Hospitalization rates among survivors of young adult malignancies

Purpose — There are limited data on healthcare utilization among survivors of young adult cancers. We aimed to describe patterns of hospitalization among a cohort of long-term survivors compared to non-cancer controls.

Methods — Persons diagnosed between the ages of 20 and 44 years with malignancies in Ontario from 1992-1999 who lived at least 5 years recurrence-free were identified using the Ontario Cancer Registry and matched to non-cancer controls. Hospitalizations were determined using hospital discharges and rates were compared between survivors and controls. Absolute excess rate of hospitalizations was determined for each type of malignancy in survivors per 100 person-years of follow-up.

Results — The cohort included 20,275 survivors and 101,344 non-cancer controls. During the study period, 6,948 (34.3%) survivors were admitted to hospital and the adjusted relative rate (ARR) of hospitalizations in survivors compared to controls was 1.51 (95% CI = 1.48 – 1.54). The rate of hospitalization was highest for survivors of upper gastrointestinal, leukemia and urologic malignancies. The hospitalization rate (per 100 person years) between survivors and controls significantly decreased from 0.22 in the first time period examined (5-8 years post-diagnosis) to 0.15 in the last time period examined (18-20 years post-diagnosis, p<0.0001), however at all time periods, survivors were more likely to be hospitalized than controls (ARR at 5-8 years = 1.67, 95% CI: 1.57-1.81, ARR at 18-20 years = 1.22, 95% CI: 1.08-1.37).

Conclusion — Survivors of young adult cancers have an increased rate of hospitalization compared to controls. Rate of hospitalization for 20-year survivors did not return to baseline, indicating a substantial and persistent burden of late-effects among this generally young population.