Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
Pediatric Oncology Unit, Karolinska University Hospital, Stockholm, Sweden.
PLoS One. 2022 Apr 1;17(4):e0265827. doi: 10.1371/journal.pone.0265827. eCollection 2022.
Childhood cancer survivors are at high risk of chronic health conditions. We aimed to explore future long-term sickness absence and disability pension in young adult childhood cancer survivors and matched references.
We performed a prospective cohort study using microdata from five Swedish nationwide registers. Among all individuals born 1976-1998 and living in Sweden, we included 3632 childhood cancer survivors and 17,468 matched references that could be followed-up for 15, 10, or 5 years, respectively. A group-based trajectory model was applied to identify trajectories of mean annual sickness absence and/or disability pension days (SADP) in each sub-cohort, with 95% confidence intervals (CI). Potential risk factors for trajectory belonging were explored using χ2 test and multinomial logistic regression.
Most young adult childhood cancer survivors (90.2-96.5%) and references (97.4-98.8%) followed a No SADP trajectory. A larger proportion of childhood cancer survivors than references followed a Moderate (33-102 days/year) or High (115-260 days/year) SADP trajectory (15-year follow-up cohorts: Moderate 4.6% versus 1.2%; High 5.1% versus 1.5%). Childhood cancer survivors of central nervous system (CNS) tumors were at higher risk of the High SADP trajectory than childhood cancer survivors of hematological or non-CNS solid tumors (hematological versus CNS: odds ratio = 2.30, 95% CI 1.23-4.30; hematological versus non-CNS: odds ratio = 0.32, 95% CI 0.13-0.79).
Although most young adult childhood cancer survivors had no SADP during follow-up, 9.7% experienced moderate or high numbers of SADP days/year throughout the 15-year follow-up; compared to 2.7% among references. CNS tumor survivors were at particular risk of SADP long-term and need extra attention in their future work prospect.
儿童癌症幸存者存在较高的慢性健康状况风险。本研究旨在探究青年期儿童癌症幸存者与匹配参照者的未来长期病假和残疾养老金情况。
本研究使用来自瑞典五个全国性登记处的微观数据进行了前瞻性队列研究。在所有 1976 年至 1998 年出生并居住在瑞典的个体中，我们纳入了 3632 名儿童癌症幸存者和 17468 名匹配参照者，分别可随访 15、10 或 5 年。采用群组轨迹模型确定每个亚队列中平均每年病假和/或残疾养老金天数（SADP）的轨迹，并给出 95%置信区间（CI）。使用卡方检验和多项逻辑回归探索轨迹归属的潜在风险因素。
大多数青年期儿童癌症幸存者（90.2-96.5%）和参照者（97.4-98.8%）遵循无 SADP 轨迹。与参照者相比，更多的儿童癌症幸存者遵循中度（33-102 天/年）或高度（115-260 天/年）SADP 轨迹（15 年随访队列：中度为 4.6%对 1.2%；高度为 5.1%对 1.5%）。中枢神经系统（CNS）肿瘤患儿癌症幸存者比血液系统或非 CNS 实体瘤患儿癌症幸存者更易出现高度 SADP 轨迹（血液系统与 CNS：比值比=2.30，95%CI 1.23-4.30；血液系统与非 CNS：比值比=0.32，95%CI 0.13-0.79）。
尽管大多数青年期儿童癌症幸存者在随访期间没有病假，但在 15 年的随访期间，9.7%的人每年有中度或高度的 SADP 天数；而参照者中这一比例为 2.7%。CNS 肿瘤幸存者长期 SADP 的风险特别高，需要在未来的工作中给予特别关注。
