Hospitalization rates among survivors of childhood cancer in the childhood cancer survivor study cohort

Abstract

Background Chronic health conditions are common among long-term childhood cancer survivors, but hospitalization rates have not been reported. The objective of this study was to determine overall and cause-specific hospitalization rates among survivors of childhood cancer and compare rates to the U.S. population. Procedure The Childhood Cancer Survivor Study (CCSS) is a retrospective cohort of 5+ year survivors of childhood malignancies treated at 26 participating centers. Self-reported hospitalizations from 10,366 survivors (diagnosed 1970–1986) were compared to U.S. population rates using age-and sex-stratified standardized incidence ratios (SIRs). Reasons for hospitalization were evaluated and associations between demographic, cancer and treatment-related risk factors with hospitalization were investigated. Results Survivors were, on average, 20.9 years from cancer diagnosis (SD: 4.6, range: 13–32) and 28.6 years of age (SD: 7.7, range: 13–51). Survivor hospitalization rates were 1.6 times the U.S. population (95% CI: 1.6; 1.7). Increased hospitalization rates were noted irrespective of gender, age at follow-up and cancer diagnosis, with highest SIRs noted among male (SIR=2.6, 95% CI: 2.2; 3.0) and female (SIR=2.7, 95% CI: 2.4; 3.1) survivors aged 45–54. Female gender, an existing chronic health condition and/or a second neoplasm, and prior treatment with radiation were associated with an increased risk of non-obstetrical hospitalization. Conclusions Survivors of childhood cancer demonstrate substantially higher hospitalization rates. Additional research is needed to further quantify the healthcare utilization and economic impact of treatment-related complications as this population ages.

Increased health care utilization by survivors of childhood lymphoblastic leukemia is confined to those treated with cranial or total body irradiation: a case cohort study

“…Our data show that, in both the survivor cohort and the control cohort, females had an increased risk for at least one hospital contact, more hospital contacts and longer hospital stays than males, which is in agreement with previous studies [15,16]. Moreover, we found that age at diagnosis did not influence the risk of having at least one hospital contact, but in the age group ≥ 10 years at cancer diagnosis, fewer hospital contacts and shorter hospital stays were seen.…”

“…Leukemia survivors included in the CCSS had a standardized incidence ratio of self-reported hospitalization of 1.4 (95%CI 1.3–1.4) compared with the general U.S. population [16]. In the BCCSS, 7.1 percent of survivors of leukemia reported having been hospitalized at least once during the observed year, a 1.4-fold risk compared with the general population (data from the National General Household Survey) [20].…”

Early Posttherapy Hospitalizations Among Survivors of Childhood Leukemia and Lymphoma

“…Consistent with prior studies, we found that survivors of both cancer types were at increased risk for hospitalizations due to infectious causes. 10,11 Such a high burden of infectious complications is not surprising given the immunosuppression associated with treatment for leukemia and lymphoma and underscores the importance of limiting potential sources of infection as expeditiously as possible once therapy is complete. One such intervention may be to remove central venous catheters as quickly as possible when transitioning off therapy.…”

“…However, long-term survivors continue to have a significantly increased risk for hospitalization well beyond three years post-therapy, and infectious and hematologic complications are common causes for hospitalizations even decades following therapy completion. 10,11 This suggests that these issues do not fully resolve with time off therapy and remain a significant contributor to ongoing survivor morbidity.…”

Physiologic Frailty As a Sign of Accelerated Aging Among Adult Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study

“…2 Nearly two thirds of CCS have at least one chronic health condition 30 years after diagnosis. 3 CCS are more likely than peers to be hospitalized for nonobstetrical reasons 4 and have mortality rates more than eight times higher than age-and sexmatched peers. 5 Even in the absence of overt organsystem disease, many young adult CCS report symptoms that interfere with daily life, including exercise-induced shortness of breath, 6 fatigue, 7 and reduced capacity to participate in physical activity, 8 with survivors of childhood acute lymphoblastic leukemia, brain tumors, and Hodgkin's lymphoma demonstrating impaired fitness.…”