Brewster D H, Clark D, Hopkins L, Bauer J, Wild S H, Edgar A B, Wallace W H
1] Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK [2] Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK.
Br J Cancer. 2014 Mar 4;110(5):1342-50. doi: 10.1038/bjc.2013.788. Epub 2013 Dec 24.
Survivors of childhood, adolescent, and young adult cancer are known to be at risk of late effects of their disease and its treatment. Most population-based studies of cancer survivors have reported on second primary cancers and mortality. The aim of this study was to research acute and psychiatric hospital admission rates and length of stay in 5-year survivors of cancer diagnosed before the age of 25 years.
This was a population-based retrospective cohort study using linked national cancer registry, acute hospital discharge, psychiatric hospital, and mortality records. The study population consisted of 5229 individuals who were diagnosed with cancer before the age of 25 years between 1981 and 2003, and who survived at least 5 years after the date of diagnosis of their primary cancer. Indirect standardisation for age and sex was used to calculate standardised bed days and hospitalisation ratios (SBDR and SHR) for both acute and psychiatric hospital admissions, and absolute excess risks (AERs) compared with the general Scottish population.
Five-year survivors of cancer, diagnosed before the age of 25 years, are at increased risk of admission to acute hospitals (SHR 2.8; 95% confidence interval 2.7-2.9) and of spending more time in hospital (SBDR 3.7; 3.6-3.7). Corresponding AERs were 6.4 (6.0-6.6) admissions and 64.8 (64.4-66.9) bed days per 100 cancer survivors per year. In contrast, 5-year survivors were not at higher risk of admission to psychiatric hospital (SHR 0.9; 0.8-1.2), and they spent significantly less time as psychiatric in-patients (SBDR 0.4; 0.4-0.4) compared with the whole population.
Using routinely collected linked records, our population-based study has demonstrated increased rates of hospitalisation in 5-year survivors of cancer diagnosed before the age of 25 years. Long-term clinical follow-up of survivors of cancer in this age group should focus on the prevention and treatment of the late effects of cancer in those patients at highest risk of hospitalisation.
儿童、青少年和青年癌症幸存者已知面临疾病及其治疗带来的远期影响风险。大多数基于人群的癌症幸存者研究报告了二次原发性癌症和死亡率情况。本研究的目的是调查25岁之前确诊癌症的5年幸存者的急性和精神科住院率及住院时长。
这是一项基于人群的回顾性队列研究，使用了国家癌症登记处、急性医院出院记录、精神科医院记录及死亡率记录的关联数据。研究人群包括1981年至2003年间25岁之前确诊癌症且在原发性癌症诊断日期后至少存活5年的5229名个体。采用年龄和性别间接标准化方法计算急性和精神科住院的标准化床日数和住院率（SBDR和SHR），并与苏格兰普通人群比较绝对超额风险（AER）。
25岁之前确诊癌症的5年幸存者入住急性医院的风险增加（SHR 2.8；95%置信区间2.7 - 2.9），且住院时间更长（SBDR 3.7；3.6 - 3.7）。相应的AER为每100名癌症幸存者每年6.4（6.0 - 6.6）次住院和64.8（64.4 - 66.9）个床日。相比之下，5年幸存者入住精神科医院的风险并未升高（SHR 0.9；0.8 - 1.2），且与总体人群相比，他们作为精神科住院患者的时间显著减少（SBDR 0.4；0.4 - 0.4）。
通过常规收集的关联记录，我们基于人群的研究表明，25岁之前确诊癌症的5年幸存者住院率有所增加。该年龄组癌症幸存者的长期临床随访应聚焦于对住院风险最高的患者预防和治疗癌症的远期影响。
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