Childhood Cancer Patients Research Articles

The mediating roles of cancer‐related rumination in the relationship between dispositional hope and psychological outcomes among childhood cancer survivors

This study aimed to examine the effects of dispositional hope on psychopathology as well as self-perceived positive change in childhood cancer survivors through the potential mediation of cancer-related ruminations. A cross-sectional design was used, and a group of childhood cancer survivors (N = 89; mean age = 23.2 years; age range = 17.2-31.3 years) were studied. Dispositional hope level was measured by the Hope Scale; positive and negative cancer-related ruminations were assessed by the Chinese Cancer-related Rumination Scale; depression symptoms were measured by Beck Depression Inventory; and anxiety symptoms were measured by Beck Anxiety Inventory. Positive adjustment outcome of posttraumatic growth (PTG) was assessed by the Chinese Post-traumatic Growth Inventory. Multiple regressions were used to analyze the relationship between dispositional hope and the outcome variables of PTG, anxiety and depression and the potential mediators of positive and negative cancer-related rumination. Dispositional hope was positively related to PTG, and the correlation was specifically mediated by positive cancer-related rumination. Dispositional hope also correlated with lower levels of depression and anxiety, specifically mediated by negative cancer-related rumination. The present finding supported hope as a significant positive factor for childhood cancer survivors, which was associated with PTG and better psychological adjustment. The findings may inform development of therapeutic intervention programs aimed at increasing childhood cancer patients' hope levels, which may be correlated with more positive cancer-related thoughts and better adjustment. The present study, which examined survivors diagnosed at young age, may enrich existing studies on the effect of onset age and adjustment outcomes.

Descriptive epidemiology of childhood cancer in Cali, Colombia 1977-2011

The objective of the present report is to describe the occurrence and survival patterns of childhood cancer over the last 20 years in Cali. Information was obtained from the Cancer Population Registry in Cali and the Municipal Department of Health . Childhood cancer international classification was used. The vital status was obtained from MDH death certificate and hospital databases. Additionally, clinical records were revised and, in some cases, telephone contact was carried out. Follow-up was done until 31/12/2011. Incident and mortality rates were estimated and adjusted for age. Life-tables were made to estimate overall survival. Between the years of 1977-2011, there were 2311 cases identified in children under 15 years of age. The IR and MR for Cali were found to be 141.2 and 55.6 per million of people per year. Leukemias, lymphomas, CNS tumors and soft tissue sarcomas showed IR of 60.1, 20.5, 25.7 and 9.4, respectively. 5-years OS was 48%, and showed an improvement from 24.9%±4.3 to 51.8%±4.6, compared 1992-96 vs 2002-06 periods. The IR found is comparable with those described in affluent countries. Taking into account that pediatric cancer is curable for about 75-80% of the cases, it presents an enormous challenge to the Colombian health system: to improve current clinical results.

Value of FDG-PET/CT Examinations in Different Cancers of Children, Focusing on Lymphomas

The aim of the study was to assess sensitivity and specificity of FDG-PET/CT in different forms of childhood cancer. We retrospectively evaluated the results dedicated of 162 FDG-PET/CT examinations of 86 children treated with: Hodgkin lymphoma (HL; n = 31), non-Hodgkin lymphoma (NHL; n = 30) and other high grade solid tumors (n = 25). Patients were admitted and treated in two departments of pediatric hematology and oncology in Hungary. FDG-PET/CT was performed for staging (n = 25) and for posttreatment evaluation (n = 137). Imaging was performed in three FDG-PET/CT Laboratories, using dedicated PET/CT scanners. False positive results were defined as resolution or absence of disease progression over at least 1 year on FDG-PET/CT scans without any intervention. In some cases histopathological evaluation of suspicious lesions was performed. Fals negative results were defined as negative FDG-PET/CT results in case of active malignancy. Positive predictive values (PPV) and negative predictive values (NPV) were calculated. NPV was 100%. The highest PPV was observed in high grade solid tumors (81%), followed by HL (65%) and NHL (61%). There was a major difference of PPV in different histological types of HL (50% in HL of mixed-cellularity subtype, 90% in nodular sclerosing, and 100% in lymphocyte-rich and lymphocyte depleted HL). We treated one patient with nodular lymphocyte predominant HL, who had 5 false positive FDG-PET/CT results. PPV of T- and B-lineage NHL were similar (60% and 62%, respectively). We observed an interesting difference of PPV in different stages of HL and NHL. In HL PPV was higher in early than in advanced disease forms: 66% in stage II HL and 60% in stage III HL, whereas there was an inverse relationship between PPV and disease stages in NHL 0% in stage I and II patients, 67% in stage III and 100% in stage IV patients. PPV was lower in males (54%) than in females (65%). PPV were 64% vs. 58% in patients under vs. over 10 years of age. Negative FDG-PET/CT results during follow-up reliably predict the absence of malignancy. Positive FDG-PET/CT scan results in general have a low PPV. The relatively high PPV in patients with histologically proven high grade solid tumors, advanced stages of NHL and with nodular sclerosing, lymphocyte-rich and lymphocyte depleted subtypes of HL warrant a confirmation by biopsy, whereas the watch-and-wait approach can be used in other forms of childhood cancer patients with a positive FDG-PET/CT result in course of follow-up examinations.

Clinical exercise interventions in pediatric oncology: a systematic review

Studies in pediatric oncology have shown a positive effect of physical activity on disease- and treatment-related side effects. Although several reviews have approved the benefits of therapeutic exercise for adult cancer patients, no systematic review exists summarizing the evidence of physical activity in pediatric oncology. We identified a total of 17 studies using the PubMed database and Cochrane library. To evaluate the evidence, we used the evaluation system of the Oxford Center for Evidence-Based Medicine 2001. The findings confirm that clinical exercise interventions are feasible and safe, especially with acute lymphoblastic leukemia (ALL) patients and during medical treatment. No adverse effects have been reported. Positive effects were found on fatigue, strength, and quality of life. Single studies present positive effects on the immune system, body composition, sleep, activity levels, and various aspects of physical functioning. Child-specific aspects such as cognitive abilities, growth, adolescence, and reintegration into peer-groups, school, and sports have barely been taken into consideration. The evidence for exercise interventions in pediatric oncology is rated level "3." Although the results are very promising, future research of high methodological quality and focusing on child-specific aspects is needed to establish evidence-based exercise recommendations, particularly for childhood cancer patients.

The development of a clinical screening instrument for tumour predisposition syndromes in childhood cancer patients

BackgroundIdentification of tumour predisposition syndromes in patients who have cancer in childhood is paramount for optimal care. A screening instrument that can help to identify such patients will facilitate physicians caring for children with cancer. The complete screening instrument should consist of a standardised series of pictures and a screening form for manifestations not visible in the pictures. Here we describe the development of such a screening form based on an international two-stage Delphi process and an initial validation of the complete instrument. Patients and methodsWe identified manifestations that may contribute to the diagnosis of a tumour predisposition syndrome through the Winter–Baraitser Dysmorphology Database and the textbook “Gorlin’s Syndromes of the Head and Neck”. In a two-round Delphi process, eight international content-experts scored the contribution of each of these manifestations. We performed a clinical validation of the instrument in a selected cohort of 10 paediatric cancer patients from another centre. ResultsIn total, 49 manifestations were found to contribute to the diagnosis of a tumour predisposition syndrome and were included in the screening form. The pilot validation study showed that patients suspected of having a tumour predisposition syndrome were recognised. Excellent correlation for indications of patient’s referral between the screening instrument and the reference standard (personal evaluation by an experienced clinical geneticist) was found. ConclusionsThe Delphi process performed by international specialists with a function as opinion leaders in their field of expertise, has led to a screening instrument for childhood cancer patients. Patients who may have a tumour predisposition syndrome and thus have an indication to be referred for further genetic analysis, can be identified using the screening instrument.

GnRH-Analogues for Ovarian Protection in Childhood Cancer Patients: How Adult Hypotheses are Relevant in Prepubertal Females

Systemic chemotherapy frequently causes primary ovarian insufficiency. In prepubertal girls, currently the only option to preserve ovarian function is ovarian tissue preservation. The use of gonadotropin-releasing hormone analogues given in combination with chemotherapy has been studied in reproductive age women. The exact mechanism is unknown, but some of the proposed protective mechanisms could theoretically protect the prepubertal ovary as it has been theorized in many of the studies on reproductive age women. None of the studies implies an adverse affect of GnRH analogue administration in terms of worsening health or cancer status. As 83% of children diagnosed with cancer will survive into adulthood, GnRH analogue administration to female childhood cancer patients in combination with chemotherapy might represent a valuable attempt to preserve future ovarian function and fertility when ovarian tissue preservation is not an option.

Psychological Distress in Parents of Children With Advanced Cancer

Parent psychological distress can impact the well-being of childhood cancer patients and other children in the home. Recognizing and alleviating factors of parent distress may improve overall family survivorship experiences following childhood cancer. To describe the prevalence and factors of psychological distress (PD) among parents of children with advanced cancer. Cohort study embedded within a randomized clinical trial (Pediatric Quality of Life and Evaluation of Symptoms Technology [PediQUEST] study). Multicenter study conducted at 3 children's hospitals (Boston Children's Hospital, Children's Hospital of Philadelphia, and Seattle Children's Hospital). Parents of children with advanced (progressive, recurrent, or refractory) cancer. Parental PD, as measured by the Kessler-6 Psychological Distress Scale. Eighty-six of 104 parents completed the Survey About Caring for Children With Cancer (83% participation); 81 parents had complete Kessler-6 Psychological Distress Scale data. More than 50% of parents reported high PD and 16% met criteria for serious PD (compared with US prevalence of 2%-3%). Parent perceptions of prognosis, goals of therapy, child symptoms/suffering, and financial hardship were associated with PD. In multivariate analyses, average parent Kessler-6 Psychological Distress Scale scores were higher among parents who believed their child was suffering highly and who reported great economic hardship. Conversely, PD was significantly lower among parents whose prognostic understanding was aligned with concrete goals of care. Parenting a child with advanced cancer is strongly associated with high to severe levels of PD. Interventions aimed at aligning prognostic understanding with concrete care goals and easing child suffering and financial hardship may mitigate parental PD.

Access to cancer chemotherapy and predictors of early mortality for childhood cancers in Uganda.

10070 Background: Although many childhood cancers respond well to chemotherapy, survival among children with cancer in sub-Saharan Africa is poor. Little is known about children’s access to specialized cancer care in SSA or factors contributing to poor early outcomes. We aimed: 1) To estimate the proportion of childhood cancer patients without access to chemotherapy in Uganda; 2) To describe 30-day survival rates and predictors of mortality post diagnosis among children with lymphoma or Kaposi sarcoma (KS), the two most common pediatric cancers in Uganda. Methods: A retrospective study of incident childhood (age< 20 years) cancers diagnosed in Kyandondo County, Uganda from 2006-2009. We compared records of the population-based Kampala Cancer Registry (KCR) and patient records at the Uganda Cancer Institute (UCI), Uganda’s sole dedicated cancer treatment center. Patient characteristics were compared using Mann-Whitney and Pearson’s chi-square tests. Kaplan-Meier method and Cox regression models were used to describe mortality. Results: Of the 658 pediatric cases recorded in the KCR, only 238 (36%) presented to UCI. Patients identified in the KCR who did not present for care were more likely to be female, diagnosed in earlier years of the study, and to have a cancer other than KS or lymphoma. Of the 177 lymphoma and KS cases at UCI, 43.7% were Burkitt lymphoma (BL), 32.5% KS, and 23.8% other lymphomas. The post diagnosis 30-day overall survival rate was 77%. In multivariate analysis, age, gender, HIV status, platelets, and stage of cancer did not impact mortality. An increased risk of death at 30 days was predicted by presence of B-symptoms (HR=10.3, p=0.05), a diagnosis of BL compared to other lymphomas (HR=14.8, p=0.007), poor performance status (Karnofsky score <70, HR=14.7, p<0.001), and anemia (HR 1.5-fold per 1g/dL decrease in hemoglobin, p=0.002). Conclusions: Childhood cancer patients in Uganda have limited access to comprehensive care. Among those presenting to the UCI, a significant proportion die before they can benefit from chemotherapy. BL diagnosis, B-symptoms, performance status and hemoglobin level may be important predictors of early mortality among childhood cancer patients in sub-Saharan Africa.

Health practices and behaviors of childhood cancer survivors not attending a comprehensive survivor clinic.

10063 Background: Little is known regarding the health practices and behaviors of childhood cancer patients who have not received recommended survivorship care, a group that represents the majority of survivors. Methods: Using the Yale Tumor Registry, consisting of patients from Southern Connecticut, we identified patients who were diagnosed from 2000-2011 with an invasive cancer at age ≤18 years, are currently alive and cancer-free at least one year after therapy, live within 100 miles of Yale HEROS Childhood Cancer Survivor Clinic, never previously attended a survivor clinic, and consented to a research study to investigate survivor care. Participants completed postal or on-line surveys regarding health communication preferences, utilization of services, and behaviors. Results: The 68 participants had a mean age of 16.8 (range 6-27) years at evaluation and 6.7 years since diagnosis with 53% female and 50% currently >18 years. Overall, 100% had seen a primary care physician and 71% their pediatric oncologist in the past year. Forty-six percent had also seen a subspecialist with orthopedics (10%), dermatology (9%), endocrinology (6%), and OB/GYN (6%) as the most common specialties; 16% reported two or more subspecialists. Most (83%) had commercial insurance, while 17% had federal insurance. For communication preferences with their providers, willingness to communicate by cell phone, text messages, and email were 59%, 56%, and 87%, respectively. For health behaviors, only 16% of participants met CDC guidelines for fruit and 19.1% for vegetable intake. Among adults, 12% were active smokers. Only 6% of children and 33% of adults met age-specific CDC recommendations for moderate weekly physical activity. Conclusions: Survivors of childhood cancer were overall highly connected to primary care and other health services, despite not participating in survivorship care. However, inadequate diet and physical activity results suggest patients could benefit from behavioral interventions.

Abstract 2750: Targeted therapy of childhood ALL and Ewing's sarcoma using antiCD19 (antiCD99)-Hybrid Polymerized Liposomal Nanoparticles (HPLN).

Abstract Current success in childhood cancer therapy improves the survival rate of patients but unfortunately not all childhood cancers have shown successful survival rates and still many types of childhood cancer continue to have a poor prognosis. Furthermore due to the poor specificity of cancer therapies almost two-third of childhood cancer survivals experience side effects such as secondary cancers, heart or lung damage, infertility or chronic hepatitis. Therefore a reliable, non-toxic high therapeutic window targeted therapy is urgently needed to treat childhood cancer patients. In our study a novel nanoparticle (HPLN) was used for the treatment of childhood ALL and Ewing's sarcoma. The tumor specific monoclonal antibody was conjugated to the PLN into which Doxorubicin was uptaken using active loading method. AntiCD19 and antiCD99 antibodies were used for targeting of ALL and Ewing tumor, respectively. These tumor specific HPLNs effectively inhibit tumor growth in a murine model of ALL and Ewing's sarcoma. Removal of targeting antibody or drug eliminates the antitumor effects, which proves this anticancer effect of HPLN is very specific to the target cancer cells and dependent upon drug. Additionally, no abnormalities in liver and kidney function tests, complete blood counts or pathology of major organs are observed from tail-vein administrations. These data provide strong evidence for the safety and efficacy of this targeted HPLN delivery system of anticancer drugs to childhood cancer. Citation Format: HyungGyoo Kang, Violette Shahbazian, Jon Nagy, Timothy Triche. Targeted therapy of childhood ALL and Ewing's sarcoma using antiCD19 (antiCD99)-Hybrid Polymerized Liposomal Nanoparticles (HPLN). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2750. doi:10.1158/1538-7445.AM2013-2750

Psychological outcomes in Swedish and Icelandic parents following a child’s cancer—in the light of site-related differences

This study determined the incidence of disease-related distress symptoms in parents from two treatment sites: a large specialized childhood cancer (CC) center in Sweden and a smaller pediatric unit in Iceland. The two groups were compared by considering differences in center type and care organization. Participants were 328 parents of 211 CC patients, in or off treatment. Illness-specific distress was assessed using the multi-dimensional Parental Psychosocial Distress in Cancer (PPD-C) questionnaire. General psychiatric symptoms were assessed using the General Health Questionnaire (GHQ-12). Swedish and Icelandic groups were compared and outcomes studied with regard to site characteristics. Parents in the general population served as a reference group. Distress outcomes in both clinical groups exceeded the levels of the reference group. Systematic differences were found between the parent groups, Icelandic parents scoring higher on 5 of the 11 distress subscales of the PPD-C and in a majority of the illness-specific domains. A tendency towards more negatively affected general mental health was found in Swedish parents (GHQ, p = 0.059). Distress outcomes exceeding those of the comparison group were found in both clinical groups. Significant distress differences were found between the Swedish and the Icelandic parents. Analysis of the outcomes indicates that center type and related differences in patient influx rate and local organization of care are viable explanations of the findings. Methods are proposed for enhancing family care at small centers in order to compensate for conditions associated with burden on parents of the child's cancer.

The development of a clinical screening tool for tumour predisposition syndromes in childhood cancer patients

The development of a clinical screening tool for tumour predisposition syndromes in childhood cancer patients

Totally Implantable Venous Access Device in Children with Cancer Lead to Disfiguring scar

Background In pediatric cancer patients scars of totally implantable venous access devices (TIVAD) are often widened and hypertrophic. This study report on the prevalence and deviation of abnormal scarring in children with a TIVAD and to describe the influencing factors for this abnormal scarring. Methods In a cross-sectional study scars of 122 childhood cancer patients (age 1–21 years) were evaluated; 72 patients had a TIVAD in-situ and in 50 the TIVAD had been removed. Outcome parameters were hypertrophy (modified Vancouver Scar Scale (mVSS), scar surface area, pain, and itching. Scar abnormality was defined as mVSS of >2, or scar width >3mm. Results Abnormal TIVAD scars were found in 107 participants. The mVSS score was higher in patients ≤45 months after removal and the widest >45 months after TIVAD removal. Multivariable analyses showed that the mVSS score was positively related with scar width (mm) and children being ≤45 months after TIVAD removal. Furthermore, TIVAD scar width was positively related with age at last TIVAD surgery, and associated with suture material. In conclusion, there was a high incidence of abnormal TIVAD scars with some pain and itching complaints. However, no typical cancer related influencing factors were associated with increasing abnormalities.

Bone mineral density deficits in childhood cancer survivors: Pathophysiology, prevalence, screening, and management

As chemotherapy and other sophisticated treatment strategies evolve and the number of survivors of long-term childhood cancer grows, the long-term complications of treatment and the cancer itself are becoming ever more important. One of the most important but often neglected complications is osteoporosis and increased risk of fracture during and after cancer treatment. Acquisition of optimal peak bone mass and strength during childhood and adolescence is critical to preventing osteoporosis later in life. However, most childhood cancer patients have multiple risk factors for bone mineral loss. Cancer itself, malnutrition, decreased physical activity during treatment, chemotherapeutic agents such as steroids, and radiotherapy cause bone mineral deficit. Furthermore, complications such as growth hormone deficiency and musculoskeletal deformity have negative effects on bone metabolism. Low bone mineral density is associated with fractures, skeletal deformity, pain, and substantial financial burden not only for childhood cancer survivors but also for public health care systems. Thus, it is important to monitor bone health in these patients and minimize their risk of developing osteoporosis and fragility fractures later in life.

Field Characteristic of In-hospital Parents' Group of Childhood Cancer Patients in Japan : Analysis of structural and participation characteristics aggregation

Field Characteristic of In-hospital Parents' Group of Childhood Cancer Patients in Japan : Analysis of structural and participation characteristics aggregation

Cross-Cultural Adaptation of the Korean Version of the Minneapolis-Manchester Quality of Life Instrument-Adolescent Form

We verified the reliability and validity of the Korean version of the Minneapolis-Manchester Quality of Life Instrument-Adolescent Form (KMMQL-AF) among Korean childhood cancer survivors. A total of 107 childhood cancer patients undergoing cancer treatment and 98 childhood cancer survivors who completed cancer treatment were recruited. To assess the internal structure of the KMMQL-AF, we performed multi-trait scaling analyses and exploratory factor analysis. Additionally, we compared each domains of the KMMQL-AF with those of the Karnofsky Performance Status Scale and the Revised Children's Manifest Anxiety Scale (RCMAS). Internal consistency of the KMMQL-AF was sufficient (Cronbach's alpha: 0.78-0.92). In multi-trait scaling analyses, the KMMQL-AF showed sufficient construct validity. The "physical functioning" domain showed moderate correlation with Karnofsky scores and the "psychological functioning" domain showed moderate-to-high correlation with the RCMAS. The KMMQL-AF discriminated between subgroups of different adolescent cancer survivors depending on treatment completion. The KMMQL-AF is a sufficiently reliable and valid instrument for measuring quality of life among Korean childhood cancer survivors.

Cancer Survivorship Care for Adult Survivors of Childhood Cancer: An Adult Based Model Facilitating Multi-Disciplinary Long-Term Follow-Up Care, Education and Research

As the number of adult survivors of childhood cancers continues to grow, the challenges of long-term follow-up (LTFU) care escalate. When adult survivors of childhood cancer are followed in a pediatric oncology setting their care can be fragmented, leading to barriers for both providers and patients. To address the need for continued LTFU care as survivors age out of the pediatric medicine arena, the STAR (Survivors Taking Action & Responsibility) Program was established in June of 2001 within an adult oncology setting at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. The 11-year old program currently has over 320 survivors enrolled (ages 19-60, all diagnosed at 21 years of age or younger). The program’s three main foci are (1) comprehensive, long-term followup clinical care, (2) patient/family education and (3) research. The STAR team includes a general internal medicine physician, a clinical health psychologist, and an advanced practice nurse with expertise in childhood cancer and late effects from cancer therapy. The program facilitates referrals to specialty care as appropriate. Patient-oriented events allow opportunities for networking, outreach and education to assist patients in becoming autonomous in their comprehensive care and survivorship. The purpose of this article is to share our experiences with the implementation of this program, offer information on how to build a similar model in institutions caring for childhood cancer patients and adult survivors of childhood cancer.

Health-related quality of life assessment in Serbian schoolchildren hospitalized for malignant disease

Although long-term survival of childhood cancer patients is significantly improved, prolonged treatment and hospitalization might have negative impacts on child development. The aim of this study was to verify profile of health-related quality of life parameters in population of schoolchildren during hospitalization and treatment for malignant disease. The Serbian version of Pediatric Quality of Life Inventory Version 4.0 (PedsQLTM4.0) Generic Core Scales was applied. A total of 120 schoolchildren were analyzed: 60 patients hospitalized for prolonged malignant disease treatment and 60 healthy schoolchildren from public schools. The study was done at the Institute for Oncology and Radiology of Serbia, as well as in four schools. Generally, schoolchildren hospitalized for cancer treatment demonstrated lower scores on physical, emotional, social and school functioning when compared to healthy schoolchildren from regular public schools. Significant differences were observed for all the 8 items of the Physical Health Scale, in 2 out of 5 items of the Emotional Functioning Scale, in 4 out of 5 items of the Social Functioning Scale, and 3 out of 5 items of the School Functioning Scale. The Serbian version of PedsQL 4.0 Generic Core Scales could be successfully used to evaluate physical, emotional, social and school functioning of hospitalized children and adolescent. Schoolchildren hospitalized for prolonged tumor treatment have poorer HRQOL scores compared to general healthy population, however the level of remaining physical, emotional and social parameters should provide solid foundation for their potential rehabilitation, education and inclusion.

Body composition in remission of childhood cancer

Here, we describe the results of a cross-sectional bioimpedance study of body composition in 552 Russian children and adolescents aged 7-17 years in remission of various types of cancer (remission time 0-15 years, median 4 years). A sample of 1500 apparently healthy individuals of the same age interval was used for comparison. Our data show high frequency of malnutrition in total cancer patients group depending on type of cancer. 52.7% of patients were malnourished according to phase angle and percentage fat mass z-score with the range between 42.2% in children with solid tumors located outside CNS and 76.8% in children with CNS tumors. The body mass index failed to identify the proportion of patients with malnutrition and showed diagnostic sensitivity 50.6% for obesity on the basis of high percentage body fat and even much less so for undernutrition – 13.4% as judged by low phase angle. Our results suggest an advantage of using phase angle as the most sensitive bioimpedance indicator for the assessment of metabolic alterations, associated risks, and the effectiveness of rehabilitation strategies in childhood cancer patients.

Suicide among childhood cancer survivors in Slovenia

Suicide is one of the causes of late mortality among childhood cancer survivors. The aim of our study was to analyse the risk of suicide among childhood cancer survivors compared with that of the general population of Slovenia. This retrospective study included patients with childhood cancer registered at the Cancer Registry of Slovenia between 1978-2008, with an observation period of 1978-2010. Childhood cancer patients and control subjects from the general population of Slovenia were matched by sex, year and age at the beginning of follow-up and time of follow-up in years. Data on the general population of Slovenia were obtained from the Statistical Office of the Republic of Slovenia. A total of 1647 patients were recorded in the Cancer Registry as having cancer during childhood, with 3 patients committing suicide. All three were male. Their age at diagnosis of cancer was 12, 13 and 2 years old; their age at suicide was 19, 32 and 28 years old. The mechanism of death was asphyxiation in all three deaths. The calculation of the expected number of suicides in the group of individuals with childhood cancer from the general Slovene population revealed the number of 3.16 persons. The comparison of the observed and expected probability showed that there was no statistically significant difference in the suicide rate between childhood cancer survivors and the general population of Slovenia.