Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer

Abstract

BACKGROUND Children and adolescents and young adults (AYAs) with cancer often experience severe respiratory morbidity and mortality from the therapies used to treat their cancers. Few studies have examined respiratory outcomes among this population using emergency department (ED) visits as an objective measure of respiratory health. METHODS ED visits for respiratory conditions were identified for children and AYAs diagnosed with cancer, 0‐25 years of age, from 1997 through 2012 (2535 cases) and compared with a birthdate‐matched and sex‐matched cohort without cancer drawn from the general population (7605 controls). Negative binomial regression with robust standard errors was used to estimate incidence rates, rate ratios (RRs), and 95% confidence intervals for primary respiratory ED visits, combined and by diagnosis (asthma, respiratory disease, and respiratory infection) from 1997 through 2015. Analyses were performed for new cases (0 to <5 years from diagnosis) and survivors (5‐18 years from diagnosis). RESULTS Subjects were followed for an average of 8 years (range, 0‐18 years). Relative to the comparison cohort, cancer cases had higher incidence rates for all types of respiratory ED visits over both follow‐up times. New cases had significantly higher RRs for any respiratory condition (RR, 4.14), respiratory disease (RR, 4.62), and respiratory infection (RR, 4.74). Among survivors, the RRs for any respiratory condition (RR, 2.00) and respiratory infection (RR, 2.10) were significantly elevated, although the magnitude tended to decline in survivorship. Demographic and clinical risk factors found to be associated with respiratory ED visits included Hispanic/other race/ethnicity, male sex, exposure to chemotherapy, diagnosis at a younger age, and a diagnosis of leukemia. CONCLUSIONS The results of the current study demonstrated that children and AYAs with cancer face an increased burden of respiratory complications compared with a comparison cohort without cancer from diagnosis through survivorship.

Fine Particulate Matter and Respiratory Healthcare Encounters among Survivors of Childhood Cancers

“…We found different results in the PM 2.5 -associated odds between the hospitalizations and the ED visits. An earlier study of this cohort found that cancer survivors had a significantly increased rate of ED visits compared to the general population, with a high rate of use for respiratory infection [57]. Nationwide, infection is a leading cause of ED visits among childhood cancer survivors [58].…”