bringing pcps “back” into cancer care through onco-primary ......bringing pcps “back” into...

Duke Community & Family Medicine Grand Rounds

June 18, 2018

Against the GrainBringing PCPs “back” into Cancer Care through Onco-Primary Care

Kevin C. Oeffinger, MDDirector, Duke Center for Onco-Primary CareProfessor with TenureDepartment of MedicineSecondary: Department of Community & Family Medicine

• Cancer continuum (screening, prevention, cancer care, survivorship)– Current care model in U.S.– Onco-primary care model

• Duke Center for Onco-Primary Care (T+13 months)

Outline

330 MPeople in the U.S., 2016

310 M

151 M

1.6 M1.1 M

Prevention Screening Cancer Therapy Survivorship

2016 Model• Preventiono Lifestyleo (Chemoprevention)o (Genetics)

• Screeningo One-size fits allo Cervicalo Breasto Colono Prostateo Lung

• Survivorshipo One-size fits all

2026 Model• Preventiono Lifestyleo Targeted chemopreventiono Population genetics

• Screeningo Risk-stratifiedo Tumor biomarkerso Expanded cancers

• Survivorshipo Risk-stratifiedo Efficient utilization of

resourceso Coordinated care

Cancer Continuum

Advances in Cancer Screening

Cancer Cases/yr % of total % of deaths

Breast 246,660 14.6% 6.8%Colorectal 134,490 8.0% 8.3%Cervical 12,990 0.8% 0.7%Prostate 180,890 10.7% 4.4%Lung 224,390 13.3% 26.5%Total 47.4% 46.7%

‘Screenable’ Cancers in the U.S.


%localized

Breast 246,660 14.6% 6.8% 61%Colorectal 134,490 8.0% 8.3% 39%Cervical 12,990 0.8% 0.7% 46%Prostate 180,890 10.7% 4.4% 80%Lung 224,390 13.3% 26.5% 16%Total 47.4% 46.7%



%localized

Breast 246,660 14.6% 6.8% 61%Colorectal 134,490 8.0% 8.3% 39%Cervical 12,990 0.8% 0.7% 46%Prostate 180,890 10.7% 4.4% 80%Lung 224,390 13.3% 26.5% 16%Total 47.4% 46.7%


Key points:• Almost 50% of cancer cases can potentially be detected

by current screening tests• These cancers account for about 50% of cancer deaths• Substantial % of cancers detected at advanced stage• Though not all screen-detected cancers can be cured,

we can do MUCH better

0102030405060708090

100

Cervical Breast Colon Prostate Lung

U.S. Cancer Screening RatesPe

rcen

t

Smith RA, et al. CA Cancer J Clin, 2017

Oeffinger KC, et al. JAMA, 2015

Siu AL, et al. Ann Intern Med, 2016

How does a woman age 40-49

make an informed decision on breast cancer

screening?

If we take 1,000 women at the age of 40 and follow them for 5 years with

an annual mammogram

6 in1000954

in100050 in1000


an annual mammogram

6 in1000954

in100050 in1000

Family History and Breast Density

6 12/1,0006 1/1,000

BRCA1 carrier6 80/1,000

1/12


an annual mammogram

6 in1000954

in100050 in1000

Family History and Breast Density

6 12/1,0006 1/1,000

BRCA1 carrier6 80/1,000

1/12

Risk-Stratified Cancer Screening

No significant difference in prostate cancer deaths between two groups.

However, 90% of control group had undergone PSA testing.

20% reduction in prostate-specific mortalityRate ratio = 0.80 (95% CI 0.65-0.98)

Moyer VA, et al. Ann Intern Med, 2012

USPSTF, JAMA 2018

Negoita S, et al. Cancer, 2018

Prostate Cancer Screening

Duke Primary Care PSA Screening Algorithm

County Practice

Durham

DPC Pickett RoadDPC CroadaileDUC CroasdaileDUC Fayetteville RoadDurham Medical CenterDurham Pediatrics – MainSutton Station Internal MedicineTriangle Family Practice

GranvilleDPC Butner-CreedmoorOxford Family Physicians

Vance DPC Henderson

Alamance

DPC MebaneKernodle Clinic West

Chatham DPC of Galloway Ridge

Orange

DPC HillsboroughDUC HillsboroughDPC MeadowmontDPC Timberlyne

Wake

DPC ApexDPC Blue RidgeDPC Brier CreekDPC Creedmoor RoadDPC MidtownDPC KnightdaleDPC MorrisvilleDPC Waverly PlaceDPC WellesleyDPC Western WakeDPC Wake ForestDPC Wakelon Internal MedicineDUC Brier CreekDUC KnightdaleDUC MorrisvilleNorth Hills Internal Medicine

Duke Primary Care andDuke Primary Care Consortium

224 primary care physicians34 practice sites

7 countiesExpanding sites and physicians

All on same EHR (Epic)Existing research infrastructure

(PBRN)

Duke Primary Care PSA Screening Algorithm

Implementation Resulted in Increased Screening

48%

70%

0%10%20%30%40%50%60%70%80%90%

100%

PSA Present

Perc

ent

Change in PSA Testing Pre-Post February 22, 2017

Pre Post

Courtesy of Kevin Shah, MD

Screening increased in all clinics, but rates of screening by clinic vary widely

Courtesy of Kevin Shah, MD

Urology ReferralsFebruary 22, 2017 – February 21, 2018

Age Group Algorithm PSAs UrologyReferrals

%

• Rapid uptake using Epic with algorithm embedded in health maintenance / lab results

• Substantial variation in practice• Under and over referrals• Need for efficient and effective informed

decision tool

Key Lessons

Decision Aid

• Development and pilot testing of a CDC-supported patient decision aid for prostate cancer screening.

• Led by John Ragsdale, MD and Sharon Hull, MD

• PCP level approaches– Adding Prostate Health Index (PHI) reflex– Role of Digital Rectal Exams– Alternative referral pathways

• Patient-level approaches– Pre-visit video vignettes via MyChart– Decision aid with visit (upcoming pilot test in 3 sites)– Improved lab result messaging within Epic

• System-level approaches– Nurse navigator (DCI-DPC liaison)– Better tracking of screening to referral to scheduled appointment– Multi-disciplinary quality improvement team– Primary care physician participation in GU oncology tumor board

Potential Approaches to Help

Chemoprevention - 2017

Uptake of SERMs for chemoprevention in clinical practice

Smith SG, et al. Ann Oncol, 2016

• ‘Liquid biopsy’– circulating cell-free DNA (cfDNA) – circulating tumor cells (CTC)

Vockley JG and Niederhuber JE. BMJ, 2015Meyskens FL, et al. J Natl Cancer Inst, 2016Albini A, et al. Clin Cancer Res, 2016

• Epigenetic-marker based system with detection rate of breast cancer similar to mammographyUehiro N, et al. Breast Ca Res, 2016

• Cancer interception Example: ErbB2 inhibition and lapatinib Li D, et al. Oncotarget, 2017

Precision Screening and Chemoprevention

Bradshaw PT, et al. Epidem, 2016

Hanrahan EO, et al. J Clin Oncol, 2007

Probability of death from breast cancer or other causes among women age 50 and older

with ER+ early stage breast cancerSEER: 1988-2001

0

20

40

60

80

100

Perc

ent

HTN Lipids DM

Chen J, et al. J Am Coll Cardiol, 2012

Percent of women with early stage breast cancer

and a cardiovascular risk factorSEER-Medicare: 2000-2007

Importance of Non-Cancer Comorbidities

Percent of breast cancer survivors adherent to their statin therapy prior to and following early stage breast cancer diagnosis and treatment

(Group Health 1990-2008, N=4,221 women)

Calip GS, et al. Breast Cancer Res Treat, 2013

0102030405060708090

100

Year - 1 Treatmentperiod

Year + 1 Year + 2 Year + 3

Perc

ent

Presented by: Kevin C. Oeffinger, MD

Predictors of nonadherence to medications among breast cancer survivors

(Group Health 1990-2008, N=2,308)

Calip GS, et al. Breast Cancer Res Treat, 2017

Presented by: Kevin C. Oeffinger, MD

Importance of Non-Cancer Comorbidities

• Most women with breast cancer will not die of breast cancer

• Continued monitoring and management of common comorbidities may be as important for longevity / QoL as treatment of the breast cancer

• Lack of standardized approaches to manage hypertension, diabetes, and lipid disorders

Management of Comorbidities• Hypertension (pre/during/post cancer) is a key

risk factor in development of heart failure in cancer survivors treated with cardiotoxic therapy– Jawa Z, et al. Medicine, 2016– Chen J, et al. J Am Coll Cardiol, 2012– Salz T, et al. J Clin Oncol, 2017

• Studies pre new AHA / ACC guidelines for HTN

• Diagnosed at age 42• Invasive ductal carcinoma• ER- PR- HER2+ • T2N1• Trastuzumab• 50 Gy to Right breast

47-year-old breast cancer survivor

150

100

50

6/13 6/14 6/15 6/16 6/18

• Diagnosed at age 42• Invasive ductal carcinoma• ER- PR- HER2+ • T2N1• Trastuzumab• 50 Gy to Right breast

47-year-old breast cancer survivor

Lipid profile•Total = 247•LDL = 188•HDL = 51•TG = 40

Statin therapy?

10-year risk = 1.8%

Chronic Cancer Patient

• Increasing number of patients with advanced cancer are now being treated as chronic cancer patients

• Management of comorbidities remains essential in this population

• ‘Cure the cancer, lose the patient’

• Randomized controlled trial• Population: Breast and prostate cancer patients receiving

cardiotoxic therapy• Primary outcome – blood pressure control• Intervention: automated text alert to patient and Epic

message to PCP when BP is above threshold• Control – usual care• Team: oncology, cardiology, primary care, population

health science, biostatistics, onco-primary care• Overarching goals:

– Blood pressure management and prevention of cardiotoxicity– Re-engage PCPs in the care of patients on therapy

Future Study

De Moor JS, et al. Cancer Epidemiol Biomarkers Prev, 2013

Cancer Survivors in the United States

There are now 14.5 million survivors in the USBy 2020, there will be almost 18 million survivors

Late Mortality Among 5+ Year SurvivorsChildhood Cancer Survivor Study (N=20,483)

Causes SMRSecond cancers 15.2 Cardiac 7.0Pulmonary 8.8

Mertens AC, et al. J Natl Cancer Inst, 2009

Armstrong GT, et al. J Clin Oncol, 2009

Cumulative Cause-Specific MortalityChildhood Cancer Survivor Study

Late Mortality Among 5+ Year HL SurvivorsMSKCC Hodgkin Lymphoma Study (1975-2000; N=747)

Matasar M, et al. J Natl Cancer Inst, 2015

Cumulative Incidence by Causes of Death for Patients With Stage I Testicular Seminoma

Beard CJ, et al. Cancer 2013

SEER Registry: N=9193 men; Diagnosed 1973-2001

Probability of death from breast cancer or other causes among women age 50 and older

with ER+ early stage breast cancerSEER: 1988-2001

Hanrahan EO, et al. J Clin Oncol, 2007

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0 5 10 15 20 25 30

73.4% with at least one chronic condition

42.4% with a severe orlife-threateningcondition or death

Cum

ulat

ive

Inci

denc

e

Years since Cancer

Cumulative incidence of chronic physical health conditions among 10,397 young adult survivors of childhood cancer

Childhood Cancer Survivor Study

Oeffinger KC, et al. N Engl J Med, 2006

Fig 1a

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Fig 1a CI

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yrs since diagnosis

cumulative incidence

Cumulative incidence curves of physical health conditions in survivors, by GRADE 1-5

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all_survivors

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50.37322190610.36428352460.38216028760.15033783780.1437327940.1569428817

50.38862217620.37961363060.39763072180.15827202010.1515260960.1650179441

60.38862217620.37961363060.39763072180.15827202010.1515260960.1650179441

60.40487649950.39580321340.41394978560.16642642340.15954093710.1733119098

70.40487649950.39580321340.41394978560.16642642340.15954093710.1733119098

70.42022159160.41109539990.42934778330.17273771020.16574741930.179728001

80.42022159160.41109539990.42934778330.17273771020.16574741930.179728001

80.43837787230.42919878840.44755695610.18229846720.17515375780.1894431767

90.43837787230.42919878840.44755695610.18229846720.17515375780.1894431767

90.45593157380.44670799810.46515514950.18967194920.18240900770.1969348907

100.45593157380.44670799810.46515514950.18967194920.18240900770.1969348907

100.47354718660.46428139880.48281297430.20012933260.19269717120.207561494

110.47354718660.46428139880.48281297430.20012933260.19269717120.207561494

110.48929998950.47999564090.49860433810.20948832440.20190108940.2170755593

120.48929998950.47999564090.49860433810.20948832440.20190108940.2170755593

120.5059243950.4965755690.5152732210.21906319540.21131153330.2268148575

130.5059243950.4965755690.5152732210.21906319540.21131153330.2268148575

130.52223797810.51283859240.53163736380.22815880190.22024229980.236075304

140.52223797810.51283859240.53163736380.22815880190.22024229980.236075304

140.53807508610.5286162080.54753396420.23917248260.23104161320.2473033519

150.53807508610.5286162080.54753396420.23917248260.23104161320.2473033519

150.55443214030.54489172730.56397255330.24912656420.24078367080.2574694577

160.55443214030.54489172730.56397255330.24912656420.24078367080.2574694577

160.56771755190.55808936250.57734574130.25802678880.24946930770.26658427

170.56771755190.55808936250.57734574130.25802678880.24946930770.26658427

170.58195898570.57220284490.59171512640.26706168370.25825033630.2758730312

180.58195898570.57220284490.59171512640.26706168370.25825033630.2758730312

180.59510194020.58519052410.60501335640.27590264220.26680203580.2850032486

190.59510194020.58519052410.60501335640.27590264220.26680203580.2850032486

190.6079369820.59782108340.61805288060.28487194180.27542580490.2943180787

200.6079369820.59782108340.61805288060.28487194180.27542580490.2943180787

200.62323207350.61279982180.63366432530.29459541680.28469774730.3044930863

210.62323207350.61279982180.63366432530.29459541680.28469774730.3044930863

210.63479820370.62404084950.64555555780.30540321960.29488309750.3159233417

220.63479820370.62404084950.64555555780.30540321960.29488309750.3159233417

220.64129064230.63027737260.6523039120.31591592890.30464152430.3271903334

230.64129064230.63027737260.6523039120.31591592890.30464152430.3271903334

230.65707373130.64514392620.66900353650.32162194210.30977347640.3334704078

240.65707373130.64514392620.66900353650.32162194210.30977347640.3334704078

240.66809684110.65508426160.68110942060.33107021090.31771220150.3444282202

250.66809684110.65508426160.68110942060.33107021090.31771220150.3444282202

250.68028027820.66505941860.69550113790.3359385090.32108154370.3507954743

260.68028027820.66505941860.69550113790.3359385090.32108154370.3507954743

260.69556632980.67533181750.71580084210.35589853120.33194208070.3798549817

270.69556632980.67533181750.71580084210.35589853120.33194208070.3798549817

270.71419620510.68381134360.74458106660.38168022650.34013437150.4232260815

280.71419620510.68381134360.74458106660.38168022650.34013437150.4232260815

280.73437857010.68951200660.77924513350.42422002380.33651863820.5119214094

290.73437857010.68951200660.77924513350.42422002380.33651863820.5119214094

290.73437857010.68951200660.77924513350.42422002380.33651863820.5119214094

300.73437857010.68951200660.77924513350.42422002380.33651863820.5119214094

30

31

31

&A

Page &P

Fig 1b

55

55

55

66

66

77

77

88

88

99

99

1010

1010

1111

1111

1212

1212

1313

1313

1414

1414

1515

1515

1616

1616

1717

1717

1818

1818

1919

1919

2020

2020

2121

2121

2222

2222

2323

2323

2424

2424

2525

2525

2626

2626

2727

2727

2828

GRADE 1-5

GRADE 3-5

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5Leukemia

0.242835131

0.0696456086

0.242835131

0.0696456086

0.2607380718

0.0773703202

0.2607380718

0.0773703202

0.2774629736

0.0832730834

0.2774629736

0.0832730834

0.2923950158

0.0892086056

0.2923950158

0.0892086056

0.3114660333

0.0964649519

0.3114660333

0.0964649519

0.3330805294

0.1019340786

0.3330805294

0.1019340786

0.354884485

0.1099018049

0.354884485

0.1099018049

0.3717359481

0.1147441624

0.3717359481

0.1147441624

0.3904167122

0.1209369611

0.3904167122

0.1209369611

0.4077446823

0.1259978646

0.4077446823

0.1259978646

0.4265295428

0.1345062006

0.4265295428

0.1345062006

0.4479583916

0.1411943675

0.4479583916

0.1411943675

0.4600227492

0.1456668106

0.4600227492

0.1456668106

0.4801558986

0.1530380939

0.4801558986

0.1530380939

0.4933615422

0.157708444

0.4933615422

0.157708444

0.5102727242

0.1624773967

0.5102727242

0.1624773967

0.5318896264

0.1695781624

0.5318896264

0.1695781624

0.5538872568

0.1776735389

0.5538872568

0.1776735389

0.5634135149

0.1869082648

0.5634135149

0.1869082648

0.5756200422

0.1977773542

0.5756200422

0.1977773542

0.604821002

0.2111757286

0.604821002

0.2111757286

0.6281817698

0.2268579168

0.6281817698

0.2268579168

0.679575459

0.2268579168

0.679575459

0.2268579168

0.679575459

0.2268579168

0.679575459

0.2268579168

Fig 1b CI

555555

555555

555555

666666

666666

777777

777777

888888

888888

999999

999999

101010101010

101010101010

111111111111

111111111111

121212121212

121212121212

131313131313

131313131313

141414141414

141414141414

151515151515

151515151515

161616161616

161616161616

171717171717

171717171717

181818181818

181818181818

191919191919

191919191919

202020202020

202020202020

212121212121

212121212121

222222222222

222222222222

232323232323

232323232323

242424242424

242424242424

252525252525

252525252525

262626262626

262626262626

272727272727

272727272727

282828282828

GRADE 1-5

GRADE 3-5

Leuk-L

Leuk-L

Leuk-U

Leuk-U

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5Leukemia

0.242835131

0.0696456086

0.0608873091

0.2280814732

0.0784039082

0.2575887888

0.242835131

0.0696456086

0.0608873091

0.2280814732

0.0784039082

0.2575887888

0.2607380718

0.0773703202

0.068176166

0.2456309275

0.0865644743

0.2758452161

0.2607380718

0.0773703202

0.068176166

0.2456309275

0.0865644743

0.2758452161

0.2774629736

0.0832730834

0.0737623511

0.262053062

0.0927838156

0.2928728853

0.2774629736

0.0832730834

0.0737623511

0.262053062

0.0927838156

0.2928728853

0.2923950158

0.0892086056

0.0793921103

0.2767352702

0.0990251009

0.3080547613

0.2923950158

0.0892086056

0.0793921103

0.2767352702

0.0990251009

0.3080547613

0.3114660333

0.0964649519

0.0862885681

0.2955137759

0.1066413356

0.3274182907

0.3114660333

0.0964649519

0.0862885681

0.2955137759

0.1066413356

0.3274182907

0.3330805294

0.1019340786

0.0914924724

0.316822863

0.1123756848

0.3493381957

0.3330805294

0.1019340786

0.0914924724

0.316822863

0.1123756848

0.3493381957

0.354884485

0.1099018049

0.099077185

0.3383413388

0.1207264247

0.3714276311

0.354884485

0.1099018049

0.099077185

0.3383413388

0.1207264247

0.3714276311

0.3717359481

0.1147441624

0.1036852387

0.354978655

0.1258030861

0.3884932412

0.3717359481

0.1147441624

0.1036852387

0.354978655

0.1258030861

0.3884932412

0.3904167122

0.1209369611

0.1095703678

0.3734200914

0.1323035544

0.407413333

0.3904167122

0.1209369611

0.1095703678

0.3734200914

0.1323035544

0.407413333

0.4077446823

0.1259978646

0.1143685969

0.3905100196

0.1376271324

0.4249793451

0.4077446823

0.1259978646

0.1143685969

0.3905100196

0.1376271324

0.4249793451

0.4265295428

0.1345062006

0.1224072454

0.4090088126

0.1466051559

0.444050273

0.4265295428

0.1345062006

0.1224072454

0.4090088126

0.1466051559

0.444050273

0.4479583916

0.1411943675

0.1286922013

0.4300562064

0.1536965338

0.4658605768

0.4479583916

0.1411943675

0.1286922013

0.4300562064

0.1536965338

0.4658605768

0.4600227492

0.1456668106

0.1328516171

0.4418481766

0.158482004

0.4781973218

0.4600227492

0.1456668106

0.1328516171

0.4418481766

0.158482004

0.4781973218

0.4801558986

0.1530380939

0.1396141603

0.4614129072

0.1664620276

0.49889889

0.4801558986

0.1530380939

0.1396141603

0.4614129072

0.1664620276

0.49889889

0.4933615422

0.157708444

0.143848742

0.4741845039

0.171568146

0.5125385804

0.4933615422

0.157708444

0.143848742

0.4741845039

0.171568146

0.5125385804

0.5102727242

0.1624773967

0.1480804469

0.4903688644

0.1768743464

0.5301765839

0.5102727242

0.1624773967

0.1480804469

0.4903688644

0.1768743464

0.5301765839

0.5318896264

0.1695781624

0.1542248735

0.5108543365

0.1849314514

0.5529249162

0.5318896264

0.1695781624

0.1542248735

0.5108543365

0.1849314514

0.5529249162

0.5538872568

0.1776735389

0.1609135402

0.5312938039

0.1944335377

0.5764807097

0.5538872568

0.1776735389

0.1609135402

0.5312938039

0.1944335377

0.5764807097

0.5634135149

0.1869082648

0.1680568943

0.5398398847

0.2057596352

0.5869871451

0.5634135149

0.1869082648

0.1680568943

0.5398398847

0.2057596352

0.5869871451

0.5756200422

0.1977773542

0.175536397

0.549901356

0.2200183114

0.6013387285

0.5756200422

0.1977773542

0.175536397

0.549901356

0.2200183114

0.6013387285

0.604821002

0.2111757286

0.1826128901

0.5706685904

0.239738567

0.6389734136

0.604821002

0.2111757286

0.1826128901

0.5706685904

0.239738567

0.6389734136

0.6281817698

0.2268579168

0.1855685156

0.5836742274

0.268147318

0.6726893122

0.6281817698

0.2268579168

0.1855685156

0.5836742274

0.268147318

0.6726893122

0.679575459

0.2268579168

0.1855685156

0.5819404382

0.268147318

0.7772104799

0.679575459

0.2268579168

0.1855685156

0.5819404382

0.268147318

0.7772104799

0.679575459

0.2268579168

0.1855685156

0.5819404382

0.268147318

0.7772104799

0.679575459

0.2268579168

0.1855685156

0.5819404382

0.268147318

0.7772104799

Fig 1c

55

55

55

66

66

77

77

88

88

99

99

1010

1010

1111

1111

1212

1212

1313

1313

1414

1414

1515

1515

1616

1616

1717

1717

1818

1818

1919

1919

2020

2020

2121

2121

2222

2222

2323

2323

2424

2424

2525

2525

2626

2626

2727

2727

2828

GRADE 1-5

GRADE 3-5

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5CNS

0.5799055968

0.2070128119

0.5799055968

0.2070128119

0.5879973028

0.2157863062

0.5879973028

0.2157863062

0.5974852247

0.2225646447

0.5974852247

0.2225646447

0.6029547045

0.2287253878

0.6029547045

0.2287253878

0.6139334422

0.2397988412

0.6139334422

0.2397988412

0.6216592705

0.2462346771

0.6216592705

0.2462346771

0.6312796298

0.2590800863

0.6312796298

0.2590800863

0.6398122377

0.2647724248

0.6398122377

0.2647724248

0.6497226913

0.2736349383

0.6497226913

0.2736349383

0.6594074564

0.2851727833

0.6594074564

0.2851727833

0.6642126376

0.2915922642

0.6642126376

0.2915922642

0.6693583434

0.299775121

0.6693583434

0.299775121

0.6748186339

0.3114231672

0.6748186339

0.3114231672

0.6772504333

0.3158674342

0.6772504333

0.3158674342

0.6840990252

0.3313240443

0.6840990252

0.3313240443

0.690222472

0.3393720115

0.690222472

0.3393720115

0.6995607284

0.3418749679

0.6995607284

0.3418749679

0.7016466766

0.3507167722

0.7016466766

0.3507167722

0.7016466766

0.3545226932

0.7016466766

0.3545226932

0.708984681

0.3545226932

0.708984681

0.3545226932

0.7159150186

0.3634444801

0.7159150186

0.3634444801

0.7263105249

0.3634444801

0.7263105249

0.3634444801

0.7263105249

0.3970441584

0.7263105249

0.3970441584

0.7263105249

0.3970441584

0.7263105249

0.3970441584

Fig 1c CI

555555

555555

555555

666666

666666

777777

777777

888888

888888

999999

999999

101010101010

101010101010

111111111111

111111111111

121212121212

121212121212

131313131313

131313131313

141414141414

141414141414

151515151515

151515151515

161616161616

161616161616

171717171717

171717171717

181818181818

181818181818

191919191919

191919191919

202020202020

202020202020

212121212121

212121212121

222222222222

222222222222

232323232323

232323232323

242424242424

242424242424

252525252525

252525252525

262626262626

262626262626

272727272727

272727272727

282828282828

GRADE 1-5

GRADE 3-5

CNS-L

CNS-U

CNS-L

CNS-U

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5CNS

0.5799055968

0.2070128119

0.1863914571

0.2276341666

0.554784558

0.6050266355

0.5799055968

0.2070128119

0.1863914571

0.2276341666

0.554784558

0.6050266355

0.5879973028

0.2157863062

0.1948488389

0.2367237735

0.5629464109

0.6130481946

0.5879973028

0.2157863062

0.1948488389

0.2367237735

0.5629464109

0.6130481946

0.5974852247

0.2225646447

0.2013908386

0.2437384509

0.5725230644

0.622447385

0.5974852247

0.2225646447

0.2013908386

0.2437384509

0.5725230644

0.622447385

0.6029547045

0.2287253878

0.2073402286

0.250110547

0.5780456607

0.6278637483

0.6029547045

0.2287253878

0.2073402286

0.250110547

0.5780456607

0.6278637483

0.6139334422

0.2397988412

0.2180432513

0.2615544311

0.5891390737

0.6387278107

0.6139334422

0.2397988412

0.2180432513

0.2615544311

0.5891390737

0.6387278107

0.6216592705

0.2462346771

0.2242607098

0.2682086444

0.5969443304

0.6463742105

0.6216592705

0.2462346771

0.2242607098

0.2682086444

0.5969443304

0.6463742105

0.6312796298

0.2590800863

0.2366482903

0.2815118824

0.6066462299

0.6559130298

0.6312796298

0.2590800863

0.2366482903

0.2815118824

0.6066462299

0.6559130298

0.6398122377

0.2647724248

0.242120161

0.2874246886

0.615238629

0.6643858464

0.6398122377

0.2647724248

0.242120161

0.2874246886

0.615238629

0.6643858464

0.6497226913

0.2736349383

0.2505996417

0.296670235

0.6251949008

0.6742504819

0.6497226913

0.2736349383

0.2505996417

0.296670235

0.6251949008

0.6742504819

0.6594074564

0.2851727833

0.261597324

0.3087482426

0.634901328

0.6839135849

0.6594074564

0.2851727833

0.261597324

0.3087482426

0.634901328

0.6839135849

0.6642126376

0.2915922642

0.2676762458

0.3155082826

0.6396946447

0.6887306305

0.6642126376

0.2915922642

0.2676762458

0.3155082826

0.6396946447

0.6887306305

0.6693583434

0.299775121

0.275380666

0.3241695761

0.6448072357

0.6939094511

0.6693583434

0.299775121

0.275380666

0.3241695761

0.6448072357

0.6939094511

0.6748186339

0.3114231672

0.2862788805

0.336567454

0.6502146753

0.6994225924

0.6748186339

0.3114231672

0.2862788805

0.336567454

0.6502146753

0.6994225924

0.6772504333

0.3158674342

0.290389289

0.3413455795

0.6526029197

0.701897947

0.6772504333

0.3158674342

0.290389289

0.3413455795

0.6526029197

0.701897947

0.6840990252

0.3313240443

0.3045048012

0.3581432873

0.6592631913

0.708934859

0.6840990252

0.3313240443

0.3045048012

0.3581432873

0.6592631913

0.708934859

0.690222472

0.3393720115

0.3117483471

0.3669956759

0.6651662538

0.7152786902

0.690222472

0.3393720115

0.3117483471

0.3669956759

0.6651662538

0.7152786902

0.6995607284

0.3418749679

0.3139269053

0.3698230305

0.6739915243

0.7251299325

0.6995607284

0.3418749679

0.3139269053

0.3698230305

0.6739915243

0.7251299325

0.7016466766

0.3507167722

0.3214228749

0.3800106694

0.6759412062

0.727352147

0.7016466766

0.3507167722

0.3214228749

0.3800106694

0.6759412062

0.727352147

0.7016466766

0.3545226932

0.3244747467

0.3845706397

0.6759412062

0.727352147

0.7016466766

0.3545226932

0.3244747467

0.3845706397

0.6759412062

0.727352147

0.708984681

0.3545226932

0.3244747467

0.3845706397

0.682044836

0.7359245261

0.708984681

0.3545226932

0.3244747467

0.3845706397

0.682044836

0.7359245261

0.7159150186

0.3634444801

0.3291398806

0.3977490797

0.6865523377

0.7452776995

0.7159150186

0.3634444801

0.3291398806

0.3977490797

0.6865523377

0.7452776995

0.7263105249

0.3634444801

0.3291398806

0.3977490797

0.692243669

0.7603773809

0.7263105249

0.3634444801

0.3291398806

0.3977490797

0.692243669

0.7603773809

0.7263105249

0.3970441584

0.3260989536

0.4679893633

0.692243669

0.7603773809

0.7263105249

0.3970441584

0.3260989536

0.4679893633

0.692243669

0.7603773809

0.7263105249

0.3970441584

0.3260989536

0.4679893633

0.692243669

0.7603773809

0.7263105249

0.3970441584

0.3260989536

0.4679893633

0.692243669

0.7603773809

Fig 1d

55

55

55

66

66

77

77

88

88

99

99

1010

1010

1111

1111

1212

1212

1313

1313

1414

1414

1515

1515

1616

1616

1717

1717

1818

1818

1919

1919

2020

2020

2121

2121

2222

2222

2323

2323

2424

2424

2525

2525

2626

2626

2727

2727

2828

GRADE 1-5

GRADE 3-5

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5HD

0.369451074

0.092124105

0.369451074

0.092124105

0.3904534606

0.1031374962

0.3904534606

0.1031374962

0.4115061323

0.116639882

0.4115061323

0.116639882

0.4283368699

0.1239259244

0.4283368699

0.1239259244

0.4542301155

0.1357514734

0.4542301155

0.1357514734

0.4736115167

0.1479351553

0.4736115167

0.1479351553

0.4967925512

0.1654142045

0.4967925512

0.1654142045

0.5232639898

0.1896395927

0.5232639898

0.1896395927

0.5442729895

0.208137346

0.5442729895

0.208137346

0.5689631142

0.2256400757

0.5689631142

0.2256400757

0.587623008

0.247492698

0.587623008

0.247492698

0.6138203958

0.2695954543

0.6138203958

0.2695954543

0.6317319167

0.2890154716

0.6317319167

0.2890154716

0.6466497272

0.307087583

0.6466497272

0.307087583

0.6605437665

0.3220329966

0.6605437665

0.3220329966

0.6710714086

0.3437266412

0.6710714086

0.3437266412

0.6851082647

0.3604255292

0.6851082647

0.3604255292

0.6927861423

0.3751454905

0.6927861423

0.3751454905

0.6943194122

0.3954319418

0.6943194122

0.3954319418

0.7153498174

0.4007262108

0.7153498174

0.4007262108

0.7205565715

0.4137668312

0.7205565715

0.4137668312

0.7300233971

0.4137668312

0.7300233971

0.4137668312

0.7450125376

0.4402048063

0.7450125376

0.4402048063

0.7674962485

0.5062997443

0.7674962485

0.5062997443

Fig 1d CI

555555

555555

555555

666666

666666

777777

777777

888888

888888

999999

999999

101010101010

101010101010

111111111111

111111111111

121212121212

121212121212

131313131313

131313131313

141414141414

141414141414

151515151515

151515151515

161616161616

161616161616

171717171717

171717171717

181818181818

181818181818

191919191919

191919191919

202020202020

202020202020

212121212121

212121212121

222222222222

222222222222

232323232323

232323232323

242424242424

242424242424

252525252525

252525252525

262626262626

262626262626

272727272727

272727272727

282828282828

GRADE 1-5

GRADE 3-5

HD-L

HD-L

HD-U

HD-U

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5HD

0.369451074

0.092124105

0.0797400195

0.348782909

0.1045081905

0.390119239

0.369451074

0.092124105

0.0797400195

0.348782909

0.1045081905

0.390119239

0.3904534606

0.1031374962

0.0901113368

0.3695628021

0.1161636556

0.4113441192

0.3904534606

0.1031374962

0.0901113368

0.3695628021

0.1161636556

0.4113441192

0.4115061323

0.116639882

0.1028831721

0.3904311708

0.130396592

0.4325810938

0.4115061323

0.116639882

0.1028831721

0.3904311708

0.130396592

0.4325810938

0.4283368699

0.1239259244

0.1097971713

0.407139827

0.1380546775

0.4495339127

0.4283368699

0.1239259244

0.1097971713

0.407139827

0.1380546775

0.4495339127

0.4542301155

0.1357514734

0.1210426071

0.4328776703

0.1504603397

0.4755825607

0.4542301155

0.1357514734

0.1210426071

0.4328776703

0.1504603397

0.4755825607

0.4736115167

0.1479351553

0.1326473025

0.4521685145

0.1632230081

0.4950545189

0.4736115167

0.1479351553

0.1326473025

0.4521685145

0.1632230081

0.4950545189

0.4967925512

0.1654142045

0.1493188693

0.4752511139

0.1815095396

0.5183339886

0.4967925512

0.1654142045

0.1493188693

0.4752511139

0.1815095396

0.5183339886

0.5232639898

0.1896395927

0.1724602642

0.5016192794

0.2068189212

0.5449087003

0.5232639898

0.1896395927

0.1724602642

0.5016192794

0.2068189212

0.5449087003

0.5442729895

0.208137346

0.1901591804

0.5225512181

0.2261155116

0.565994761

0.5442729895

0.208137346

0.1901591804

0.5225512181

0.2261155116

0.565994761

0.5689631142

0.2256400757

0.2068875031

0.5471472494

0.2443926483

0.5907789791

0.5689631142

0.2256400757

0.2068875031

0.5471472494

0.2443926483

0.5907789791

0.587623008

0.247492698

0.2277572041

0.5657255105

0.2672281919

0.6095205055

0.587623008

0.247492698

0.2277572041

0.5657255105

0.2672281919

0.6095205055

0.6138203958

0.2695954543

0.2488694156

0.5918000502

0.290321493

0.6358407414

0.6138203958

0.2695954543

0.2488694156

0.5918000502

0.290321493

0.6358407414

0.6317319167

0.2890154716

0.26738038

0.6096126736

0.3106505632

0.6538511597

0.6317319167

0.2890154716

0.26738038

0.6096126736

0.3106505632

0.6538511597

0.6466497272

0.307087583

0.2845363216

0.6243972667

0.3296388445

0.6689021878

0.6466497272

0.307087583

0.2845363216

0.6243972667

0.3296388445

0.6689021878

0.6605437665

0.3220329966

0.2986584373

0.6381078018

0.3454075558

0.6829797311

0.6605437665

0.3220329966

0.2986584373

0.6381078018

0.3454075558

0.6829797311

0.6710714086

0.3437266412

0.3190652597

0.6484289965

0.3683880227

0.6937138206

0.6710714086

0.3437266412

0.3190652597

0.6484289965

0.3683880227

0.6937138206

0.6851082647

0.3604255292

0.33466811

0.6621325759

0.3861829484

0.7080839535

0.6851082647

0.3604255292

0.33466811

0.6621325759

0.3861829484

0.7080839535

0.6927861423

0.3751454905

0.3482732273

0.6696028335

0.4020177538

0.7159694512

0.6927861423

0.3751454905

0.3482732273

0.6696028335

0.4020177538

0.7159694512

0.6943194122

0.3954319418

0.3666967734

0.6710670441

0.4241671101

0.7175717803

0.6943194122

0.3954319418

0.3666967734

0.6710670441

0.4241671101

0.7175717803

0.7153498174

0.4007262108

0.3713411652

0.6908126012

0.4301112563

0.7398870336

0.7153498174

0.4007262108

0.3713411652

0.6908126012

0.4301112563

0.7398870336

0.7205565715

0.4137668312

0.3816002645

0.6955237477

0.4459333978

0.7455893953

0.7205565715

0.4137668312

0.3816002645

0.6955237477

0.4459333978

0.7455893953

0.7300233971

0.4137668312

0.3816002645

0.7029167023

0.4459333978

0.7571300919

0.7300233971

0.4137668312

0.3816002645

0.7029167023

0.4459333978

0.7571300919

0.7450125376

0.4402048063

0.3934731813

0.7135275515

0.4869364314

0.7764975238

0.7450125376

0.4402048063

0.3934731813

0.7135275515

0.4869364314

0.7764975238

0.7674962485

0.5062997443

0.4150868077

0.7224249271

0.5975126808

0.8125675699

0.7674962485

0.5062997443

0.4150868077

0.7224249271

0.5975126808

0.8125675699

Fig 1e

55

55

55

66

66

77

77

88

88

99

99

1010

1010

1111

1111

1212

1212

1313

1313

1414

1414

1515

1515

1616

1616

1717

1717

1818

1818

1919

1919

2020

2020

2121

2121

2222

2222

2323

2323

2424

2424

2525

2525

2626

2626

2727

2727

2828

GRADE 1-5

GRADE 3-5

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5NHL

0.3381147541

0.1178278689

0.3381147541

0.1178278689

0.3504098361

0.1239825665

0.3504098361

0.1239825665

0.36891157

0.1322278146

0.36891157

0.1322278146

0.3957250832

0.1384266517

0.3957250832

0.1384266517

0.4165321085

0.1436367173

0.4165321085

0.1436367173

0.4378075846

0.1522067435

0.4378075846

0.1522067435

0.452198801

0.1577786984

0.452198801

0.1577786984

0.4652477288

0.1649185195

0.4652477288

0.1649185195

0.4833501503

0.1713657554

0.4833501503

0.1713657554

0.4989591356

0.1784838677

0.4989591356

0.1784838677

0.5205666152

0.1894281402

0.5205666152

0.1894281402

0.531170622

0.1965672612

0.531170622

0.1965672612

0.5391036347

0.2007221528

0.5391036347

0.2007221528

0.5460612769

0.2129014279

0.5460612769

0.2129014279

0.5542169238

0.2188687835

0.5542169238

0.2188687835

0.5674471953

0.229725235

0.5674471953

0.229725235

0.5960772184

0.2479806694

0.5960772184

0.2479806694

0.6012049838

0.2539732141

0.6012049838

0.2539732141

0.6135890208

0.2539732141

0.6135890208

0.2539732141

0.6135890208

0.2539732141

0.6135890208

0.2539732141

0.6252060285

0.2539732141

0.6252060285

0.2539732141

0.6252060285

0.2539732141

0.6252060285

0.2539732141

0.6613478303

0.2539732141

0.6613478303

0.2539732141

0.6613478303

0.2539732141

0.6613478303

0.2539732141

Fig 1e CI

555555

555555

555555

666666

666666

777777

777777

888888

888888

999999

999999

101010101010

101010101010

111111111111

111111111111

121212121212

121212121212

131313131313

131313131313

141414141414

141414141414

151515151515

151515151515

161616161616

161616161616

171717171717

171717171717

181818181818

181818181818

191919191919

191919191919

202020202020

202020202020

212121212121

212121212121

222222222222

222222222222

232323232323

232323232323

242424242424

242424242424

252525252525

252525252525

262626262626

262626262626

272727272727

272727272727

282828282828

NHL-L

NHL-L

NHL-U

NHL-U

GRADE 1-5

GRADE 3-5

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5NHL

0.0976008518

0.3084353912

0.1380548859

0.367794117

0.3381147541

0.1178278689

0.0976008518

0.3084353912

0.1380548859

0.367794117

0.3381147541

0.1178278689

0.1033058262

0.3204776093

0.1446593067

0.3803420628

0.3504098361

0.1239825665

0.1033058262

0.3204776093

0.1446593067

0.3803420628

0.3504098361

0.1239825665

0.110970905

0.3386360844

0.1534847241

0.3991870555

0.36891157

0.1322278146

0.110970905

0.3386360844

0.1534847241

0.3991870555

0.36891157

0.1322278146

0.1167506159

0.3650316574

0.1601026875

0.426418509

0.3957250832

0.1384266517

0.1167506159

0.3650316574

0.1601026875

0.426418509

0.3957250832

0.1384266517

0.1216159342

0.3855705494

0.1656575003

0.4474936676

0.4165321085

0.1436367173

0.1216159342

0.3855705494

0.1656575003

0.4474936676

0.4165321085

0.1436367173

0.1296197336

0.4066025949

0.1747937534

0.4690125744

0.4378075846

0.1522067435

0.1296197336

0.4066025949

0.1747937534

0.4690125744

0.4378075846

0.1522067435

0.1348181808

0.4208274374

0.180739216

0.4835701647

0.452198801

0.1577786984

0.1348181808

0.4208274374

0.180739216

0.4835701647

0.452198801

0.1577786984

0.1414526883

0.4336903789

0.1883843507

0.4968050786

0.4652477288

0.1649185195

0.1414526883

0.4336903789

0.1883843507

0.4968050786

0.4652477288

0.1649185195

0.1474103358

0.4514690195

0.195321175

0.5152312812

0.4833501503

0.1713657554

0.1474103358

0.4514690195

0.195321175

0.5152312812

0.4833501503

0.1713657554

0.1539352907

0.46673576

0.2030324447

0.5311825113

0.4989591356

0.1784838677

0.1539352907

0.46673576

0.2030324447

0.5311825113

0.4989591356

0.1784838677

0.1639032688

0.4878088767

0.2149530116

0.5533243538

0.5205666152

0.1894281402

0.1639032688

0.4878088767

0.2149530116

0.5533243538

0.5205666152

0.1894281402

0.1703263387

0.4980596387

0.2228081836

0.5642816054

0.531170622

0.1965672612

0.1703263387

0.4980596387

0.2228081836

0.5642816054

0.531170622

0.1965672612

0.1739929612

0.5056556098

0.2274513444

0.5725516596

0.5391036347

0.2007221528

0.1739929612

0.5056556098

0.2274513444

0.5725516596

0.5391036347

0.2007221528

0.1845294271

0.5122076088

0.2412734287

0.579914945

0.5460612769

0.2129014279

0.1845294271

0.5122076088

0.2412734287

0.579914945

0.5460612769

0.2129014279

0.1895326821

0.5197419457

0.248204885

0.5886919018

0.5542169238

0.2188687835

0.1895326821

0.5197419457

0.248204885

0.5886919018

0.5542169238

0.2188687835

0.1983337216

0.5316544892

0.2611167485

0.6032399014

0.5674471953

0.229725235

0.1983337216

0.5316544892

0.2611167485

0.6032399014

0.5674471953

0.229725235

0.2126130447

0.5569345397

0.283348294

0.6352198972

0.5960772184

0.2479806694

0.2126130447

0.5569345397

0.283348294

0.6352198972

0.5960772184

0.2479806694

0.2169948371

0.5613088313

0.2909515911

0.6411011363

0.6012049838

0.2539732141

0.2169948371

0.5613088313

0.2909515911

0.6411011363

0.6012049838

0.2539732141

0.2169948371

0.5714607841

0.2909515911

0.6557172576

0.6135890208

0.2539732141

0.2169948371

0.5714607841

0.2909515911

0.6557172576

0.6135890208

0.2539732141

0.2169948371

0.5714607841

0.2909515911

0.6557172576

0.6135890208

0.2539732141

0.2169948371

0.5714607841

0.2909515911

0.6557172576

0.6135890208

0.2539732141

0.2169948371

0.578695656

0.2909515911

0.6717164011

0.6252060285

0.2539732141

0.2169948371

0.578695656

0.2909515911

0.6717164011

0.6252060285

0.2539732141

0.2169948371

0.578695656

0.2909515911

0.6717164011

0.6252060285

0.2539732141

0.2169948371

0.578695656

0.2909515911

0.6717164011

0.6252060285

0.2539732141

0.2169948371

0.5837136178

0.2909515911

0.7389820428

0.6613478303

0.2539732141

0.2169948371

0.5837136178

0.2909515911

0.7389820428

0.6613478303

0.2539732141

0.2169948371

0.5837136178

0.2909515911

0.7389820428

0.6613478303

0.2539732141

0.2169948371

0.5837136178

0.2909515911

0.7389820428

0.6613478303

0.2539732141

Fig 1f

55

55

55

66

66

77

77

88

88

99

99

1010

1010

1111

1111

1212

1212

1313

1313

1414

1414

1515

1515

1616

1616

1717

1717

1818

1818

1919

1919

2020

2020

2121

2121

2222

2222

2323

2323

2424

2424

2525

2525

2626

2626

2727

2727

2828

GRADE 1-5

GRADE 3-5

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5Wilms

0.1661849711

0.049132948

0.1661849711

0.049132948

0.1806358382

0.0520231214

0.1806358382

0.0520231214

0.2052023121

0.063583815

0.2052023121

0.063583815

0.225433526

0.0693641618

0.225433526

0.0693641618

0.2456647399

0.0823699422

0.2456647399

0.0823699422

0.2645234004

0.088187048

0.2645234004

0.088187048

0.2878267167

0.0984162409

0.2878267167

0.0984162409

0.3130017486

0.1102809433

0.3130017486

0.1102809433

0.3327248838

0.1178747605

0.3327248838

0.1178747605

0.3608731225

0.128828842

0.3608731225

0.128828842

0.3888421769

0.1470666216

0.3888421769

0.1470666216

0.4158112809

0.1506892187

0.4158112809

0.1506892187

0.4434211733

0.1586606614

0.4434211733

0.1586606614

0.461065746

0.1697798572

0.461065746

0.1697798572

0.4895516356

0.1777638043

0.4895516356

0.1777638043

0.5140236045

0.1873001856

0.5140236045

0.1873001856

0.5291921802

0.195271374

0.5291921802

0.195271374

0.5562561127

0.2002145461

0.5562561127

0.2002145461

0.5672821593

0.2121409294

0.5672821593

0.2121409294

0.5879559966

0.2204491965

0.5879559966

0.2204491965

0.5879559966

0.2204491965

0.5879559966

0.2204491965

0.5879559966

0.2204491965

0.5879559966

0.2204491965

0.5879559966

0.2204491965

0.5879559966

0.2204491965

0.5879559966

0.2204491965

0.5879559966

0.2204491965

Fig 1f-CI

555555

555555

555555

666666

666666

777777

777777

888888

888888

999999

999999

101010101010

101010101010

111111111111

111111111111

121212121212

121212121212

131313131313

131313131313

141414141414

141414141414

151515151515

151515151515

161616161616

161616161616

171717171717

171717171717

181818181818

181818181818

191919191919

191919191919

202020202020

202020202020

212121212121

212121212121

222222222222

222222222222

232323232323

232323232323

242424242424

242424242424

252525252525

252525252525

262626262626

262626262626

272727272727

272727272727

282828282828

GRADE 1-5

GRADE 3-5

Wilm-L

Wilm-L

Wilm-U

Wilm-U

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5Wilms

0.1661849711

0.049132948

0.0330283705

0.1384496143

0.0652375255

0.1939203278

0.1661849711

0.049132948

0.0330283705

0.1384496143

0.0652375255

0.1939203278

0.1806358382

0.0520231214

0.0354768517

0.1519713979

0.0685693911

0.2093002784

0.1806358382

0.0520231214

0.0354768517

0.1519713979

0.0685693911

0.2093002784

0.2052023121

0.063583815

0.0454031079

0.1751122942

0.0817645222

0.2352923301

0.2052023121

0.063583815

0.0454031079

0.1751122942

0.0817645222

0.2352923301

0.225433526

0.0693641618

0.0504337317

0.1942990455

0.088294592

0.2565680065

0.225433526

0.0693641618

0.0504337317

0.1942990455

0.088294592

0.2565680065

0.2456647399

0.0823699422

0.0618856378

0.2135904801

0.1028542466

0.2777389996

0.2456647399

0.0823699422

0.0618856378

0.2135904801

0.1028542466

0.2777389996

0.2645234004

0.088187048

0.0670542235

0.2316534749

0.1093198725

0.2973933258

0.2645234004

0.088187048

0.0670542235

0.2316534749

0.1093198725

0.2973933258

0.2878267167

0.0984162409

0.0762033536

0.2540731398

0.1206291281

0.3215802936

0.2878267167

0.0984162409

0.0762033536

0.2540731398

0.1206291281

0.3215802936

0.3130017486

0.1102809433

0.0868882124

0.2783847667

0.1336736742

0.3476187306

0.3130017486

0.1102809433

0.0868882124

0.2783847667

0.1336736742

0.3476187306

0.3327248838

0.1178747605

0.0937532744

0.2974805014

0.1419962467

0.3679692662

0.3327248838

0.1178747605

0.0937532744

0.2974805014

0.1419962467

0.3679692662

0.3608731225

0.128828842

0.1036789303

0.3247963512

0.1539787536

0.3969498939

0.3608731225

0.128828842

0.1036789303

0.3247963512

0.1539787536

0.3969498939

0.3888421769

0.1470666216

0.1202331104

0.3519758548

0.1739001328

0.425708499

0.3888421769

0.1470666216

0.1202331104

0.3519758548

0.1739001328

0.425708499

0.4158112809

0.1506892187

0.1235040688

0.378130763

0.1778743686

0.4534917988

0.4158112809

0.1506892187

0.1235040688

0.378130763

0.1778743686

0.4534917988

0.4434211733

0.1586606614

0.1306307927

0.4048472054

0.1866905302

0.4819951412

0.4434211733

0.1586606614

0.1306307927

0.4048472054

0.1866905302

0.4819951412

0.461065746

0.1697798572

0.140475191

0.4218265029

0.1990845235

0.500304989

0.461065746

0.1697798572

0.140475191

0.4218265029

0.1990845235

0.500304989

0.4895516356

0.1777638043

0.1473805318

0.4489414111

0.2081470769

0.5301618601

0.4895516356

0.1777638043

0.1473805318

0.4489414111

0.2081470769

0.5301618601

0.5140236045

0.1873001856

0.1554111913

0.4719778708

0.2191891799

0.5560693381

0.5140236045

0.1873001856

0.1554111913

0.4719778708

0.2191891799

0.5560693381

0.5291921802

0.195271374

0.161837352

0.4859203557

0.228705396

0.5724640047

0.5291921802

0.195271374

0.161837352

0.4859203557

0.228705396

0.5724640047

0.5562561127

0.2002145461

0.1656116008

0.5104022029

0.2348174914

0.6021100225

0.5562561127

0.2002145461

0.1656116008

0.5104022029

0.2348174914

0.6021100225

0.5672821593

0.2121409294

0.1743159976

0.520110394

0.2499658612

0.6144539245

0.5672821593

0.2121409294

0.1743159976

0.520110394

0.2499658612

0.6144539245

0.5879559966

0.2204491965

0.1796735679

0.5376284019

0.261224825

0.6382835913

0.5879559966

0.2204491965

0.1796735679

0.5376284019

0.261224825

0.6382835913

0.5879559966

0.2204491965

0.1796735679

0.5376284019

0.261224825

0.6382835913

0.5879559966

0.2204491965

0.1796735679

0.5376284019

0.261224825

0.6382835913

0.5879559966

0.2204491965

0.1796735679

0.5376284019

0.261224825

0.6382835913

0.5879559966

0.2204491965

0.1796735679

0.5376284019

0.261224825

0.6382835913

0.5879559966

0.2204491965

0.1796735679

0.5376284019

0.261224825

0.6382835913

0.5879559966

0.2204491965

0.1796735679

0.5376284019

0.261224825

0.6382835913

0.5879559966

0.2204491965

0.1796735679

0.5376284019

0.261224825

0.6382835913

0.5879559966

0.2204491965

0.1796735679

0.5376284019

0.261224825

0.6382835913

Fig 1g

55

55

55

66

66

77

77

88

88

99

99

1010

1010

1111

1111

1212

1212

1313

1313

1414

1414

1515

1515

1616

1616

1717

1717

1818

1818

1919

1919

2020

2020

2121

2121

2222

2222

2323

2323

2424

2424

2525

2525

2626

2626

2727

2727

2828

GRADE 1-5

GRADE 3-5

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors GRADE 1-5 and GRADE 3-5Neuroblastoma

0.2528735632

0.0804597701

0.2528735632

0.0804597701

0.2644035125

0.0873911529

0.2644035125

0.0873911529

0.2851574213

0.0897016138

0.2851574213

0.0897016138

0.30591133

0.0966329966

0.30591133

0.0966329966

0.3174412794

0.1012658589

0.3174412794

0.1012658589

0.3335832084

0.1082151522

0.3335832084

0.1082151522

0.3520311273

0.1151644455

0.3520311273

0.1151644455

0.3660697909

0.1198468571

0.3660697909

0.1198468571

0.3988266725

0.1339702286

0.3988266725

0.1339702286

0.4105723543

0.1410909256

0.4105723543

0.1410909256

0.4318015867

0.1506661053

0.4318015867

0.1506661053

0.44639277

0.1605842765

0.44639277

0.1605842765

0.4740223972

0.170973247

0.4740223972

0.170973247

0.4927212359

0.1796276305

0.4927212359

0.1796276305

0.5170297261

0.1896162314

0.5170297261

0.1896162314

0.5279398359

0.1934654971

0.5279398359

0.1934654971

0.5442215899

0.2072681895

0.5442215899

0.2072681895

0.5590496159

0.2239336626

0.5590496159

0.2239336626

0.571645466

0.2239336626

0.571645466

0.2239336626

0.5974097047

0.2343999017

0.5974097047

0.2343999017

0.6130243949

0.2544352738

0.6130243949

0.2544352738

0.6353310951

0.2859194299

0.6353310951

0.2859194299

0.6353310951

0.3357693438

0.6353310951

0.3357693438

0.6353310951

0.3357693438

0.6353310951

0.3357693438

Fig 1g- CI

555555

555555

555555

666666

666666

777777

777777

888888

888888

999999

999999

101010101010

101010101010

111111111111

111111111111

121212121212

121212121212

131313131313

131313131313

141414141414

141414141414

151515151515

151515151515

161616161616

161616161616

171717171717

171717171717

181818181818

181818181818

191919191919

191919191919

202020202020

202020202020

212121212121

212121212121

222222222222

222222222222

232323232323

232323232323

242424242424

242424242424

252525252525

252525252525

262626262626

262626262626

272727272727

272727272727

282828282828

GRADE 1-5

GRADE 3-5

Neuro-L

Neuro-L

Neuro-U

Neuro-U

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors GRADE 1-5 and GRADE 3-5Neuroblastoma

0.2528735632

0.0804597701

0.0548982779

0.2120265591

0.1060212624

0.2937205673

0.2528735632

0.0804597701

0.0548982779

0.2120265591

0.1060212624

0.2937205673

0.2644035125

0.0873911529

0.0608461923

0.2229554504

0.1139361136

0.3058515746

0.2644035125

0.0873911529

0.0608461923

0.2229554504

0.1139361136

0.3058515746

0.2851574213

0.0897016138

0.0628403591

0.2427188138

0.1165628686

0.3275960288

0.2851574213

0.0897016138

0.0628403591

0.2427188138

0.1165628686

0.3275960288

0.30591133

0.0966329966

0.0688546891

0.2625928645

0.1244113042

0.3492297956

0.30591133

0.0966329966

0.0688546891

0.2625928645

0.1244113042

0.3492297956

0.3174412794

0.1012658589

0.0728976451

0.2736793399

0.1296340726

0.3612032188

0.3174412794

0.1012658589

0.0728976451

0.2736793399

0.1296340726

0.3612032188

0.3335832084

0.1082151522

0.0789966558

0.289252506

0.1374336486

0.3779139108

0.3335832084

0.1082151522

0.0789966558

0.289252506

0.1374336486

0.3779139108

0.3520311273

0.1151644455

0.0851340382

0.3071221772

0.1451948529

0.3969400773

0.3520311273

0.1151644455

0.0851340382

0.3071221772

0.1451948529

0.3969400773

0.3660697909

0.1198468571

0.0892822294

0.3207506949

0.1504114848

0.4113888868

0.3660697909

0.1198468571

0.0892822294

0.3207506949

0.1504114848

0.4113888868

0.3988266725

0.1339702286

0.1018747581

0.3527152423

0.166065699

0.4449381027

0.3988266725

0.1339702286

0.1018747581

0.3527152423

0.166065699

0.4449381027

0.4105723543

0.1410909256

0.1082634542

0.3642267796

0.1739183969

0.456917929

0.4105723543

0.1410909256

0.1082634542

0.3642267796

0.1739183969

0.456917929

0.4318015867

0.1506661053

0.1168900899

0.385096066

0.1844421206

0.4785071074

0.4318015867

0.1506661053

0.1168900899

0.385096066

0.1844421206

0.4785071074

0.44639277

0.1605842765

0.1258323259

0.3994501923

0.1953362271

0.4933353477

0.44639277

0.1605842765

0.1258323259

0.3994501923

0.1953362271

0.4933353477

0.4740223972

0.170973247

0.1351912108

0.4266688025

0.2067552832

0.521375992

0.4740223972

0.170973247

0.1351912108

0.4266688025

0.2067552832

0.521375992

0.4927212359

0.1796276305

0.1429035777

0.4450691939

0.2163516832

0.5403732778

0.4927212359

0.1796276305

0.1429035777

0.4450691939

0.2163516832

0.5403732778

0.5170297261

0.1896162314

0.1516401031

0.4687788782

0.2275923596

0.565280574

0.5170297261

0.1896162314

0.1516401031

0.4687788782

0.2275923596

0.565280574

0.5279398359

0.1934654971

0.1549278834

0.4792277853

0.2320031108

0.5766518865

0.5279398359

0.1934654971

0.1549278834

0.4792277853

0.2320031108

0.5766518865

0.5442215899

0.2072681895

0.1663488749

0.494651861

0.2481875041

0.5937913189

0.5442215899

0.2072681895

0.1663488749

0.494651861

0.2481875041

0.5937913189

0.5590496159

0.2239336626

0.17974667

0.5083429309

0.2681206552

0.6097563009

0.5590496159

0.2239336626

0.17974667

0.5083429309

0.2681206552

0.6097563009

0.571645466

0.2239336626

0.17974667

0.5194851293

0.2681206552

0.6238058027

0.571645466

0.2239336626

0.17974667

0.5194851293

0.2681206552

0.6238058027

0.5974097047

0.2343999017

0.1862886933

0.5408962867

0.2825111102

0.6539231228

0.5974097047

0.2343999017

0.1862886933

0.5408962867

0.2825111102

0.6539231228

0.6130243949

0.2544352738

0.1936704096

0.5510647983

0.315200138

0.6749839915

0.6130243949

0.2544352738

0.1936704096

0.5510647983

0.315200138

0.6749839915

0.6353310951

0.2859194299

0.2022033184

0.5634325029

0.3696355414

0.7072296873

0.6353310951

0.2859194299

0.2022033184

0.5634325029

0.3696355414

0.7072296873

0.6353310951

0.3357693438

0.2141392298

0.5634325029

0.4573994577

0.7072296873

0.6353310951

0.3357693438

0.2141392298

0.5634325029

0.4573994577

0.7072296873

0.6353310951

0.3357693438

0.2141392298

0.5634325029

0.4573994577

0.7072296873

0.6353310951

0.3357693438

0.2141392298

0.5634325029

0.4573994577

0.7072296873

Fig 1h

55

55

55

66

66

77

77

88

88

99

99

1010

1010

1111

1111

1212

1212

1313

1313

1414

1414

1515

1515

1616

1616

1717

1717

1818

1818

1919

1919

2020

2020

2121

2121

2222

2222

2323

2323

2424

2424

2525

2525

2626

2626

2727

2727

2828

GRADE 1-5

GRADE 3-5

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5Sarcoma

0.3933209647

0.1781076067

0.3933209647

0.1781076067

0.4109733542

0.1827669564

0.4109733542

0.1827669564

0.4240430121

0.1893202107

0.4240430121

0.1893202107

0.4438119662

0.195927881

0.4438119662

0.195927881

0.4646318775

0.2092232177

0.4646318775

0.2092232177

0.4830596523

0.2170747753

0.4830596523

0.2170747753

0.4991959009

0.2304119077

0.4991959009

0.2304119077

0.5095297933

0.2368198598

0.5095297933

0.2368198598

0.5203653309

0.2468959153

0.5203653309

0.2468959153

0.5294671825

0.2516455711

0.5294671825

0.2516455711

0.537962244

0.2568093898

0.537962244

0.2568093898

0.5457322592

0.2680011765

0.5457322592

0.2680011765

0.5571395017

0.2772846862

0.5571395017

0.2772846862

0.5811901793

0.2826386008

0.5811901793

0.2826386008

0.5978465528

0.2909784633

0.5978465528

0.2909784633

0.6144671062

0.2958084995

0.6144671062

0.2958084995

0.6218748324

0.3075385874

0.6218748324

0.3075385874

0.628208975

0.3184688966

0.628208975

0.3184688966

0.6425891907

0.3312894097

0.6425891907

0.3312894097

0.660767954

0.3312894097

0.660767954

0.3312894097

0.6676582917

0.3398549473

0.6676582917

0.3398549473

0.6781751229

0.3398549473

0.6781751229

0.3398549473

0.6781751229

0.3398549473

0.6781751229

0.3398549473

0.7160357153

0.3398549473

0.7160357153

0.3398549473

Fig 1h CI

555555

555555

555555

666666

666666

777777

777777

888888

888888

999999

999999

101010101010

101010101010

111111111111

111111111111

121212121212

121212121212

131313131313

131313131313

141414141414

141414141414

151515151515

151515151515

161616161616

161616161616

171717171717

171717171717

181818181818

181818181818

191919191919

191919191919

202020202020

202020202020

212121212121

212121212121

222222222222

222222222222

232323232323

232323232323

242424242424

242424242424

252525252525

252525252525

262626262626

262626262626

272727272727

272727272727

282828282828

GRADE 1-5

Sar_L

Sar-U

GRADE 3-5

Sar-L

Sar_U

yrs since diagnosis


Cumulative incidence curves of physical health conditions in survivors for GRADE 1-5 and GRADE 3-5Sarcoma

0.3933209647

0.3641601447

0.4224817848

0.1781076067

0.1552676432

0.2009475702

0.3933209647

0.3641601447

0.4224817848

0.1781076067

0.1552676432

0.2009475702

0.4109733542

0.3816005996

0.4403461088

0.1827669564

0.1596942164

0.2058396965

0.4109733542

0.3816005996

0.4403461088

0.1827669564

0.1596942164

0.2058396965

0.4240430121

0.3945349031

0.4535511211

0.1893202107

0.1659273234

0.212713098

0.4240430121

0.3945349031

0.4535511211

0.1893202107

0.1659273234

0.212713098

0.4438119662

0.4141300066

0.4734939258

0.195927881

0.1722190466

0.2196367154

0.4438119662

0.4141300066

0.4734939258

0.195927881

0.1722190466

0.2196367154

0.4646318775

0.4348132681

0.494450487

0.2092232177

0.1849050022

0.2335414333

0.4646318775

0.4348132681

0.494450487

0.2092232177

0.1849050022

0.2335414333

0.4830596523

0.4531384081

0.5129808966

0.2170747753

0.1923968811

0.2417526695

0.4830596523

0.4531384081

0.5129808966

0.2170747753

0.1923968811

0.2417526695

0.4991959009

0.4691824707

0.5292093311

0.2304119077

0.2051119032

0.2557119121

0.4991959009

0.4691824707

0.5292093311

0.2304119077

0.2051119032

0.2557119121

0.5095297933

0.4794604273

0.5395991592

0.2368198598

0.2112163185

0.262423401

0.5095297933

0.4794604273

0.5395991592

0.2368198598

0.2112163185

0.262423401

0.5203653309

0.4902203118

0.55051035

0.2468959153

0.2207981293

0.2729937012

0.5203653309

0.4902203118

0.55051035

0.2468959153

0.2207981293

0.2729937012

0.5294671825

0.4992425399

0.5596918252

0.2516455711

0.225300769

0.2779903731

0.5294671825

0.4992425399

0.5596918252

0.2516455711

0.225300769

0.2779903731

0.537962244

0.5076365386

0.5682879495

0.2568093898

0.2301650854

0.2834536942

0.537962244

0.5076365386

0.5682879495

0.2568093898

0.2301650854

0.2834536942

0.5457322592

0.5152876911

0.5761768273

0.2680011765

0.2406538231

0.2953485299

0.5457322592

0.5152876911

0.5761768273

0.2680011765

0.2406538231

0.2953485299

0.5571395017

0.5264545392

0.5878244643

0.2772846862

0.2492950558

0.3052743167

0.5571395017

0.5264545392

0.5878244643

0.2772846862

0.2492950558

0.3052743167

0.5811901793

0.5498686921

0.6125116665

0.2826386008

0.2542094889

0.3110677126

0.5811901793

0.5498686921

0.6125116665

0.2826386008

0.2542094889

0.3110677126

0.5978465528

0.5659600417

0.629733064

0.2909784633

0.2617315541

0.3202253724

0.5978465528

0.5659600417

0.629733064

0.2909784633

0.2617315541

0.3202253724

0.6144671062

0.5819223986

0.6470118138

0.2958084995

0.2660069823

0.3256100167

0.6144671062

0.5819223986

0.6470118138

0.2958084995

0.2660069823

0.3256100167

0.6218748324

0.5889171681

0.6548324966

0.3075385874

0.2761033349

0.3389738399

0.6218748324

0.5889171681

0.6548324966

0.3075385874

0.2761033349

0.3389738399

0.628208975

0.5946801562

0.6617377938

0.3184688966

0.2851988872

0.3517389061

0.628208975

0.5946801562

0.6617377938

0.3184688966

0.2851988872

0.3517389061

0.6425891907

0.6076038843

0.6775744972

0.3312894097

0.2956467047

0.3669321147

0.6425891907

0.6076038843

0.6775744972

0.3312894097

0.2956467047

0.3669321147

0.660767954

0.6234809874

0.6980549206

0.3312894097

0.2956467047

0.3669321147

0.660767954

0.6234809874

0.6980549206

0.3312894097

0.2956467047

0.3669321147

0.6676582917

0.6288681406

0.7064484428

0.3398549473

0.3009424447

0.3787674499

0.6676582917

0.6288681406

0.7064484428

0.3398549473

0.3009424447

0.3787674499

0.6781751229

0.6357369397

0.7206133062

0.3398549473

0.3009424447

0.3787674499

0.6781751229

0.6357369397

0.7206133062

0.3398549473

0.3009424447

0.3787674499

0.6781751229

0.6357369397

0.7206133062

0.3398549473

0.30

bringing pcps “back” into cancer care through onco-primary ......bringing pcps “back” into...

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