Hospitalization and mortality outcomes in the first five years after a childhood cancer diagnosis: a population-based study

Abstract Hospitalization and mortality outcomes in the first five years after a childhood cancer diagnosis: a population-based study Angela Steineck, MD Chair of the Supervisory Committee: Beth Mueller, DrPH Department of Epidemiology Background: Children with cancer are frequently hospitalized. However, hospitalization and death by disease category are not well defined <5 years from diagnosis compared with the general population. Methods: We conducted a retrospective cohort study using linked cancer-hospital discharge-vital registry records to identify cancer cases <20 years at diagnosis during 1987-2012 (n = 4,567) and comparison children without cancer, matched on birth year and sex (n = 45,582). Further data linkage identified serious morbidities resulting in hospitalizations or deaths <5 years from diagnosis. These outcomes were categorized as cancer- vs. non-cancer-related. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to compare relative hospitalization and mortality <5 years from diagnosis by disease category and after excluding cancer-related outcomes. Among cancer cases, relative risks (RRs) of these outcomes for children with CNS/solid tumor cases compared with children with leukemia/lymphoma were also estimated. Results: Greater rates of all-cause hospitalization (281.5/1,000 vs. 6.2/1,000 person-years) and death (40.7/1,000 vs. 0.15/1,000 person-years) were observed in childhood cancer cases than comparators and across all diagnosis categories. Increased rates of hospitalization (31.0/1,000 vs. 6.2/1,000 person-years; HR 5.0, 95% CI 4.5-5.5) and death (1.0/1,000 vs. 0.15/1,000 person-years; HR 10.4, 95% CI 5.6-19.1) remained when cancer-related outcomes were excluded. Although HRs for hospitalization and death did not differ greatly by treatment era, absolute rates of hospitalization were greater (1987-1999: 233.3/1,000; 2000-2012: 320.0/1,000 person-years) and death was lesser (1987-1999: 46.3/1,000; 2000-2012: 36.8/1,000 person-years) in the later treatment era among cases. Among cancer cases, children with CNS/solid tumors were less likely to have a cancer-related hospitalization (RR 0.91, 95% CI 0.87-0.97) than were those with leukemia/lymphoma. Conclusion: Children with cancer experience greater rates of hospitalization and death in all disease categories, even when cancer-related diagnoses are excluded. Results may guide future toxicity mitigation initiatives and anticipatory guidance provided to families of children with cancer.