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Report: Childhood Cancer Survivors Often Hospitalized Years After Cancer Treatment

Admissions 67% higher for survivors versus healthy controls

Survivors of childhood cancers were hospitalized more often and for longer periods because of blood disorders and other problems, many years after cancer treatment was completed, compared with the general population, according to a new study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research (AACR).

“Our findings demonstrate that childhood cancer survivors face ongoing problems that can lead to hospitalization, even for those who are decades past their original cancer diagnosis. This can negatively impact their quality of life,” said lead investigator Anne C. Kirchhoff, PhD, MPH.

“Regular cancer-focused health care is important for identifying health problems for survivors throughout their lives,” Kirchhoff added. “Patients and families who have experienced childhood cancer should obtain a cancer treatment summary and recommendations for follow-up care from their oncologist, and coordinate their follow-up care with their oncology and primary care doctors to ensure their health care needs are being managed.”

In the study, childhood cancer survivors were 52% more likely to be hospitalized, and their number of admissions was 67% higher, compared with age- and sex-matched individuals who did not have cancer. Survivors were also 35% more likely to have stayed longer every time they were hospitalized compared with controls.

“The Affordable Care Act has several provisions that will improve insurance for cancer survivors, including expanding coverage to dependents up to age 26, prohibiting insurance denials based on health status, and eliminating lifetime limits on coverage,” Kirchhoff noted. “Better insurance coverage should hopefully help survivors identify and manage health problems at earlier, less costly stages.”

Kirchhoff and her colleagues identified 1,499 childhood cancer survivors treated between 1975 and 2005 who were at least 5 years past their original cancer diagnosis in the Utah Population Database (UPDB) and in the Utah Cancer Registry. Data on subsequent hospitalizations were obtained from the Utah Department of Health hospital discharge records. Using the UPDB, the researchers also identified 7,713 cancer-free subjects , who served as the age- and sex-matched controls.

Approximately 50% of the survivors included in the study were female, and 98% were non-Hispanic white. The researchers found that both male and female survivors were more likely to have been hospitalized than their respective controls. Female survivors also had a longer average length of hospital stay than had female controls.

More than 10% of survivors of central nervous system tumors, neuroblastoma, or malignant bone tumors were hospitalized five or more times during the follow-up period, and the hospital admission rates were approximately two times higher for survivors of neuroblastoma and bone tumors, respectively, compared with controls.

“We saw higher rates of hospitalization across most cancer types, but not for all cancers, which gives us clues as to which groups of survivors may need better surveillance in the long term,” Kirchhoff said.

Common reasons for hospitalizations for the survivors compared with the controls included conditions such as blood disorders (e.g., anemia) and cancer, although it is unclear whether this was for their original cancer diagnosis or for new cancers. Infections, nervous system problems, and respiratory problems were other leading reasons for hospitalization.

Kirchhoff and her colleagues plan to conduct further analyses to better understand the reasons survivors are hospitalized and their hospital-related costs.

Source: AACR; June 12, 2014.

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