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Kremer Group

Leontien Kremer

The group is focusing on survivorship research, epidemiological studies, and evidence based pediatric oncology. We have expertise in performing large epidemiological studies on cohorts of children with cancer and survivors, and in systematic reviews and guidelines. We quantify the role of cancer treatment and other important risk factors as they impact health and quality of life. Research is embedded in local, national (LATER study group), and international networks.

Years after treatment, childhood cancer survivors are at high risk of developing long-term side effects due to their previous cancer treatment. In the Netherlands we have identified more than 12.000 5 years survivors treated for childhood cancer between 1963 and 2012. Our group is focussing on the quantification of this risk and identification of risk factors and potential interventions.

Survivorship research

Current topics are:
• Overall mortality
• Overall burden of disease
• Health care burden/ evaluation of care
• Subsequent tumors
• Cardiovascular toxicity
• Female fertility
• Male fertility
• Fatigue
• Radiation epidemiology

Epidemiological trends among children with cancer

Most of the children ≤ 14 years are treated by pediatric oncologists, however for young adolescents (15-17 years) this percentage is around 50%. To get better insight in the progress made against childhood cancer and to detect whether there is room for improvement,  trends in incidence, survival and mortality are studied in collaboration with the Netherlands Cancer Registry.. Our group is focussing on these three outcome measures of cancer burden for children and young adolescents who are diagnosed in the Netherlands since the 1990s.

Systematic reviews and Guidelines

Systematic reviews and guidelines are the cornerstone for patient care and the starting point for new clinical research in pediatric oncology. The editorial base of Cochrane Childhood Cancer, based in the Princess Máxima Center www.childhoodcancer.cochrane.org is responsible for the (inter)national support, the editorial process and the publication in the Cochrane Library (an internet journal IF 6,124) of Cochrane systematic reviews on childhood cancer. Furthermore our group is providing the methodology to develop guidelines in pediatric oncology on surveillance of childhood cancer survivors (www.IGHG.org) and on fertility preservation.

Key publications

J Clin Oncol. IF: 24.0 Teepen JC, van Leeuwen FE, Tissing WJ, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, van der Pal HJ, Loonen JJ, Bresters D, Versluys B, Neggers SJCMM, Jaspers MWM, Hauptmann M, van der Heiden-van der Loo M, Visser O, Kremer LCM, Ronckers CM; DCOG LATER Study Group. Long-Term Risk of Subsequent Malignant Neoplasms After Treatment of Childhood Cancer in the DCOG LATER Study Cohort: Role of Chemotherapy. J Clin Oncol. 2017 Jul 10;35(20):2288-98.  PubMed PMID: 28530852

Lancet Oncol. IF: 33.9 Armenian SH, Hudson MM, Mulder RL, Chen MH, Constine LS, Dwyer M, Nathan PC, Tissing WJ, Shankar S, Sieswerda E, Skinner R, Steinberger J, van Dalen EC, van der Pal H, Wallace WH, Levitt G, Kremer LC; International Late Effects of Childhood Cancer Guideline Harmonization Group. Recommendations for cardiomyopathy surveillance for survivors of childhood cancer: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol. 2015 Mar;16(3):e123-36. PubMed PMID: 25752563

Nat Genet. IF: 31.6 Aminkeng F, Bhavsar AP, Visscher H, Rassekh SR, Li Y, Lee JW, Brunham LR, Caron HN, van Dalen EC, Kremer LC, van der Pal HJ, Amstutz U, Rieder MJ, Bernstein D, Carleton BC, Hayden MR, Ross CJ; Canadian Pharmacogenomics Network for Drug Safety Consortium. A coding variant in RARG confers susceptibility to anthracycline-induced cardiotoxicity in childhood cancer. Nat Genet. 2015 Sep;47(9):1079-84. PubMed PMID: 26237429

Lancet Oncol. IF: 33.9 Mulder RL, Kremer LC, Hudson MM, Bhatia S, Landier W, Levitt G, Constine LS, Wallace WH, van Leeuwen FE, Ronckers CM, Henderson TO, Dwyer M, Skinner R, Oeffinger KC; International Late Effects of Childhood Cancer Guideline Harmonization Group. Recommendations for breast cancer surveillance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol. 2013 Dec;14(13):e621-9. PubMed PMID: 24275135

J Clin Oncol IF: 24.0 van der Pal HJ, van Dalen EC, van Delden E, van Dijk IW, Kok WE, Geskus RB, Sieswerda E, Oldenburger F, Koning CC, van Leeuwen FE, Caron HN, Kremer LC. High risk of symptomatic cardiac events in childhood cancer survivors. J Clin Oncol.2012 May 1;30(13):1429-37. PubMed PMID: 22473161

PI: Leontien Kremer

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