Dr Clare Frobisher PhD

• PhD Nutrition 2004
• BSc (Hons) Food and Human Nutrition 1997

Clare Frobisher qualified with a BSc (Hons) in Food and Human Nutrition from the University of Newcastle Upon Tyne in 1997. She went on to study for a PhD in Nutrition at Liverpool John Moores University. During her Phd studies she attended a 10 week nutritional epidemiology course at Umea University in Sweden as part of a student exchange.

In 2002 Clare joined the Department of Social Medicine at the University of Bristol to work on the Boyd Orr cohort study. During this time she looked at the reproducibility of the dietary assessment method used by the cohort members.

Clare moved in 2005 to the University of Birmingham, to join the research team for the British Childhood Cancer Survivor Study (BCCSS). During this time, she attended the advanced course in epidemiological analysis at the London School of Hygiene and Tropical Medicine, in 2005, and the advanced epidemiological and statistical methods course at the Department of Social Medicine, University of Bristol, in 2008.

The BCCSS comprises 17,981 individuals who were diagnosed with cancer aged 0-14 years inclusive, between 1940 and 1991 in Britain, and survived at least 5 years. Using the completed questionnaires from the eligible childhood cancer survivors, Clare has investigated several late effects in this particular cohort, which involved:

- comparison of marriage rates in the survivors to the general population, and the demographic, cancer, treatment and social factors associated with being ever married and age at first marriage in the survivors;

- assessment of the prevalence of divorce and the associated explanatory factors within the survivors;

- comparison of smoking rates and age at initiation in the survivors to the general population, and the associated explanatory factors within the survivors for being a smoker and age at initiation;

- comparison of drinking behaviours within the survivors to those seen in the general population, and the associated explanatory factors within the survivors for these behaviours;

- a cohort analysis of the risk of bladder tumours after childhood cancer, in particular the risk was compared to that seen in the general population and the associated explanatory factors within the survivors for developing a bladder tumour;

- a cohort analysis of the risk of any subsequent primary neoplasm (SPN) after childhood cancer, in particular comparing the risk to that seen in the general population.

Teaching Programmes

Medicine and Surgery MBChB

Small group teaching:

• Clinical Epidemiology (Year 1)
• Cancer (Year 2)
• Epidemiological Methods (Year 3)

Public Health MPH/Diploma/Certificate:

• Advanced Applied Epidemiology module

Clare is interested in supervising doctoral research students in the following areas:

Late physical and social effects in 5-year survivors of childhood cancer.

If you are interested in studying any of these subject areas please contact Clare directly, or 
for any general doctoral research enquiries, please email mds-gradschool@contacts.bham.ac.uk

Research Themes

Childhood cancer, survivorship, late effects, psycho-social outcomes, subsequent primary neoplasms.   

Research Activity

Subsequent primary neoplasms (SPN) in childhood cancer survivors

Using the 17,981 5-year childhood cancer survivor cohort (the BCCSS), Clare has investigated the risk of any subsequent primary neoplasm in these individuals. Key findings include: (i) survivors were 4 times more likely to develop a SPN than expected; (ii) in absolute terms, overall 17 SPNs per 10,000 survivors per year was observed; (iii) cumulative incidence for a SPN increased from 1.6% at age 20 years to 13.5% at age 60 years; iv) the absolute risk beyond 40 years was highest for digestive and genito-urinary SPNs.

Clare investigated the risk of one particular group of SPNs, that of the bladder, in the childhood cancer survivors. Although the absolute risk of a bladder tumour after childhood cancer was low (0.37 cases/10,000 survivors/year), the relative risk was four times that expected from the general population. Specific groups of survivors e.g. those diagnosed with heritable retinoblastoma and those treated with chemotherapy were at the highest risk.

Alcohol consumption and smoking behaviour in childhood cancer survivors

Using completed and returned questionnaires from the 10,493 survivors, both smoking and drinking behaviours were investigated. Clare found that the odds of the survivors being a current smoker was approximately half that seen in the general population. However, survivors of Hodgkin’s lymphoma, Wilms’ tumour or a soft tissue sarcoma were more likely to be a current regular smoker, had greater rates of initiating smoking and were the groups closest to the general population for the likelihood of being a smoker, than survivors of other childhood cancer types.

On investigating the survivors’ drinking behaviours, Clare found that they were less likely than the general population to: be a current drinker; consume over weekly recommended levels; consume harmful amounts. Survivors of a central nervous system neoplasm or leukaemia, particularly those treated with brain irradiation, were the least likely to have adverse drinking behaviours when compared to the general population. However, survivors of Hodgkin lymphoma, non-Hodgkin lymphoma, Wilms tumour, bone sarcoma and soft tissue sarcoma had adverse drinking behaviours at levels expected from the general population.

Marriage and divorce rates in the childhood cancer survivors

From the completed BCCSS questionnaires, Clare found that the level of marriage was lower in particular survivor groups for instance, in those diagnosed with a central nervous system (CNS) neoplasm and those who received radiotherapy, compared to leukaemia survivors or those who did not have radiotherapy treatment, respectively. The deficits in the proportion ever married compared to the general population were mostly between 9%-18% among males and 7%-10% among females. The largest ever married deficits were among male CNS neoplasm survivors aged 30y or over (29%-38%). Age at first marriage among survivors was related to: sex, childhood cancer type, age at diagnosis, chemotherapy, radiotherapy, mental retardation, and level of educational attainment.

Although the survivors were found not to be marrying at the same level as that seen in the general population, it was reassuring to show that these survivors did not experience any excess of divorce compared to the general population. In-fact the survivors as a whole were less likely to be divorced or separated than the comparable British population. It is also encouraging that cancer or treatment factors such as childhood cancer type were not related to the likelihood of divorce or separation in these survivors.

• Attended and presented work at the ‘International conference on long term complications of treatment of children and adolescents for cancer’ and the ‘European symposium on late complications after childhood cancer’.