Stenmarker Margaretha, Mallios Panagiotis, Hedayati Elham, Rodriguez-Wallberg Kenny A, Johnsson Aina, Alfredsson Joakim, Ekman Bertil, Legert Karin Garming, Borland Maria, Mellergård Johan, Eriksson Moa, Marteinsdottir Ina, Davidson Thomas, Engerström Lars, Sandsveden Malte, Keskisärkkä Robin, Singull Martin, Hubbert Laila
Department of Oncology, Department of Biomedical Sciences and Clinical Sciences, Linkoping University, Linkoping, Sweden.
Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Lancet Reg Health Eur. 2024 May 15;42:100925. doi: 10.1016/j.lanepe.2024.100925. eCollection 2024 Jul.
BACKGROUND: Despite progress in managing cancer in children, adolescents, and young adults (CAYAs), persistent complications may impact their quality of life. This study covers the morbidity and mortality, among CAYAs, with the aim to investigate the influence of socioeconomic factors on outcomes. METHODS: This retrospective matched cohort study included the entire Swedish population of individuals under 25 with cancer 1958-2021. The population was identified from the Cancer Register, and controls were paired 1:5 based on age, sex, and residence. Multiple registers provided data on morbidity, mortality, and demographics. FINDINGS: This survey covering 63 years, identified 65,173 CAYAs and matched controls, a total of 378,108 individuals (74% females). CAYAs exhibited a 3.04-times higher risk for subsequent cancer (Odds ratio (OR) 95% confidence interval (CI) 2.92-3.17, p < 0.0001), a 1.23-times higher risk for cardiovascular disease (OR 95% CI 1.20-1.26, p < 0.0001), and a 1.41-times higher risk for external affliction (OR 95% CI 1.34-1.49, p < 0.0001). CAYAs had a higher mortality hazard, and after adjusting for socioeconomic factors, males, individuals born outside Europe, and those with greater sick-leave had a higher association with mortality, while education and marriage showed a beneficial association. INTERPRETATION: The Rebuc study, showed an increased risk for serious complications among young cancer patients in Sweden. Patient-specific variables, demographics, and socioeconomic factors influenced mortality. These results underscore the impact of cancer on the health and lifespan of young individuals and the necessity for further research to address socioeconomic disparities in cancer care. FUNDING: Grants from the Medical Research Council of Southeast Sweden (FORSS), ALF Grants, Region Ostergotland, and The Swedish Childhood Cancer Fund.
背景:尽管儿童、青少年和青年癌症患者(CAYAs)的癌症管理取得了进展,但持续性并发症可能会影响他们的生活质量。本研究涵盖了CAYAs的发病率和死亡率,旨在调查社会经济因素对治疗结果的影响。 方法:这项回顾性匹配队列研究纳入了1958年至2021年瑞典所有25岁以下的癌症患者。研究对象从癌症登记处确定,对照组根据年龄、性别和居住地按1:5进行配对。多个登记处提供了发病率、死亡率和人口统计学数据。 研究结果:这项涵盖63年的调查确定了65173名CAYAs及匹配的对照组,共计378108人(74%为女性)。CAYAs患后续癌症的风险高3.04倍(优势比(OR)95%置信区间(CI)2.92 - 3.17,p < 0.0001),患心血管疾病的风险高1.23倍(OR 95% CI 1.20 - 1.26,p < 0.0001),患外部疾病的风险高1.41倍(OR 95% CI 1.34 - 1.49,p < 0.0001)。CAYAs的死亡风险更高,在调整社会经济因素后,男性、非欧洲出生的个体以及病假时间较长的个体与死亡率的关联更高,而教育和婚姻则显示出有益的关联。 解读:Rebuc研究表明,瑞典年轻癌症患者出现严重并发症的风险增加。患者特定变量、人口统计学和社会经济因素影响死亡率。这些结果强调了癌症对年轻人健康和寿命的影响,以及进一步研究解决癌症护理中社会经济差异问题的必要性。 资金来源:瑞典东南部医学研究委员会(FORSS)、ALF资助、东约特兰地区以及瑞典儿童癌症基金提供的资助。
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