Early Posttherapy Hospitalizations Among Survivors of Childhood Leukemia and Lymphoma

Abstract

Long-term survivors of childhood cancers are at increased risk for hospitalization. To test the hypothesis that many treatment-related morbidities are identifiable in the early post-therapy period, we determined the rates and causes for hospitalization among survivors of leukemia and lymphoma during the first three years post-therapy. Using a health plan claims database, we identified patients aged 0-21 years-old treated for leukemia or lymphoma from 2000-2010. Survivors were matched 10:1 with similar children without a history of cancer. Hospitalization rates over three years were compared using Cox proportional hazards regression and risks of cause-specific hospitalization were compared using log-binomial models. Nineteen percent of childhood leukemia and lymphoma survivors were hospitalized in the first three years off therapy. Leukemia survivors (N=529) experienced over six times (HR: 6.3, 95%CI: 4.9-8.0) and lymphoma survivors (N=454) over three times the hospitalization rate of controls (HR: 3.2, 95%CI: 2.5-4.2). Compared with children without a cancer history, survivors were at increased risk for hospitalization due to infectious causes (leukemia RR: 60.0, 95%CI: 23.4-154.0; lymphoma RR: 10.0, 95%CI: 4.4-22.9). Additionally, lymphoma survivors were at increased risk for cardiovascular-(RR: 15.0, 95%CI: 5.4-42.0) and pulmonary-(RR: 8.1, 95%CI: 3.9-16.8) related hospitalizations. These findings highlight the morbidity experienced by survivors and suggest that treatment-associated complications may be emerging soon after therapy completion.

Mortality and survival patterns of childhood lymphomas: geographic and age‐specific patterns in Southern‐Eastern European and SEER/US registration data

“…In addition, recent studies have pointed to the significant impact of enduring compliance to therapy since young patients will require long‐term and molecularly targeted therapy under regular monitoring. Their prognosis also seems to be dismal in case of relapsed or refractory disease, especially for specific subtypes, such as the B‐cell and lymphoblastic NHL . Last, the known poor prognosis of specific NHL subtypes, namely, mature B‐cell and mature T‐cell and NK‐cell lymphomas in younger compared with older children, is also in accordance with previous studies; the cancer registration type of our data entailing a high proportion of NHL NOS cases is to be, however, acknowledged.…”

Long-Term Risk of Infections After Treatment of Childhood Leukemia: A Population-Based Cohort Study Using Administrative Health Data

“…32 In the Childhood Cancer Survivors Study, 5-year cancer survivors self-reported a 30% higher frequency of infections compared with their siblings 33 and were at a 1.6 to 2.7 increased risk of infection-related hospitalizations compared with the general population. 34 Finally, higher rates of infection-related hospitalizations have been reported in retrospective cohort studies, [35][36][37] especially in the initial years post-treatment. In our study, the absence of a difference between groups for 31 : moderately intensive, low-, standard-, or intermediate-risk precursor B-cell ALL; very intensive, high-risk or very-high-risk precursor B-cell ALL, T-cell ALL, AML and Down syndrome or acute promyelocytic leukemia; and most intensive, AML not associated with Down syndrome or any treatment protocol that requires HSCT.…”

Impact of multimorbidity subgroups on the health care use of early pediatric cancer survivors

“…Although the increased association between pediatric cancer and chronic conditions in adulthood has been well studied, the conditions experienced by early survivors–children and adolescents who are only a few years out from the completion of therapy–are unclear . This population has been shown to fill more prescriptions from more drug classes, and to be at an increased risk of having a hospitalization, compared with children who have not experienced cancer . Unfortunately, existing evidence does not consider the variety of combinations of conditions these children might experience, and the way those conditions relate to one another.…”