title: Risk of hospitalization for survivors of childhood and adolescent cancer.
abstract: BACKGROUND
  Childhood cancer survivors may be at increased risk of hospitalization because of cancer-related late effects.
  
  
  METHODS
  Using data from population-based research resources in Utah, we identified childhood and adolescent cancer survivors who were diagnosed from 1973 to 2005 (N = 2,571). We selected a comparison cohort based on birth year and sex (N = 7,713). Hospitalizations from 1996 to 2010, excluding pregnancy and delivery, were determined from discharge records. Multivariable regressions were used to evaluate hospitalization admissions, length of stay, and diagnosis for survivors starting five years from diagnosis versus the comparison cohort.
  
  
  RESULTS
  When follow-up began in 1996, there were N = 1,499 survivors and N = 7,219 comparisons who were alive and eligible for follow-up. Average follow-up for survivors was 13.5 years (SD = 8.5) and for the comparison 14.0 years (SD = 8.7; P = 0.05). Survivors were hospitalized, on average, 1.62 (SD = 3.37) times contrasted to 0.79 (SD = 1.73) for the comparison cohort. In multivariable analyses, the hazard ratio (HR) of any hospitalization since 1996 was higher for survivors than the comparison cohort [HR, 1.52, 95% confidence interval (CI), 1.31-1.66]. Survivors experienced a higher hospital admission rate [rate ratio (RR) = 1.67; 95% CI, 1.58-1.77] than the comparison cohort. The number of hospitalizations was highest for neuroblastoma (RR = 2.21; 95% CI, 1.84-2.66) and bone tumors (RR = 2.55; 95% CI, 2.14-3.02) in reference to the comparison cohort. Survivors were hospitalized because of blood disorders more often (HR, 14.2; 95% CI, 6.3-32.0).
  
  
  CONCLUSIONS
  The risk of hospitalization and lengths of stay are elevated among childhood cancer survivors.
  
  
  CONCLUSIONS
  Research to identify strategies to prevent and manage survivors' health problems in outpatient settings is needed.
authors.affiliation: Authors' Affiliations: Cancer Control and Population Sciences Research Program; Center for Children's Cancer Research; Department of Pediatrics, University of Utah School of Medicine; anne.kirchhoff@hci.utah.edu.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kirchhoff
authors.affiliation: Authors' Affiliations: Cancer Control and Population Sciences Research Program; Center for Children's Cancer Research; Department of Pediatrics, University of Utah School of Medicine;
authors.forename: Mark N
authors.initials: MN
authors.lastname: Fluchel
authors.affiliation: Center for Children's Cancer Research; Department of Pediatrics, University of Utah School of Medicine;
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wright
authors.affiliation: Department of Internal Medicine, Division of Epidemiology;
authors.forename: Jian
authors.initials: J
authors.lastname: Ying
authors.affiliation: Authors' Affiliations: Cancer Control and Population Sciences Research Program; Department of Internal Medicine, Division of Epidemiology;
authors.forename: Carol
authors.initials: C
authors.lastname: Sweeney
authors.affiliation: Authors' Affiliations: Cancer Control and Population Sciences Research Program;
authors.forename: Julia
authors.initials: J
authors.lastname: Bodson
authors.affiliation: Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey; and.
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Stroup
authors.affiliation: Authors' Affiliations: Cancer Control and Population Sciences Research Program; Pedigree and Population Resource (Utah Population Database), Huntsman Cancer Institute; Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah;
authors.forename: Ken R
authors.initials: KR
authors.lastname: Smith
authors.affiliation: Pedigree and Population Resource (Utah Population Database), Huntsman Cancer Institute;
authors.forename: Alison
authors.initials: A
authors.lastname: Fraser
authors.affiliation: Department of Internal Medicine and University of New Mexico Cancer Center, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Kinney
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult