title: High Hospitalization Rates in Survivors of Childhood Cancer: A Longitudinal Follow-Up Study Using Medical Record Linkage.
abstract: Hospitalization rates over time of childhood cancer survivors (CCS) provide insight into the burden of unfavorable health conditions on CCS and health care resources. The objective of our study was to examine trends in hospitalizations of CCS and risk factors in comparison with the general population. We performed a medical record linkage study of a cohort of 1564 ≥five-year CCS with national registers. We obtained a random sample of the general population matched on year of birth, gender and calendar year per CCS retrieved. We quantified and compared hospitalization rates of CCS and reference persons from 1995 until 2005, and we analyzed risk factors for hospitalization within the CCS cohort with multivariable Poisson models. We retrieved hospitalization information from 1382 CCS and 25583 reference persons. The overall relative hospitalization rate (RHR) was 2.2 (95%CI:1.9-2.5) for CCS compared to reference persons. CCS with central nervous system and solid tumors had highest RHRs. Hospitalization rates in CCS were increased compared to reference persons up to at least 30 years after primary diagnosis, with highest rates 5-10 and 20-30 years after primary cancer. RHRs were highest for hospitalizations due to neoplasms (10.7; 95%CI:7.1-16.3) and endocrine/nutritional/metabolic disorders (7.3; 95%CI:4.6-11.7). Female gender (P<0.001), radiotherapy to head and/or neck (P<0.001) or thorax and/or abdomen (P = 0.03) and surgery (P = 0.01) were associated with higher hospitalization rates in CCS. In conclusion, CCS have increased hospitalization rates compared to the general population, up to at least 30 years after primary cancer treatment. These findings imply a high and long-term burden of unfavorable health conditions after childhood cancer on survivors and health care resources.
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital / Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Elske
authors.initials: E
authors.lastname: Sieswerda
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital / Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Font-Gonzalez
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital / Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Heinen
authors.affiliation: Center for Human Factors Engineering of Health Information Technology (HITlab), Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Monique W
authors.initials: MW
authors.lastname: Jaspers
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital / Academic Medical Center, Amsterdam, the Netherlands.|Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Helena J
authors.initials: HJ
authors.lastname: van der Pal
authors.affiliation: Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
authors.forename: Flora E
authors.initials: FE
authors.lastname: van Leeuwen
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital / Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Huib N
authors.initials: HN
authors.lastname: Caron
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Geskus
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital / Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Leontien C
authors.initials: LC
authors.lastname: Kremer
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D017281:Cost of Illness; D005260:Female; D006257:Head / Q000528:radiation effects; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D015233:Models, Statistical; D009333:Neck / Q000528:radiation effects; D009369:Neoplasms / Q000145:classification / Q000473:pathology / Q000534:rehabilitation* / Q000628:therapy; D009426:Netherlands; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D017741:Survivors / Q000706:statistics & numerical data*; D013909:Thorax / Q000528:radiation effects