About the Cancer Control and Survivorship Program

Therapeutic advances continue to improve survival rates for pediatric cancers. However, long-term side effects of treatment remain a critical burden for survivors, shortening life expectancy and impacting quality of life. The overarching goal of the Cancer Control and Survivorship Program (CCSP) is to conduct innovative clinical, genetic and observational research and translate the findings into effective strategies to reduce treatment-related complications and improve the quality of life of childhood cancer survivors.

To improve quality of life, we must consider the magnitude and scope of morbidity of the childhood cancer experience. This includes understanding the contribution of cancer and/or its treatment to subsequent neoplasms, early onset of chronic disease, accelerated aging and premature mortality. 

The CCSP focuses on identifying the prevalence and risk factors for adverse treatment-related outcomes and translating these findings into clinical practice. Research housed under the umbrella of the CCSP focuses on three areas: identifying high-risk groups, characterizing genetic contributions to treatment-related outcomes and translating observational discoveries into clinical practice. 

Program Leaders

Gerard Zambetti
Greg Armstrong, MD, MSCE

Department of Epidemiology and Cancer Control

  • Member, St. Jude Faculty 
  • Chair, Department of Epidemiology and Cancer Control
  • Co-Leader, Cancer Control & Survivorship Program
  • Endowed Chair in Epidemiology & Cancer Control

Kirsten Ness, PT, PhD, FAPTA

Department of Epidemiology and Cancer Control

  • Member, St. Jude Faculty 
  • PI, Human Performance Lab
  • Co-Leader, Cancer Control and Survivorship Program
  • Endowed Chair in Cancer Survivorship

Identification of high-risk groups 

CCSP research focuses on characterizing disease burden among aging survivors. The data obtained from longitudinal studies have identified adverse treatment-related outcomes for pediatric diseases such as acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), B-cell non-Hodgkin lymphoma and Hodgkin lymphoma. As a result, treatment strategies for several ongoing clinical trials have been modified to mitigate risks. Data obtained in these longitudinal studies have also shown that survivors of childhood cancers experience accelerated physiologic aging, giving direction to future studies that identify mechanisms responsible for this phenomenon. Researchers have also identified lifestyle, health behaviors and modifiable risk factors that can be addressed to prevent or mitigate chronic disease in cancer survivors. 

The information gathered from CCSP-led studies has been pivotal in guiding long-term follow-up care so aging survivors can live full, healthy lives. Additionally, these data lay the foundations for the design and implementation of clinical trials and inform health policy. The CCSP freely shares all data from more than 30,000 survivors participating in our large cohorts, available on the St. Jude Survivorship Portal. This resource provides unique data visualizations, in-cloud statistical analyses of both clinical and genetic data and access to data to download and use for independent analysis.

Read more about the St. Jude Survivorship Portal - the first data portal for sharing, analyzing and visualizing pediatric cancer survivorship data.  

Understanding the impact of genetics on treatment-related outcomes

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The relationship between genetic predisposition and late effects has been largely unexplored. Using whole genome/exome sequencing and DNA methylation data, researchers found that many five-year survivors carry cancer predisposing variants, increasing the risk for subsequent malignant neoplasms and early mortality. Researchers in the CCSP are now studying the shared genetic basis for pediatric cancer and late effects, thereby providing valuable insight into molecular mechanisms and ancestry-related variants in late outcomes. 

Research focused on the biomarkers of aging survivors has identified associations between leukocyte telomere length and epigenetic age acceleration among survivors with specific cancer treatment exposures as well as concordance between epigenetic age acceleration and chronic health conditions. Other key findings revealed genetic variants linked to increased risk for neuropathy and cardiomyopathy. 

Translation of research into clinical practice

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The CCSP is committed to establishing and disseminating information that will directly impact all survivors of childhood cancer no matter where they received their therapy. Members of the CCSP are leaders for the translation of knowledge into the Children’s Oncology Group (COG) Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancer and into the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG). These collaborations establish evidence and consensus-based guidelines that promote long-term health and quality of life. 

In addition, research in the CCSP is translated into risk prediction models to inform current survivor care delivery. Program members have developed clinically available risk calculators for individual risk prediction of health-related issues such as breast cancer, acute ovarian failure and insufficiency, ischemic heart disease and stroke, heart failure and kidney failure. The ability to calculate an individual survivor’s risk for chronic disease gives survivors and their care providers knowledge for clinical health care decision making. 

Lastly, the CCSP is involved in expanding institutional and collaborative intervention trials that improve long-term outcomes for high-risk groups. Widening the depth and breadth of survivorship research will provide much needed critical data that will inform health surveillance and health preserving interventions for long-term survivors. 

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