NEW YORK (Reuters Health) - Young adult cancer survivors will continue to have high hospitalization rates over time, a Canadian study shows.
In five-year cancer survivors diagnosed between ages 20 and 44, hospitalization rates were elevated for at least 20 years, compared to rates in age- and sex-matched controls, according to Dr. Nancy N. Baxter at St. Michael's Hospital in Toronto and colleagues.
For all malignancies except melanoma and testicular cancer, the adjusted relative rate (ARR) of hospitalizations was significantly higher among survivors than controls.
"Late effects and complications of cancer treatments are experienced by many survivors for the rest of their lives," Dr. Baxter told Reuters Health in an e-mail.
The patients in this population-based study were treated from 1992-1999.
"Therapies have changed, she said. "In some cases there may be fewer late effects, but in others, they may be worse."
The study cohort included 20,275 survivors of young adult cancers who were recurrence-free for at least five years, and 101,344 controls. The authors observed survivors for a median of 9.93 years (range 0-16 years), according to their report online July 13 in the Journal of Clinical Oncology.
During this period, 34.3% had at least one hospitalization, vs. 27.3% for controls. The rate per 100 person-years was similar between male and female survivors.
Overall, the ARR of hospitalization in survivors compared with controls was 1.51.
At all time periods, survivors were more likely to be hospitalized than controls. The rate of hospitalization (per 100-person years) among survivors was 0.22 during years 5 to 8, 9 to11, and 12 to14. It decreased significantly during years 15 to 17 and 18 to 20, falling to 0.17 and 0.15, respectively (p
Among controls, the hospitalization rate was relatively constant during all time periods, ranging from 0.13 at 5 to 8 years to 0.12 at years 18 to 20.
The ARR of hospitalizations in survivors compared with controls was also relatively constant during for the first three3 time periods: 1.67, 1.55, and 1.57 at years 5 to 8, 9 to 11, and 12 to 14, respectively. It decreased to 1.36 at 15 to 17 years and 1.22 at years 18 to 20.
Those who survived gastrointestinal, urologic, colorectal, or brain cancers, or leukemia or lymphoma, had an ARR of hospitalization at least twice that of controls.
"We only looked at hospital admissions, not visits to the family doctor or medical conditions and disabilities that didn't require inpatient care," Dr. Baxter said, explaining that this likely underestimated the long-term impact of intense treatments that include surgery, chemotherapy, radiation, and hormonal therapy.
Lillie D. Shockney, Director of Cancer Survivorship Programs at the Sidney Kimmel Cancer Center at Johns Hopkins in Baltimore, said in an e-mail to Reuters Health that physical symptoms can be "guilty by association."
"If a patient had cancer, more tests, including inpatient procedures, might be done to rule out recurrence or the presence of a new malignancy," she said.
Studies such as this one could pave the way for more detailed research on the risk of treatment-related conditions that lead to more medical care, she said.
Shockney also said the report raises awareness of the need to pay special attention to cancer survivors; to consider survivorship as we would a chronic illness.
"Understanding the late effects of cancer treatment will help us design better treatments, counsel patients, and improve symptom management," said Dr. Baxter.