therapies for high-risk populations on health and psychosocial outcomes. % With Characteristic T1 1970-74 T2 1975-79 T3 1980-84 T4 1985-89 T5 1990-94 T6 1995-99 Any RT* 79 75 64 50 40 34 RT to brain* 30 36 32 24 18 16 RT to neck* 24 19 16 9 7 7 RT to abdomen* 28 22 19 12 8 9 RT to chest ≥ 30 Gy* 21 13 8 4 1 1 Any Chemotherapy* 75 81 81 85 86 87 Any alkylating agents* 45 49 55 57 58 60 ANT 1-250 mg/m2* 3 12 18 34 45 52 ANT >250 mg/m2* 11 24 24 23 17 14 Any epipodophyllotoxins* 1 4 9 25 34 36 Platinum* <1 2 7 12 14 17 *Trend p-value <0.0001.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".