title: Risk and associated risk factors of hospitalization for specific health problems over time in childhood cancer survivors: a medical record linkage study.
abstract: Childhood cancer survivors (CCS) experience higher hospitalization rates compared to the general population for neoplasms, circulatory diseases, endocrine/nutritional/metabolic diseases and eye disorders. We studied trends in hospitalization rates and associated patient and treatment-specific risk factors for diagnosis subgroups among these four diseases. We performed medical record linkage of a ≥5-year CCS cohort with national registers, and obtained a random reference sample matched on age, gender and calendar year per CCS. For each diagnosis subgroup we compared hospitalization rates and trends over time in CCS and the reference population. Further, we analyzed risk factors for hospitalizations within the four CCS diagnosis groups. We used multivariate Poisson regression for all models. We retrieved hospitalization data from 1382 CCS and 26,583 reference persons. CCS had increased hospitalization rates for almost all diagnosis subgroups examined. Hospitalization rates for endocrine/nutritional/metabolic diseases appeared to increase with longer time since primary cancer diagnosis up to 30 years after primary cancer diagnosis. Survivors initially treated with radiotherapy had increased hospitalization rates for neoplasms (P < 0.001), those initially treated with anthracyclines (2.5 [1.1-5.5]) and radiotherapy to thorax and/or abdomen (9.3 [2.4-36.6]) had increased hospitalization rates for diseases of the circulatory system, and those initially treated with radiotherapy to head and/or neck had increased hospitalization rates for endocrine/nutritional/metabolic diseases (6.7 [3.5-12.7]) and diseases of the eye (3.6 [1.5-8.9]). Our study highlights that long-term health problems resulting in hospitalizations are still clinically relevant later in life of CCS. The identified treatment-related risk factors associated with hospitalizations support targeted follow-up care for these risk groups of CCS.
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Anna
authors.identifier: http://orcid.org/0000-0003-2292-3204
authors.initials: A
authors.lastname: Font-Gonzalez
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Elizabeth Lieke A M
authors.initials: ELAM
authors.lastname: Feijen
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Geskus
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marcel G W
authors.initials: MGW
authors.lastname: Dijkgraaf
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.|Department of Medical Oncology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Helena J H
authors.initials: HJH
authors.lastname: van der Pal
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Heinen
authors.affiliation: Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HITlab), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Monique W
authors.initials: MW
authors.lastname: Jaspers
authors.affiliation: Department of Epidemiology, National Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Flora E
authors.initials: FE
authors.lastname: van Leeuwen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.
authors.forename: J B Johannes
authors.initials: JBJ
authors.lastname: Reitsma
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Hubert N
authors.initials: HN
authors.lastname: Caron
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Elske
authors.initials: E
authors.lastname: Sieswerda
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Leontien C
authors.initials: LC
authors.lastname: Kremer
mesh_terms: D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology*; D018943:Anthracyclines / Q000009:adverse effects; D000073116:Cancer Survivors / Q000523:psychology*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D055815:Young Adult
chemical_list: D018943:Anthracyclines
keywords: Childhood cancer; hospitalization; medical record linkage; registries; survivors