Hospitalization and mortality among pediatric cancer survivors: a population-based study
Menée aux Etats-Unis à partir de données portant sur 3 152 patients ayant survécu plus de 5 ans à un cancer diagnostiqué avant l'âge de 20 ans, cette étude analyse les facteurs associés au risque d'hospitalisation et de décès, sur la période 1982-2014 (durée médiane de suivi : 9 ans)
Purpose : We examined serious long-term outcomes among childhood cancer survivors using population-based data. Methods : We used 1982–2014 Washington State data to compare hospitalization and/or death (including cause-specific) during up to 27 years follow-up among all 5+ year childhood cancer survivors < 20 years at diagnosis (n = 3,152) and a sample of comparison children within birth cohorts, with assessment by cancer type and child/family characteristics. Results : During follow-up (9 years median), 12% of survivors had hospitalizations; 4% died. Greatest absolute risks/1,000 person-years were for hospitalization/deaths due to cancers (8.1), infection (6.2), injuries (6.0), and endocrine/metabolic disorders (5.8). Hazard ratios (HR) and 95% confidence intervals (CI) for hospitalization (2.7, 95% CI 2.4–3.0) and any-cause death (14.7, 95% CI 11.3–19.1) were increased, and for all cause-specific outcomes examined, most notably cancer- (35.1, 95% CI 23.7–51.9), hematological- (6.7, 95% CI 5.3–8.5), nervous system- (6.4, 95% CI 5.2–7.8), and circulatory- (5.2, 95% CI 4.1–6.5) related outcomes. Hospitalizations occurred more often among females and those receiving radiation, with modest differences by urban/rural birth residence and race/ethnicity. Cause-specific outcomes varied by cancer type. Conclusions : This study suggests increased risks for the rarely-studied outcomes of long-term fracture and injury, and confirms increased risks of selected other conditions among survivors. Multi-state pooling of population-based data would increase the ability to evaluate outcomes for uncommon cancer types and by racial/ethnic groups under-represented in many studies.