Establishment of a Lifetime of Cohort of Adults Surviving Childhood Cancer (SJLIFE)

Childhood cancer predisposes to health risks that may not become apparent until many years after completion of therapy. The SJLIFE protocol is designed to establish a lifetime cohort of childhood cancer survivors treated at St. Jude Children's Research Hospital to facilitate evaluation of health outcomes in aging adults surviving pediatric cancer.

The study focuses on the following Primary and secondary objectives:

• To establish a lifetime cohort of childhood cancer survivors treated at St. Jude Children's Research Hospital to facilitate evaluation of health outcomes in aging adults surviving pediatric cancer.
• To estimate the prevalence, cumulative incidence, and latency of selected late treatment complications following predisposing therapeutic exposures in adults surviving pediatric cancer.
• To identify treatment, genetic, demographic, and psychosocial / behavioral related predictors of adverse health outcomes.
• To develop risk profiles for adverse health outcomes across the age spectrum to guide development of clinical screening guidelines and risk-reducing interventions.
• To identify factors that may be protective against the development of specific late treatment complications.
• To generate data for a series of future hypothesis-driven trials
• To serve as a source for the collection of samples from adult volunteers for future SJLIFE research.

SJLIFE will be implemented in progressive stages with specific objectives to permit knowledge gained in each phase to inform content/format/study design of subsequent stages. The planned stages of the study include 1) Pre-Recruitment Study, 2) Barriers to Participation Survey, 3) Pilot Study of Recruitment Strategies, 4) Pilot Studies of High-Risk Survivor Cohorts, 5) Cross-Sectional Study of 10-year survivors, and 6) Prospective Lifetime Cohort Study.

Stage I entails telephone interviews with a random sampling of potentially eligible survivors to obtain subjective feedback regarding barriers and facilitators to SJLIFE recruitment and participation. The random sample will include thirty alumnus survivors representing a broad representation of race, gender, attained age, years from diagnosis and primary diagnostic groups. The interview content comprised assessment of interest, decision-making factors, and barriers to participation, current

In Stage 2, the Barriers to Participation Survey will be distributed to a random sampling of 500 patients representative of the potentially eligible cohort by age, race, sex, geographic distribution, primary diagnosis and time from diagnosis; 200 patients will be randomly selected up front to receive follow-up communication by telephone if they fail to return completed surveys. Information obtained from responses to the questionnaire will inform a subsequent randomized recruitment trial and provide insight regarding retention procedures.

In Stage 3, a pilot study will be undertaken to assess feasibility and potential pitfalls in recruitment for the Lifetime Cohort. Introductory letters will be sent to 300 alumni survivors, with a broad representation across targeted diagnostic groups, to invite their participation in the Lifetime Cohort. Recruitment approaches will be informed by the findings of the Barriers to Participation Survey. Parameters that will be assessed related to feasibility include 1) accuracy of contact information in hospital system (need for tracing of potentially eligible research participants); 2) number of eligible participants actively or passively declining study participation; and 3) reasons for declining participation. The pilot study will provide insight regarding the need for implementing procedures to track potential study participants who are "lost to follow-up" or incentives to recruit and retain study participants.

In Stage 4, a pilot study will be undertaken in 20 groups of 20 survivors identified by SJLIFE investigators to be at high risk for cancer-related morbidity based on specific demographic, diagnostic, therapeutic, or genetic/familiar factors. In addition to utilizing data collected from the risk-based evaluations performed in the Cross-Sectional study these individuals will undergo more extensive assessment beyond the screening recommendations outlined in the COG Guidelines to determine the frequency and more thoroughly characterize the extent specific treatment complications, as well as define the need for further study. Knowledge gained in this pilot study will provide important preliminary results that will be used to develop proposals for extramural funding for further study of the identified vulnerable populations.

In Stage 5, a cross-sectional study of the cohort of 10 or more year alumnus survivors will be undertaken using a risk-based assessment as recommended by the COG Guidelines. The first year of the study will target accrual of survivors with a diagnosis of acute lymphoblastic leukemia, Hodgkin lymphoma, and acute myeloid leukemia who are 30 years or older. The second year will target enrollment of survivors of central nervous system tumors, Wilms' tumor and other bone/soft tissue sarcomas. The third year will target accrual of the remaining diagnostic subtypes. The prevalence of late treatment complications detected by risk-based screening will provide important information regarding the appropriateness of the COG Guidelines recommendations in at risk survivor populations after specific therapeutic exposures.

In Stage 6, information gained from the evaluations of survivors in the cross-sectional cohort will inform the final composition of the "high priority" cohort that will be invited to continue with periodic onsite evaluations in the prospective study. Evaluations will be undertaken using the same risk-based assessment as recommended by the COG Guidelines. The frequency of follow-up of the specific diagnostic subtypes will vary according to the prevalence of treatment complications determined during the cross-sectional study. In general, most survivors will have evaluations scheduled every 2 to 5 years. Survivors not targeted as high priority for onsite outcomes investigation will continue with follow-up through mail questionnaires and the St. Jude Cancer Registry.

Several activities are planned to optimize communication with participating survivors about research activities involving the Lifetime Cohort. A newsletter will be distributed on a semi-annual basis for the purpose of 1) maintaining contact through periodic mailings (which include an address correction request from the post-office that can identify individuals who have moved from their last known address and may require additional tracing to re-establish contact); 2) providing an update on the status of the project; and 3) maintaining and enhancing the relationship with participants and 4) educating survivors about selected topics of health-related importance. In addition, a website will be developed that will serve as a resource that updates the progress of Lifetime Cohort activities.

Adults who are siblings, parents, other relatives or friends of St. Jude patients or former St. Jude patients will be invited to participate as a control in this study during the time of the child's St. Jude clinic visit. Employees who request to be in the study may volunteer if they are not a SJLIFE study team member or not supervised by a SJLIFE study team member. Flyers will also be placed in the clinic areas and elevators on the SJCRH campus. In addition, recruitment drives may be held periodically in various locations on the St. Jude Children's Research Hospital (SJCRH) campus. An announcement of the drive may be made by email and placed in St. Jude Today. Their participation in the study involves the storage of biological samples. Controls will be recruited by, and should discuss their desire to participate with, a member of the St. Jude Life clinical staff. The individual will then be registered as a "Research Participant" by a member of the study team and informed consent will be obtained using the SJLIFE Banking Control consent document. The individual will then be registered as a "Research Participant" by a member of the study team and informed consent will be obtained. Participants will be compensated with a $25 gift card for their participation.

Control enrollment to this protocol is expected to average 200-300 participants in the first year; with an estimated targeted accrual of 1200.

Childhood cancer survivors treated at SJCRH recruited from selected diagnostic groups of almost 4000 adults surviving 10 or more years from their diagnosis of childhood cancer.

Adults who are siblings, parents, relatives or friends of St. Jude patients or former St. Jude patients will be invited to participate as a control in this study during the time of the child's St. Jude clinic visit.Controls will be recruited by, and should discuss their desire to participate with, a member of the St. Jude Life clinical and/or research staff. The individual will then be registered as a "Research Participant" by a member of the study team and informed consent will be obtained using the SJLIFE Banking Control consent document.

• Research Participants
  Participants with a diagnosis of childhood malignancy treated or followed at SJCRH
• Control Participants
  Siblings, parents, relatives or friends of St. Jude patients or former patients or SJCRH employees who are not SJLIFE study team members or supervised by a SJLIFE study team members

Inclusion Criteria:

• Patient will have a diagnosis of childhood malignancy treated or followed at St. Jude Children's Research Hospital.
• Patient will be a St. Jude alumnus at least ten years from diagnosis.
• Patient is at least 18 years of age
• Patient is willing to participate at any level of study
• Patient is willing to comply with the guidelines of St. Jude domiciliary care facilities
• Patient must sign informed consent for study participation.

Control Participant:

• ≥18 years of age
• Siblings, parents, relatives or friends of St. Jude patients or former patients or SJCRH employees who are not SJLIFE study team members or supervised by a SJLIFE study team members.

Exclusion Criteria:

• Patient refuses to participate at any level of study