Increased health care utilization by survivors of childhood lymphoblastic leukemia is confined to those treated with cranial or total body irradiation: a case cohort study

Abstract

BackgroundPrevious studies have indicated that survivors of childhood acute lymphoblastic leukemia (ALL) have an increased morbidity measured in terms of health care utilization. However, earlier studies have several potentially important limitations. To overcome some of these, we investigated hospital contact rates, and predictors thereof, among 5-year survivors of ALL in a population-based setting, and compared them to a control cohort regarding outcome measures from a comprehensive nation-wide health register.MethodsAll individuals diagnosed with ALL before the age of 18 in Southern Sweden during 1970–1999 and alive January 2007 (n = 213; male = 107) were identified through the Swedish Cancer Register. Each subject was matched to fifty controls, identified in the Swedish Population Register. All study subjects were linked to the National Hospital Register and detailed information was obtained on all hospital contacts (hospital admissions and outpatients visits) starting five years after cancer diagnosis, and the corresponding date for the controls, until 2009.ResultsThe median follow-up among the 5-year survivors of ALL was 16 years (range 5–33), accruing a total of 3,527 person-years. Of the 213 5-year survivors, 105 (49.3%) had at least one hospital contact compared to 3,634 (34.1%) of the controls (p < 0.001). Survivors had more hospital contacts (3 [1–6] vs. 2 [1–4] contacts, p < 0.001) and more total days in hospital (6 [2–18] vs. 3 [1–7] days, p < 0.001) than the controls during the study period. Logistic regression analysis showed that survivors treated with cranial irradiation and/or total body irradiation (45% and 7%, respectively) had an increased risk of at least one hospital contact (OR 2.3, 95%CI; 1.5–3.6 and OR 11.0, 95%CI; 3.2–50.7, respectively), while there was no significant difference between the non-irradiated survivors and controls.ConclusionsWe show that irradiated survivors of childhood ALL have an increased morbidity measured in terms of hospital contacts, in comparison to non-irradiated survivors and controls, while non-irradiated survivors have not. These findings are encouraging regarding the future morbidity of children currently treated for ALL, as radiotherapy is necessary only for a minority of these.

Food Habits, Lifestyle Factors, and Risk of Prostate Cancer in Central Argentina: A Case Control Study Involving Self-Motivated Health Behavior Modifications after Diagnosis

“…Tobacco is recognized as the major preventable risk factor for most cancers [ 103 ], contributing to one in three cancers [ 104 ]. Tobacco has been associated with lung, oral cavity, pharynx, larynx, esophagus, stomach, liver, urinary tract, cervix, and other cancers [ 105 ].…”

Excess morbidity and mortality among survivors of childhood acute lymphoblastic leukaemia: 25 years of follow-up from the United Kingdom Childhood Cancer Study (UKCCS)

“…Our study, which uses linked rather than self-reported data and population controls, is one of only two (17) to separate secondary care activity associated with cancer follow-up from activity associated with other morbidities; finding that survivors not only experienced higher rates of admission but also higher rates of outpatient visits, neither of which abated over their TYA years. Reported less often are the types of conditions underlying these associations, with four studies assessing risks by organ system (8,12,14,17). Survivors in these studies were diagnosed over a wider period than the study reported here, and had median follow-up times that were shorter; 9 to 17 years from diagnosis, compared to 25 years here.…”

“…(4)(5)(6) With respect to the latter, however, much of the information on late effects among survivors has come either from analyses of hospitalizations or from questionnaires completed by consenting individuals. (7)(8)(9)(10)(11)(12)(13)(14)(15)(16) As is evident from the studies summarized in Table 1 (which includes those that examined all leukaemias combined and those that also included young adults), less attention has been paid to chronic conditions that do not require hospital admission, (17,18) and to morbidity patterns that change over time. (11,19) The longitudinal data examined in this report contain information on hospital outpatient attendances, as well as inpatient episodes, cancer registrations, and deaths.…”

Physicians’ experience with follow-up care of childhood cancer survivors – challenges and needs

“…Follow-up care of the growing population of childhood cancer survivors will become a public health concern [2,3,5,7]. It is therefore important to provide high-quality and cost-effective care for this population with increased medical needs [38][39][40][41]. A model of care including not only specialists but also primary care physicians might prevent over-or undertreatment of survivors and thereby reduce loss to follow up [42][43][44].…”