Findings from a study to be published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Researchshows that, compared with the general population, survivors of childhood cancers are more often hospitalized and for longer durations because of blood disorders and other problems, many years after cancer treatment was completed.[1]

Commenting on the results Anne C. Kirchhoff, PhD, MPH, assistant professor of pediatrics at the Huntsman Cancer Institute of the Universityof Utah in Salt Lake City and co-lead author of the study noted: “Our findings demonstrate that childhood cancer survivors face ongoing problems that can lead to hospitalization, even for those who are decades past their original cancer diagnosis. This can negatively impact their quality of life.”

Identifying health problems
“Regular cancer-focused health care is important for identifying health problems for survivors throughout their lives,” Kirchhoff added. “Patients and families who have experienced childhood cancer should obtain a cancer treatment summary and recommendations for follow-up care from their oncologist, and coordinate their follow-up care with their oncology and primary care doctors to ensure their health care needs are being managed.”

…better health insurance coverage will help survivors of Childhood Cancer identify and manage health problems at earlier, less costly stages…

In this study, survivors were 52% more likely to be hospitalized, and their number of admissions was 67% higher, compared with age and sex-matched individuals who did not have cancer. Survivors were also 35% more likely to have stayed longer every time they were hospitalized, compared with controls.

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The Affordable Care Act (ACA) has several provisions that will improve insurance for cancer survivors, including expanding coverage to dependents up to age 26, prohibiting insurance denials based on health status, and eliminating lifetime limits on coverage,” Kirchhoff noted. “Better insurance coverage should hopefully help survivors identify and manage health problems at earlier, less costly stages.”

Population database
Kirchhoff and colleagues identified 1,499 childhood cancer survivors treated between 1975 and 2005 who were at least five years past their original cancer diagnosis from the Utah Population Database or UPDB and the Utah Cancer Registry. They collected information including demographics, type of cancer, and type of treatment. Data on subsequent hospitalizations were obtained from the Utah Department of Health hospital discharge records. Using UPDB, they also identified 7,713 subjects who did not have cancer, who served as age and sex-matched controls in this study.

About 50% of the survivors included in this study were female, and 98%were non-Hispanic white. The researchers found that both female survivors and male survivors were more likely to have been hospitalized than their respective controls. Female survivors also had a longer average length of hospital stay than female controls.

More than 10% of survivors of central nervous system (CNS) tumors, neuroblastoma (a cancer that develops from immature nerve cells found in several areas of the body andmost commonly affects children age 5 or younger)or malignant bone tumors were hospitalized five or more times during the follow-up period. The study’s authors noted thats the hospital admission rates were approximately two times higher for survivors of neuroblastoma and bone tumors, respectively, compared with controls. “We saw higher rates of hospitalization across most cancer types, but not for all cancers, which gives us clues as to which groups of survivors may need better surveillance in the long term,” Kirchhoff explained.

Blood and Cancer
Common reasons for hospitalizations for survivors compared with the controls included conditions like blood disorders (such as anemia) and cancer, although it is unclear if this was for their original cancer diagnosis or new cancers. Infections, nervous system problems, and respiratory problems were other leading reasons for hospitalization.

Kirchhoff and colleagues will conduct further analyses to better understand the reasons survivors are hospitalized and their hospital-related costs.

Other studies
An earlier, unrelated study Kirchhoff and colleagues showed that survivors of adolescent and young adult (AYA) cancers have a high risk of chronic conditions such as cardiovascular disease and asthma. These conditions may affect their ability to attend school, have a job and impact their overall health related Quality of Life (hrQOL). Based on these results, the authors of this study conclude that early detection and management of health problems could help these cancer survivors control health problems before their ability to attend school or employment is disrupted.[3]

For more information:
[1] Kirchhoff AC, Fluchel MN, Wright J, Ying J, Sweeney C, Bodson C, Stroup AM, Smith KR, Fraser A, Kinney AY. Risk of Hospitalization for Survivors of Childhood and Adolescent Cancer Published OnlineFirst June 12, 2014 [Article]
[2] Kirchhoff AC – Profile [Video Interview]
[3] Kirchhoff AC, McFadden M, Warner EL, Kinney AY Quality of Life and Comorbidities Impact Education and Employment for Survivors of Adolescent and Young Adult Cancers. Cancer Epidemiol Biomarkers Prev March 2014 23; 568 [Article]

Photo: Anne C. Kirchhoff, PhD, MPH. Photo Courtesy: ?2014 Huntsman Cancer Institute at the University of Utah.

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