title: Health care use of long-term survivors of childhood cancer: the British Childhood Cancer Survivor Study.
abstract: OBJECTIVE
  Survivors of childhood cancer are at high risk of chronic conditions, but few studies investigated whether this translates into increased health care utilization. We compared health care service utilization between childhood cancer survivors and the general British population and investigated potential risk factors.
  
  
  METHODS
  We used data from the British Childhood Cancer Survivor Study, a population-based cohort of 17,981 individuals diagnosed with childhood cancer (1940-1991) and surviving ≥ 5 years. Frequency of talks to a doctor, hospital outpatient visits, and day-patient and inpatient hospitalizations were ascertained by questionnaire in 10,483 survivors and were compared with the General Household Survey 2002 data by using logistic regression.
  
  
  RESULTS
  Among survivors, 16.5% had talked to a doctor in the last 2 weeks, 25.5% had attended the outpatient department of a hospital in the last 3 months, 11.9% had been hospitalized as a day patient in the last 12 months, and 9.8% had been hospitalized as an inpatient in the last 12 months. Survivors had talked slightly more often to a doctor than the general population (odds ratio [OR], 1.2; 95% CI, 1.1 to 1.3) and experienced increased hospital outpatient visits (OR, 2.5; 95% CI, 2.3 to 2.8), day-patient hospitalizations (OR, 1.4; 95% CI, 1.3 to 1.6) and inpatient hospitalizations (OR, 1.9; 95% CI, 1.7 to 2.2). Survivors of Hodgkin's lymphoma, neuroblastoma, and Wilms tumor had the highest ORs for day-patient care, whereas survivors of CNS tumors and bone sarcomas had the highest OR for outpatient and inpatient care. The OR of health care use did not vary significantly with age of survivor.
  
  
  CONCLUSIONS
  We have quantified how excess morbidity experienced by survivors of childhood cancer translates into increased use of health care facilities.
authors.affiliation: Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT United Kingdom.
authors.forename: Cornelia E
authors.initials: CE
authors.lastname: Rebholz
authors.forename: Raoul C
authors.initials: RC
authors.lastname: Reulen
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Toogood
authors.forename: Clare
authors.initials: C
authors.lastname: Frobisher
authors.forename: Emma R
authors.initials: ER
authors.lastname: Lancashire
authors.forename: David L
authors.initials: DL
authors.lastname: Winter
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Kuehni
authors.forename: Michael M
authors.initials: MM
authors.lastname: Hawkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001859:Bone Neoplasms / Q000150:complications; D016543:Central Nervous System Neoplasms / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006689:Hodgkin Disease / Q000150:complications; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D009447:Neuroblastoma / Q000150:complications; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data*; D012008:Recurrence; D012175:Retinoblastoma / Q000150:complications; D012509:Sarcoma / Q000150:complications; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D009396:Wilms Tumor / Q000150:complications; D055815:Young Adult