Multimorbidity patterns and risk of hospitalisation in children: A population cohort study of 3.6 million children in England, with illustrative examples from childhood cancer survivors

Chung, Sheng‐Chia; Mueller, Stefanie H.; Green, Katherine; Hargrave, Darren; Lai, Alvina G.

doi:10.1016/j.lanepe.2022.100433

Cited by 11 publications

(7 citation statements)

References 53 publications

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“…We can attribute this to several factors, including centralization of cancer treatment at hospital‐based centers for children and AYA due to specialist team needs which leads to longer hospital stays and increased costs. Because of their weak immune systems, children with cancer are more susceptible to severe illnesses, such as septicemia, fever, and neutropenia, resulting in increased hospitalizations during treatment 80–84 …”

Section: Discussionmentioning

confidence: 99%

“…Because of their weak immune systems, children with cancer are more susceptible to severe illnesses, such as septicemia, fever, and neutropenia, resulting in increased hospitalizations during treatment. [80][81][82][83][84] Although over 50% of new cancer cases are from lowand middle-income (LMICs), 85 there are several obstacles to the conduct of quality research in these countries such as limited resources, poor research infrastructure and general lack of comprehensive cancer registration and surveillance systems that generate reliable data. 85…”

Section: Summary Of Evidencementioning

confidence: 99%

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Healthcare costs of cancer among children, adolescents, and young adults: A scoping review

Nabukalu,

Gordon,

Lowe

et al. 2024

Cancer Medicine

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ObjectiveTo collate and critically review international evidence on the direct health system costs of children and adolescents and young adults (AYA) with cancer.MethodsWe conducted searches in PubMed, MEDLINE, CINAHL, and Scopus. Articles were limited to studies involving people aged 0–39 years at cancer diagnosis and published from 2012 to 2022. Two reviewers screened the articles and evaluated the studies using the Consolidated Health Economic Evaluation Reporting Standards checklist. The reviewers synthesized the findings using a narrative approach and presented the costs in 2022 US dollars for comparability.ResultsOverall, the mean healthcare costs for all cancers in the 5 years post diagnosis ranged from US$36,670 among children in Korea to US$127,946 among AYA in the USA.During the first year, the mean costs among children 0–14 years ranged from US$34,953 in Chile to over US$130,000 in Canada. These were higher than the costs for AYA, estimated at US$61,855 in Canada. At the end of life, the mean costs were estimated at over US$300,000 among children and US$235,265 among adolescents in Canada.Leukemia was the most expensive cancer type, estimated at US$50,133 in Chile, to US$152,533 among children in Canada. Overall, more than a third of the total cost is related to hospitalizations. All the included studies were of good quality.ConclusionsHealthcare costs associated with cancer are substantial among children, and AYA. More research is needed on the cost of cancer in low‐ and middle‐income countries and harmonization of costs across countries.

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Section: Discussionmentioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

Healthcare costs of cancer among children, adolescents, and young adults: A scoping review

Nabukalu,

Gordon,

Lowe

et al. 2024

Cancer Medicine

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“…The role of comorbidity should be considered at different stages along the cancer care pathway. Due to the advancements in cancer treatment, more and more patients are surviving cancer and comorbidity may increase the risk of developing late effects 51 , 52 during the survivorship period. Comorbidity may increase the risk of certain cancers and the risk of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Pan-cancer analyses of the associations between 109 pre-existing conditions and cancer treatment patterns across 19 adult cancers

Chang,

Lai

2024

Sci Rep

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Comorbidities present considerable challenges to cancer treatment and care. However, little is known about the effect of comorbidity on cancer treatment decisions across a wide range of cancer types and treatment modalities. Harnessing a cohort of 280,543 patients spanning 19 site-specific cancers, we explored pan-cancer frequencies of 109 comorbidities. Multinomial logistic regression was used to analyse the relationship between comorbidities and cancer treatment types, while binomial logistic regression examined the association between comorbidities and chemotherapy drug types, adjusting for demographic and clinical factors. Patients with comorbidity exhibited lower odds of receiving chemotherapy and multimodality treatment. End-stage renal disease was significantly associated with a decreased odds of receiving chemotherapy and surgery. Patients with prostate cancer who have comorbid non-acute cystitis, obstructive and reflux uropathy, urolithiasis, or hypertension were less likely to receive chemotherapy. Among patients with breast cancer, dementia, left bundle branch block, peripheral arterial disease, epilepsy, Barrett’s oesophagus, ischaemic stroke, unstable angina and asthma were associated with lower odds of receiving multimodal chemotherapy, radiotherapy and surgery. Comorbidity is also consistently associated with the lower odds of receiving chemotherapy when comparing across 10 drug classes. Patients with comorbid dementia, intracerebral haemorrhage, subarachnoid haemorrhage, oesophageal varices, liver fibrosis sclerosis and cirrhosis and secondary pulmonary hypertension were less likely to receive antimetabolites. Comorbidity can influence the effectiveness and tolerability of cancer treatment and ultimately, prognosis. Multi-specialty collaborative care is essential for the management of comorbidity during cancer treatment, including prophylactic measures to manage toxicities.

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“…For example, UK cohort studies linked to routine health data found that CYP living in deprived areas were less likely to access primary care relative to their wealthier peers and more likely to use acute care. [11][12][13] Inequalities in CYP access to care may result from variation in the supply of healthcare by area deprivation 14 ; differences in how conditions are identified and managed, for example, because of increased multimorbidity in CYP in deprived areas 15 or variation in healthcare professionals' (HCPs) expertise. 16 Marginalised CYP and caregivers may not identify themselves as requiring health treatment or may lack knowledge of available healthcare services and how to navigate complex healthcare systems.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Access to primary care for children and young people (CYP) in the UK: a scoping review of CYP’s, caregivers’ and healthcare professionals’ views and experiences of facilitators and barriers

Herlitz,

Ashford,

Powell

et al. 2024

BMJ Open

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ObjectivesTo examine children and young people’s (CYP), caregivers’ and healthcare professionals’ (HCPs) views or experiences of facilitators and barriers to CYP access to UK primary care services to better understand healthcare inequity. To explore differences across CYP subpopulations with greater health needs from deprived areas, identifying as ethnic minorities, with experiences of state care, special educational needs or disabilities, chronic conditions or mental health problems.DesignScoping review.Eligibility criteriaIncluded studies were in English, published 2012–2022 and reported: the views/experiences of CYP (0–25 years), caregivers or HCPs about accessing UK primary care; using quantitative or qualitative empirical methods.Data sourcesPubMed, CINAHL, Web of Science, PsycINFO and Scopus.ResultsWe included 47 reports (46 studies). CYP/caregivers’ decision to access care was facilitated by CYP/caregivers’ or their family/friends’ ability to identify a health issue as warranting healthcare attention. Barriers to accessing care included perceived stigma (eg, being seen as a bad parent), embarrassment and discrimination experiences. CYP and caregivers believed longer opening hours could facilitate more timely access to care. Caregivers and HCPs reported that delayed or rejected referrals to secondary or adult care were a barrier to having needs met, especially for CYP with poor mental health. CYP and caregivers in numerous studies emphasised the importance of communication and trust with HCPs, including taking their concerns seriously, being knowledgeable and providing continuity of care for CYP. Common barriers reported across high-need subpopulations were caregivers needing knowledge and confidence to advocate for their child, gaps in HCP’s knowledge and a lack of connectedness between primary and secondary care.ConclusionsConnecting general practices and community health workers/services, improving CYP/caregivers’ understanding of common childhood conditions, addressing HCP’s knowledge gaps in paediatric care and integrated approaches between primary and secondary care may reduce inequity in access.

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Multimorbidity patterns and risk of hospitalisation in children: A population cohort study of 3.6 million children in England, with illustrative examples from childhood cancer survivors

Cited by 11 publications

References 53 publications

Healthcare costs of cancer among children, adolescents, and young adults: A scoping review

Healthcare costs of cancer among children, adolescents, and young adults: A scoping review

Pan-cancer analyses of the associations between 109 pre-existing conditions and cancer treatment patterns across 19 adult cancers

Access to primary care for children and young people (CYP) in the UK: a scoping review of CYP’s, caregivers’ and healthcare professionals’ views and experiences of facilitators and barriers

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