Hospitalization after Adolescent and Young Adult (AYA) Cancer: A population-based study in Utah

Background: Adolescents and young adults (AYA, age 15 39 years) with cancer may be at elevated risk for late morbidity following their cancer treatment, but few studies have quantified the excess burden of severe disease in this population. Using population-based data from Utah, we examined the risk of inpatient hospitalizations among AYA cancer survivors compared with their siblings and the general population. Methods: Survivors of AYA cancer who were 2 years from diagnosis and diagnosed from 1994 to 2015 (N 1/4 6,330), their siblings (N 1/4 12,924), and an age- and sex-matched comparison cohort (N 1/4 18,171) were identified using the Utah Population Database (UPDB). Hospitalizations from 1996 to 2017 were identified from statewide discharge records in the UPDB. We estimated multivariable-adjusted hazard ratios (HR) for first hospitalization and rate ratios (RR) for total hospitalizations for survivors relative to the matched comparison cohort and siblings. Results: Overall, the risk of a first hospitalization was higher among AYA cancer survivors than the matched populationbased cohort [HR 1/4 1.93; 95% confidence interval (CI), 1.81 2.06]. Risk was most elevated for survivors of leukemia (HR 1/4 4.76), central nervous system tumors (HR 1/4 3.45), colorectal cancers (HR 1/4 2.83), non-Hodgkin lymphoma (HR 1/4 2.76), and breast cancer (HR 1/4 2.37). The rate of total hospitalizations was also increased among survivors relative to the comparison cohort (RR 1/4 2.05; 95% CI, 1.95 2.14). Patterns were generally similar in analyses comparing survivors to their siblings. Conclusions: AYA cancer survivors have a higher burden of inpatient hospitalization than their siblings and the general population. Impact: Results indicate the importance of long-term, riskbased follow-up care to prevent and treat severe morbidities after cancer treatment