Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Cancer. 2018 Oct 1;124(19):3924-3933. doi: 10.1002/cncr.31650. Epub 2018 Oct 6.
Children and adolescents and young adults (AYAs) with cancer often experience severe respiratory morbidity and mortality from the therapies used to treat their cancers. Few studies have examined respiratory outcomes among this population using emergency department (ED) visits as an objective measure of respiratory health.
ED visits for respiratory conditions were identified for children and AYAs diagnosed with cancer, 0-25 years of age, from 1997 through 2012 (2535 cases) and compared with a birthdate-matched and sex-matched cohort without cancer drawn from the general population (7605 controls). Negative binomial regression with robust standard errors was used to estimate incidence rates, rate ratios (RRs), and 95% confidence intervals for primary respiratory ED visits, combined and by diagnosis (asthma, respiratory disease, and respiratory infection) from 1997 through 2015. Analyses were performed for new cases (0 to <5 years from diagnosis) and survivors (5-18 years from diagnosis).
Subjects were followed for an average of 8 years (range, 0-18 years). Relative to the comparison cohort, cancer cases had higher incidence rates for all types of respiratory ED visits over both follow-up times. New cases had significantly higher RRs for any respiratory condition (RR, 4.14), respiratory disease (RR, 4.62), and respiratory infection (RR, 4.74). Among survivors, the RRs for any respiratory condition (RR, 2.00) and respiratory infection (RR, 2.10) were significantly elevated, although the magnitude tended to decline in survivorship. Demographic and clinical risk factors found to be associated with respiratory ED visits included Hispanic/other race/ethnicity, male sex, exposure to chemotherapy, diagnosis at a younger age, and a diagnosis of leukemia.
The results of the current study demonstrated that children and AYAs with cancer face an increased burden of respiratory complications compared with a comparison cohort without cancer from diagnosis through survivorship.
儿童、青少年和青年癌症患者（AYAs）在接受癌症治疗时常会出现严重的呼吸系统并发症和死亡率。很少有研究使用急诊就诊（ED）作为呼吸系统健康的客观衡量标准来评估该人群的呼吸系统结局。
1997 年至 2012 年间，我们对诊断为癌症（0-25 岁）的儿童和 AYAs 的 ED 就诊情况进行了分析，以识别出呼吸系统疾病，并与从一般人群中随机选择的出生日期和性别匹配的无癌症对照组（7605 例）进行了比较。使用具有稳健标准误差的负二项回归来估计 1997 年至 2015 年期间，新诊断（0-<5 年）和生存者（5-18 年）的原发性呼吸系统 ED 就诊、合并就诊以及按诊断（哮喘、呼吸疾病和呼吸道感染）的发生率、发生率比（RR）和 95%置信区间。
受试者平均随访 8 年（0-18 年）。与对照组相比，癌症患者在随访期间的所有类型的呼吸系统 ED 就诊的发生率均较高。新诊断病例的所有呼吸系统疾病（RR，4.14）、呼吸疾病（RR，4.62）和呼吸道感染（RR，4.74）的 RR 显著更高。在生存者中，所有呼吸系统疾病（RR，2.00）和呼吸道感染（RR，2.10）的 RR 显著升高，尽管随着生存时间的延长，RR 值呈下降趋势。与 ED 就诊相关的人口统计学和临床危险因素包括西班牙裔/其他种族/民族、男性、化疗暴露、较年轻的诊断年龄和白血病诊断。
当前研究的结果表明，癌症儿童和 AYAs 与无癌症对照组相比，从诊断到生存期间面临着呼吸系统并发症的负担增加。
