Hospitalization and mortality among pediatric cancer survivors: a population-based study

Cancer Causes Control. 2018 Nov;29(11):1047-1057. doi: 10.1007/s10552-018-1078-0. Epub 2018 Sep 5.


Purpose: We examined serious long-term outcomes among childhood cancer survivors using population-based data.

Methods: We used 1982-2014 Washington State data to compare hospitalization and/or death (including cause-specific) during up to 27 years follow-up among all 5+ year childhood cancer survivors < 20 years at diagnosis (n = 3,152) and a sample of comparison children within birth cohorts, with assessment by cancer type and child/family characteristics.

Results: During follow-up (9 years median), 12% of survivors had hospitalizations; 4% died. Greatest absolute risks/1,000 person-years were for hospitalization/deaths due to cancers (8.1), infection (6.2), injuries (6.0), and endocrine/metabolic disorders (5.8). Hazard ratios (HR) and 95% confidence intervals (CI) for hospitalization (2.7, 95% CI 2.4-3.0) and any-cause death (14.7, 95% CI 11.3-19.1) were increased, and for all cause-specific outcomes examined, most notably cancer- (35.1, 95% CI 23.7-51.9), hematological- (6.7, 95% CI 5.3-8.5), nervous system- (6.4, 95% CI 5.2-7.8), and circulatory- (5.2, 95% CI 4.1-6.5) related outcomes. Hospitalizations occurred more often among females and those receiving radiation, with modest differences by urban/rural birth residence and race/ethnicity. Cause-specific outcomes varied by cancer type.

Conclusions: This study suggests increased risks for the rarely-studied outcomes of long-term fracture and injury, and confirms increased risks of selected other conditions among survivors. Multi-state pooling of population-based data would increase the ability to evaluate outcomes for uncommon cancer types and by racial/ethnic groups under-represented in many studies.

Keywords: Childhood cancer; Cohort; Hospitalization; Late effects; Morbidity; Survivorship.

MeSH terms

  • Adolescent
  • Adult
  • Antineoplastic Agents / adverse effects
  • Cancer Survivors / statistics & numerical data*
  • Cause of Death*
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Hospitalization / statistics & numerical data*
  • Humans
  • Infant
  • Male
  • Neoplasms / mortality
  • Neoplasms / therapy
  • Population Surveillance
  • Proportional Hazards Models
  • Race Factors
  • Radiotherapy / adverse effects
  • Residence Characteristics
  • Washington / epidemiology
  • Young Adult


  • Antineoplastic Agents