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.

Figure 1

Cause-specific SIRs, AERs and hospitalization rates by organ system and cancer diagnosis^a SIR, standardized incidence ratio; 95% CI, 95% confidence interval; AER, absolute excess risk; CNS, central nervous system tumor; HD, Hodgkin disease; NHL, non-Hodgkin lymphoma; NB, neuroblastoma; STS, soft tissue sarcoma. ^aCompared with U.S. cause-specific rate. Obstetric hospitalizations are not included. Rates are presented as hospitalizations per 1,000 person-years with error bars representing the 95% confidence interval.