Tang Grace H, Sutradhar Rinku, Chan Wing C, Gupta Sumit, Krzyzanowska Monika, Pechlivanoglou Petros, Nathan Paul C
Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada.
Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.
J Cancer Surviv. 2025 Jul 17. doi: 10.1007/s11764-025-01863-9.
Survivors of childhood and adolescent cancers are at increased risk for late effects. Few studies have investigated if this translates into increased healthcare utilization during survivorship. We compared rates of healthcare utilization between survivors of childhood and adolescent cancer and matched cancer-free controls.
This was a population-based matched cohort study using administrative databases in Ontario, Canada. The survivor cohort included individuals diagnosed with cancer ≤ 21 years old who had survived ≥ 5 years from their primary cancer diagnosis or relapse/recurrence during childhood/adolescence. Each survivor was matched to 5 controls based on year of birth, sex, and geographic location. Andersen-Gill recurrent event regression models were used to evaluate the association between survivorship and the rates of hospitalization, surgeries, diagnostic imaging, visits to the emergency department (ED), primary care physician (PCP), and sub-specialists. Models were adjusted for income quintile and comorbidity.
We identified 8090 survivors and 40,450 matched controls. Median follow-up time from index was 9 years. Compared to controls, survivors had higher rates of hospitalizations (adjusted relative rate (aRR) 1.82, 95% confidence interval [CI] 1.68-1.96), surgeries (aRR, 1.26; 95%CI, 1.20-1.32), sub-specialist visits (aRR, 1.55; 95%CI, 1.50-1.61), and diagnostic imaging (aRR, 1.48; 95%CI, 1.44-1.52). Rates of PCP and ED visits did not differ.
Cancer survivors have higher rates of healthcare use compared to matched cancer-free controls in a publicly funded healthcare system.
Our findings suggest survivors do not receive additional care from their PCPs or visits to the ED. Future research is needed from other jurisdictions to supplement our findings.
儿童期和青少年期癌症幸存者出现晚期效应的风险增加。很少有研究调查这是否会转化为生存期内医疗保健利用率的提高。我们比较了儿童期和青少年期癌症幸存者与匹配的无癌对照者的医疗保健利用率。
这是一项基于人群的匹配队列研究，使用了加拿大安大略省的行政数据库。幸存者队列包括在21岁及以下被诊断患有癌症且自初次癌症诊断或儿童期/青少年期复发后存活至少5年的个体。根据出生年份、性别和地理位置，将每位幸存者与5名对照者进行匹配。使用安德森-吉尔复发事件回归模型来评估生存期与住院率、手术率、诊断性影像学检查率、急诊就诊率、初级保健医生就诊率以及专科医生就诊率之间的关联。模型对收入五分位数和合并症进行了调整。
我们确定了8090名幸存者和40450名匹配的对照者。自索引日期起的中位随访时间为9年。与对照者相比，幸存者的住院率（调整后相对率[aRR]为1.82，95%置信区间[CI]为1.68 - 1.96）、手术率（aRR为1.26；95%CI为1.20 - 1.32）、专科医生就诊率（aRR为1.55；95%CI为1.50 - 1.61）和诊断性影像学检查率（aRR为1.48；95%CI为1.44 - 1.52）更高。初级保健医生就诊率和急诊就诊率没有差异。
在公共资助的医疗保健系统中，癌症幸存者的医疗保健使用率高于匹配的无癌对照者。
我们的研究结果表明，幸存者并未从其初级保健医生处获得额外护理或增加急诊就诊。需要其他司法管辖区的未来研究来补充我们的研究结果。
