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Utah study: Childhood cancer survivors at risk for adult hospitalizations

Published June 12, 2014 3:40 pm

Research • Treatment saves lives, but also takes a toll, U. study shows.
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The lasting health problems faced by survivors of childhood cancer are well documented.

But a new study of about 1,500 former cancer patients in Utah shows those health woes, caused by chemotherapy, radiation and surgery, can lead to frequent and prolonged hospitalization decades after a patient's cancer diagnosis.

"We've done a great job at improving outcomes for pediatric patients, but these patients have several decades of life after their cancer therapy, and the health problems they face require better prevention and treatment," said the study's lead author, Anne Kirchhoff, an assistant professor of pediatrics at the University of Utah's Huntsman Cancer Institute.

Childhood cancer is rare, accounting for less than 1 percent of all cancers diagnosed annually, according to the American Cancer Society.

It's also generally treatable. Treatment advances have raised the five-year survival rate from 60 percent in the mid-1970s to 80 percent, and many children are cured.

But the treatments take a toll, with some side effects surfacing just after treatment and others showing up months, or years, later.

They vary depending on the type of cancer and treatment endured and range from blood disorders and weakened hearts to recurrent cancers.

Researchers over the past decade have been charting those health effects to better understand patients' post-cancer needs.

Kirchhoff's findings replicate conclusions from earlier work, including the seminal Childhood Cancer Survivor Study coordinated by St. Jude Children's Research Hospital.

"Past studies on long-term health have been based on surveys and self-reported data. Ours looked at actual [hospital] discharge data," she said.

Kirchhoff and her colleagues tapped the Utah Population Database and the Utah Cancer Registry to identify 1,499 childhood cancer survivors treated between 1975 and 2005, and 7,713 Utahns who had never had a cancer diagnosis. They then ran those individuals through a repository of hospitalization data kept by the state Department of Health.

Survivors were 52 percent more likely to be hospitalized as adults and the number of their hospitalizations was 67 percent higher than the cancer-free group. Survivors were also 35 percent more likely to have longer hospitals stays than those in the control group.

Results were published Thursday in the journal "Cancer Epidemiology, Biomarkers & Prevention."

Blood disorders such as anemia, infections, nervous system and respiratory problems and recurrent cancers were common reasons for survivors to wind up in a hospital.

But Kirchhoff said more work needs to be done to understand the reasons survivors get sick and to calculate the medical expenses they shoulder.

"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," said Kirchhoff.

In the United States, lack of access to health insurance has been a dilemma for cancer survivors whose prolonged treatment can lead to job losses and the loss of health benefits. Insurers are now prohibited from denying coverage to those with pre-existing conditions under the Affordable Care Act.

"We're hoping we'll see improvements in health insurance coverage for this population. We weren't able to look at that in this study, but hope to later," Kirchhoff said.

kstewart@sltrib.com Twitter: @KStewart4Trib