Increased rates of hospitalization among survivors of young adult malignancies
1. In a retrospective cohort study of over 20 000 survivors of young adult cancers, rates of subsequent hospitalization after a 5-year recurrence-free period were significantly higher compared to non-cancer controls.
Evidence Rating Level: 3 (Average)
Study Rundown: Due to advances in cancer therapy, the survival rates for malignancy among adolescents and young adults have increased. Given the increased life expectancies of this patient cohort, they are at significant risk for non-oncologic complications. Previous studies have demonstrated that childhood survivors of cancer are at increased risk for future hospitalization. However, the specific long-term risks of young adult cancers survivors remains unclear. The purpose of this study was to evaluate the frequency and patterns of hospitalization among cancer survivors diagnosed as young adults. This was a retrospective cohort study of a large cancer registry, which compared hospitalization rates of over 20 000 5-year survivors of young adult cancers with over 100 000 age- and sex-matched controls. At the conclusion of the study, survivors of young adult cancers were found to have a 1.5 times increased risk of hospitalization compared to non-cancer controls. The rates of hospitalization were highest for survivors of gastrointestinal, leukemia, and urologic malignancies. Although the risk declined over time, it remained significantly elevated for up to 20 years from diagnosis compared to non-cancer controls. The results suggest an increased risk of morbidity post-cancer treatment for survivors of young-adult cancers. This was the largest cohort study to analyze hospitalization rates for young-adult cancer survivor patients with findings that may help to guide counseling and long-term planning for young adults undergoing cancer therapy.
Click to read the study in JCO
Relevant Reading: Risk of hospitalization for survivors of childhood and adolescent cancer
In-Depth [retrospective cohort]: This retrospective cohort study analyzed cancer patients from the Ontario Cancer Registry (OCR) between the ages of 20 to 44 years, who lived at least 5 years recurrence-free from 1992 to 1999. Exclusion criteria included evidence of recurrent disease, or the lack of health coverage during the follow-up period. Overall, 20 275 young adult cancer survivors were included in the study along with 10 ,344 healthy age- and sex-matched controls. Rates of hospitalization were compared between these 2Â groups. After a median follow-up of 9.93 years, 34% of the cancer-survivor cohort had at least one hospitalization. The overall adjusted relative rate (ARR) of hospitalization among survivors compared to controls was 1.51 (95% CI: 1.48 to 1.54). Specific malignancies that demonstrated the highest rate of hospitalization compared to controls were survivors of gastrointestinal (RR: 2.49; 95% CI: 2.15 to 2.87), leukemia (RR: 2.23; 95% CI: 1.92 to 2.59), and urologic (RR: 2.20; 95% CI: 2.03 to 2.38) malignancies. There was no significant difference among survivors of melanoma and testicular cancer. For survivors, the hospitalization rate stayed constant during years 5 to 14 of follow-up, then dropped significantly (p < 0.0001) from 15 to 20 years, while this rate remained unchanged for controls.
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