title: 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.
  
  
  METHODS
  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.
authors.affiliation: Division of Pediatric Hematology, Oncology and BMT, Helen DeVos Children's Hospital, Grand Rapids, Michigan 49503, USA. beth.kurt@devoschildrens.org
authors.forename: Beth A
authors.initials: BA
authors.lastname: Kurt
authors.forename: Vikki G
authors.initials: VG
authors.lastname: Nolan
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Neglia
authors.forename: Jean M
authors.initials: JM
authors.lastname: Tersak
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Hutchinson
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012737:Sex Factors; D017741:Survivors; D013997:Time Factors; D014481:United States / Q000453:epidemiology