Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.
School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.
Aust N Z J Psychiatry. 2024 Jun;58(6):515-527. doi: 10.1177/00048674241233871. Epub 2024 Feb 25.
We examined the impact of long-term mental health outcomes on healthcare services utilisation among childhood cancer survivors in Western Australia using linked hospitalisations and community-based mental healthcare records from 1987 to 2019.
The study cohort included 2977 childhood cancer survivors diagnosed with cancer at age < 18 years in Western Australia from 1982 to 2014 and a matched non-cancer control group of 24,994 individuals. Adjusted hazard ratios of recurrent events were estimated using the Andersen-Gill model. The cumulative burden of events over time was assessed using the method of mean cumulative count. The annual percentage change in events was estimated using the negative binomial regression model.
The results showed higher community-based service contacts (rate/100 person-years: 30.2, 95% confidence interval = [29.7-30.7] vs 22.8, 95% confidence interval = [22.6-22.9]) and hospitalisations (rate/1000 person-years: 14.8, 95% confidence interval = [13.6-16.0] vs 12.7, 95% confidence interval = [12.3-13.1]) in childhood cancer survivors compared to the control group. Childhood cancer survivors had a significantly higher risk of any event (adjusted hazard ratio = 1.5, 95% confidence interval = [1.1-2.0]). The cumulative burden of events increased with time since diagnosis and across age groups. The annual percentage change for hospitalisations and service contacts significantly increased over time ( < 0.05). Substance abuse was the leading cause of hospitalisations, while mood/affective and anxiety disorders were common causes of service contacts. Risk factors associated with increased service events included cancer diagnosis at age < 5 years, leukaemia diagnosis, high socioeconomic deprivation, and an attained age of < 18 years.
The elevated utilisation of healthcare services observed among childhood cancer survivors emphasises the need for periodic assessment of psychiatric disorders, particularly in high-risk survivors, to facilitate early management and optimise healthcare resources.
本研究利用 1987 年至 2019 年期间西澳大利亚州的住院和社区心理健康保健记录，研究长期心理健康结局对儿童癌症幸存者医疗服务利用的影响。
研究队列包括 1982 年至 2014 年期间在西澳大利亚州被诊断患有癌症且年龄<18 岁的 2977 名儿童癌症幸存者，以及 24994 名非癌症对照组个体。使用 Andersen-Gill 模型估计复发性事件的调整后风险比。使用平均累积计数法评估随时间推移的累积事件负担。使用负二项回归模型估计事件的年百分比变化。
结果显示，与对照组相比，儿童癌症幸存者的社区服务接触率（每 100 人年的发生率：30.2，95%置信区间[29.7-30.7]）和住院率（每 1000 人年的发生率：14.8，95%置信区间[13.6-16.0]）更高。与对照组相比，儿童癌症幸存者发生任何事件的风险显著更高（调整后的风险比=1.5，95%置信区间[1.1-2.0]）。随着诊断后时间的推移和年龄组的变化，事件的累积负担增加。住院和服务接触的年百分比变化随着时间的推移显著增加（<0.05）。药物滥用是导致住院的主要原因，而情绪/情感和焦虑障碍是导致服务接触的常见原因。与服务事件增加相关的风险因素包括<5 岁时癌症诊断、白血病诊断、高社会经济剥夺以及<18 岁时获得的年龄。
观察到儿童癌症幸存者医疗服务利用率增加，强调需要定期评估精神障碍，特别是对高危幸存者，以促进早期管理和优化医疗资源。
