Healthcare utilization among survivors of childhood and adolescent cancer: a population-based study

Introduction — Survivors of childhood and adolescent cancers are at increased risk for late effects. Few studies have investigated if this translates into increased healthcare utilization during survivorship. We compared rates of healthcare utilization between survivors of childhood and adolescent cancer and matched cancer-free controls.

Methods — This was a population-based matched cohort study using administrative databases in Ontario, Canada. The survivor cohort included individuals diagnosed with cancer ≤ 21 years old who had survived ≥ 5 years from their primary cancer diagnosis or relapse/recurrence during childhood/adolescence. Each survivor was matched to 5 controls based on year of birth, sex, and geographic location. Andersen-Gill recurrent event regression models were used to evaluate the association between survivorship and the rates of hospitalization, surgeries, diagnostic imaging, visits to the emergency department (ED), primary care physician (PCP), and sub-specialists. Models were adjusted for income quintile and comorbidity.

Results — We identified 8090 survivors and 40,450 matched controls. Median follow-up time from index was 9 years. Compared to controls, survivors had higher rates of hospitalizations (adjusted relative rate (aRR) 1.82, 95% confidence interval [CI] 1.68–1.96), surgeries (aRR, 1.26; 95%CI, 1.20–1.32), sub-specialist visits (aRR, 1.55; 95%CI, 1.50–1.61), and diagnostic imaging (aRR, 1.48; 95%CI, 1.44–1.52). Rates of PCP and ED visits did not differ.

Conclusions — Cancer survivors have higher rates of healthcare use compared to matched cancer-free controls in a publicly funded healthcare system.