Cancer Causes Control

Purpose:Children with cancer are frequently hospitalized. However, hospitalization and death by disease category are not well defined <5 years from diagnosis.Methods:We conducted a retrospective cohort study using linked cancer registry-hospital discharge-vital 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). Data linkage identified serious morbidities resulting in cancer- and non-cancer-related hospitalizations or deaths <5 years from diagnosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to compare relative hospitalization and mortality by disease category and after excluding cancer-related outcomes. Among cancer cases, relative risks (RRs) of these outcomes for children with solid tumors 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 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) rates 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 were lesser (1987-1999: 46.3/1,000; 2000-2012: 36.8/1,000 person-years) in the later treatment era among cases. Children with solid tumors were less likely to have a cancer-related hospitalization than were those with leukemia/lymphoma (RR 0.91, 95% CI 0.84-0.98).Conclusion:Even after excluding cancer-related diagnoses, children with cancer experience greater rates of hospitalization and death in all disease categories. Results may guide future toxicity mitigation initiatives and inform anticipatory guidance for families of children with cancer.20212022-07-01T00:00:00ZT32 CA009351/CA/NCI NIH HHSUnited States/5T32CA009351-40/HL/NHLBI NIH HHSUnited States/N01 CN067009/CN/NCI NIH HHSUnited States/DP12-1205 DP003899-02/CC/CDC HHSUnited States/HHSN261201300012I/CA/NCI NIH HHSUnited States/N01PC35142/CA/NCI NIH HHSUnited States/HHSN261201000029C/CA/NCI NIH HHSUnited States/N01 CN005230/CN/NCI NIH HHSUnited States/U58 DP003899/DP/NCCDPHP CDC HHSUnited States/33835282PMC82158871159