Hospital contact for mental disorders in survivors of childhood cancer and their siblings in Denmark: a population-based cohort study

Lund, Lasse Wegener; Winther, Jeanette Falck; Dalton, Susanne Oksbjerg; Cederkvist, Luise; Jeppesen, Pia; Deltour, Isabelle; Hargreave, Marie; Kjær, Susanne K.; Jensen, Allan; Rechnitzer, Catherine; Andersen, Klaus Kaae; Schmiegelow, Kjeld; Johansen, Christoffer

doi:10.1016/s1470-2045(13)70351-6

Cited by 69 publications

(111 citation statements)

References 22 publications

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“…An increased risk for mental health hospitalization has been previously reported among Danish survivors of childhood cancers. 23 However, when compared to the control group, the hospitalization rates for psychiatric causes we observed were no higher than those of the general pediatric population. Our findings are consistent with other studies that reported no increased risk of psychiatric hospitalization among pediatric cancer survivors 12 and that found an increased risk only among the subset of survivors of brain tumors.…”

Section: Discussioncontrasting

confidence: 59%

Early Posttherapy Hospitalizations Among Survivors of Childhood Leukemia and Lymphoma

Smitherman¹,

Wilkins²,

Blatt³

et al. 2016

Journal of Pediatric Hematology/Oncology

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Long-term survivors of childhood cancers are at increased risk for hospitalization. To test the hypothesis that many treatment-related morbidities are identifiable in the early post-therapy period, we determined the rates and causes for hospitalization among survivors of leukemia and lymphoma during the first three years post-therapy. Using a health plan claims database, we identified patients aged 0-21 years-old treated for leukemia or lymphoma from 2000-2010. Survivors were matched 10:1 with similar children without a history of cancer. Hospitalization rates over three years were compared using Cox proportional hazards regression and risks of cause-specific hospitalization were compared using log-binomial models. Nineteen percent of childhood leukemia and lymphoma survivors were hospitalized in the first three years off therapy. Leukemia survivors (N=529) experienced over six times (HR: 6.3, 95%CI: 4.9-8.0) and lymphoma survivors (N=454) over three times the hospitalization rate of controls (HR: 3.2, 95%CI: 2.5-4.2). Compared with children without a cancer history, survivors were at increased risk for hospitalization due to infectious causes (leukemia RR: 60.0, 95%CI: 23.4-154.0; lymphoma RR: 10.0, 95%CI: 4.4-22.9). Additionally, lymphoma survivors were at increased risk for cardiovascular-(RR: 15.0, 95%CI: 5.4-42.0) and pulmonary-(RR: 8.1, 95%CI: 3.9-16.8) related hospitalizations. These findings highlight the morbidity experienced by survivors and suggest that treatment-associated complications may be emerging soon after therapy completion.

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Section: Discussioncontrasting

confidence: 59%

Early Posttherapy Hospitalizations Among Survivors of Childhood Leukemia and Lymphoma

Smitherman¹,

Wilkins²,

Blatt³

et al. 2016

Journal of Pediatric Hematology/Oncology

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“…However, many of them will have been burdened by severe acute toxic eff ects that can cause permanent organ damage, such as osteonecrosis, chronic pancreatitis, thrombosis, and neurotoxicity, and even more patients will develop additional severe late eff ects that challenge their ability to establish and live a normal adult life. 28,29 Although the cumulative risk of each of the 14 acute toxic eff ects addressed in this report is about 5-10% or less, about half of all patients will be aff ected by at least one of the 14 eff ects. 30 As such, in the overall evaluation of acute lymphoblastic leukaemia treatment protocols, there is a need for the development of strategies to quantify the overall acute and long-term burden of treatment and balance it against event-free survival.…”

Section: Discussionmentioning

confidence: 87%

Consensus definitions of 14 severe acute toxic effects for childhood lymphoblastic leukaemia treatment: a Delphi consensus

Schmiegelow

Attarbaschi

Barzilai

et al. 2016

The Lancet Oncology

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208

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Although there are high survival rates for children with acute lymphoblastic leukaemia, their outcome is often counterbalanced by the burden of toxic eff ects. This is because reported frequencies vary widely across studies, partly because of diverse defi nitions of toxic eff ects. Using the Delphi method, 15 international childhood acute lymphoblastic leukaemia study groups assessed acute lymphoblastic leukaemia protocols to address toxic eff ects that were to be considered by the Ponte di Legno working group. 14 acute toxic eff ects (hypersensitivity to asparaginase, hyperlipidaemia, osteonecrosis, asparaginase-associated pancreatitis, arterial hypertension, posterior reversible encephalopathy syndrome, seizures, depressed level of consciousness, methotrexate-related stroke-like syndrome, peripheral neuropathy, high-dose methotrexate-related nephrotoxicity, sinusoidal obstructive syndrome, thrombo embolism, and Pneumocystis jirovecii pneumonia) that are serious but too rare to be addressed comprehensively within any single group, or are deemed to need consensus defi nitions for reliable incidence comparisons, were selected for assessment. Our results showed that none of the protocols addressed all 14 toxic eff ects, that no two protocols shared identical defi nitions of all toxic eff ects, and that no toxic eff ect defi nition was shared by all protocols. Using the Delphi method over three face-to-face plenary meetings, consensus defi nitions were obtained for all 14 toxic eff ects. In the overall assessment of outcome of acute lymphoblastic leukaemia treatment, these expert opinion-based defi nitions will allow reliable comparisons of frequencies and severities of acute toxic eff ects across treatment protocols, and facilitate international research on cause, guidelines for treatment adaptation, preventive strategies, and development of consensus algorithms for reporting on acute lymphoblastic leukaemia treatment.

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“…Moreover, we cannot exclude the possibility that our results were affected by better medical surveillance of the survivors than the population comparisons, which could explain part of the longer hospital stays in the survivors. Not covered by the present study of the somatic disease burden but important to stress is the fact that many childhood cancer survivors face additional and sometimes significant challenges due to cognitive and other psychological adverse effects from cancer and its treatment [3,7]. …”

Section: Discussionmentioning

confidence: 99%

“…We did not include the ICD sections of ill-defined diseases and the group of injuries and violence in the analysis, as these were regarded as too unspecific for solid conclusions. Mental disorders were the focus of a previous study [3], and childbirth and pregnancy complications require special considerations and will be investigated in separate publications.…”

Section: Methodsmentioning

confidence: 99%

“…These major improvements in survival come, however, at a price. Because of intense exposure to radiation and highly toxic compounds during treatment, a high proportion of survivors of childhood cancer now face somatic, mental, and cognitive late effects, many of which become clinically apparent even decades after the cancer was cured [3–7]. Only a limited number of studies have investigated the hospitalisation pattern subsequent to treatment for cancer diagnosed during childhood, adolescence, and young adulthood [8–13].…”

Section: Introductionmentioning

confidence: 99%

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Long-term inpatient disease burden in the Adult Life after Childhood Cancer in Scandinavia (ALiCCS) study: A cohort study of 21,297 childhood cancer survivors

et al. 2017

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BackgroundSurvivors of childhood cancer are at increased risk for a wide range of late effects. However, no large population-based studies have included the whole range of somatic diagnoses including subgroup diagnoses and all main types of childhood cancers. Therefore, we aimed to provide the most detailed overview of the long-term risk of hospitalisation in survivors of childhood cancer.Methods and findingsFrom the national cancer registers of Denmark, Finland, Iceland, and Sweden, we identified 21,297 5-year survivors of childhood cancer diagnosed with cancer before the age of 20 years in the periods 1943–2008 in Denmark, 1971–2008 in Finland, 1955–2008 in Iceland, and 1958–2008 in Sweden. We randomly selected 152,231 population comparison individuals matched by age, sex, year, and country (or municipality in Sweden) from the national population registers. Using a cohort design, study participants were followed in the national hospital registers in Denmark, 1977–2010; Finland, 1975–2012; Iceland, 1999–2008; and Sweden, 1968–2009. Disease-specific hospitalisation rates in survivors and comparison individuals were used to calculate survivors’ standardised hospitalisation rate ratios (RRs), absolute excess risks (AERs), and standardised bed day ratios (SBDRs) based on length of stay in hospital. We adjusted for sex, age, and year by indirect standardisation. During 336,554 person-years of follow-up (mean: 16 years; range: 0–42 years), childhood cancer survivors experienced 21,325 first hospitalisations for diseases in one or more of 120 disease categories (cancer recurrence not included), when 10,999 were expected, yielding an overall RR of 1.94 (95% confidence interval [95% CI] 1.91–1.97). The AER was 3,068 (2,980–3,156) per 100,000 person-years, meaning that for each additional year of follow-up, an average of 3 of 100 survivors were hospitalised for a new excess disease beyond the background rates. Approximately 50% of the excess hospitalisations were for diseases of the nervous system (19.1% of all excess hospitalisations), endocrine system (11.1%), digestive organs (10.5%), and respiratory system (10.0%). Survivors of all types of childhood cancer were at increased, persistent risk for subsequent hospitalisation, the highest risks being those of survivors of neuroblastoma (RR: 2.6 [2.4–2.8]; n = 876), hepatic tumours (RR: 2.5 [2.0–3.1]; n = 92), central nervous system tumours (RR: 2.4 [2.3–2.5]; n = 6,175), and Hodgkin lymphoma (RR: 2.4 [2.3–2.5]; n = 2,027). Survivors spent on average five times as many days in hospital as comparison individuals (SBDR: 4.96 [4.94–4.98]; n = 422,218). The analyses of bed days in hospital included new primary cancers and recurrences. Of the total 422,218 days survivors spent in hospital, 47% (197,596 bed days) were for new primary cancers and recurrences. Our study is likely to underestimate the absolute overall disease burden experienced by survivors, as less severe late effects are missed if they are treated sufficiently in the outpatient setting or in the primary health ca...

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Hospital contact for mental disorders in survivors of childhood cancer and their siblings in Denmark: a population-based cohort study

Cited by 69 publications

References 22 publications

Early Posttherapy Hospitalizations Among Survivors of Childhood Leukemia and Lymphoma

Early Posttherapy Hospitalizations Among Survivors of Childhood Leukemia and Lymphoma

Consensus definitions of 14 severe acute toxic effects for childhood lymphoblastic leukaemia treatment: a Delphi consensus

Long-term inpatient disease burden in the Adult Life after Childhood Cancer in Scandinavia (ALiCCS) study: A cohort study of 21,297 childhood cancer survivors

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