![Page 1: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/1.jpg)
Anna Font-GonzalezPhD Student
Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands
Burden of disease in childhood cancer survivors and consequences for the healthcare system: a follow-up
study using medical record linkageDag van de Gezondheidsstatistieken, 12th September 2013
![Page 2: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/2.jpg)
Childhood cancer survivors
• Childhood cancer survivors (CCS): ↑ chronic health conditions
• Serious outcome of health condition• Impact on patients’ daily life• Impact on health care system / society
Long term trends of hospitalizations over time? Hospitalization-related health problems
underlying hospitalizations?
![Page 3: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/3.jpg)
Objectives
Objective 1. To define long term trends of hospitalizations in CCS over time
Objective 2. To define hospitalization-related health problems in CCS hospitalizations
![Page 4: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/4.jpg)
GBA: Municipal Personal Records Database
• Administrative database• Goal: provide data for population statistics• Demographic information
• 1995-2008
![Page 5: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/5.jpg)
LMR: Hospital Discharge Register
• Administrative register• Hospitalization-related health problems: Diagnosis
at hospital discharge ICD9-CM• Hospitalization registration includes:
• DoB• Gender• Postal code at the date of discharge
• 1995-2005
![Page 6: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/6.jpg)
Difficulty hospitalization register
(1) Hospitalizations lost if a person changes address
LMR
Postal code 1 Postal code 2
X
GBA
![Page 7: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/7.jpg)
Difficulty hospitalization register
Not unique Unique Not unique
(2) Hospitalized persons are not always a unique person
LMR
GBA
![Page 8: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/8.jpg)
Eligible reference population 1995-2005N=28 255
Unique Reference Population
N=26 583(94%)
Corresponding year of birth, gender and calendar year (date of 5-year survival)
Gender, date of birth and postal code at the date of discharge
CCS eligible for linkageEKZ/ AMC cohort
N=1564
Dutch Municipal Population Registry (GBA) N=1477
Dutch National Medical Registry (LMR) 1995-2005
Unique CCS
N=1382 (88%)
BSN Gender, date of birth and postal code
Cohort Study Using Record Linkage
Excluded:Non-linked to GBA
Excluded:Non-unique after 5-year survivor
Excluded:Non-unique after matched date 5-year survival
![Page 9: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/9.jpg)
Practical issues
• Remote access to CBS
• Shared computer
• Outputs
![Page 10: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/10.jpg)
Objective 1: Hospitalizations in CCS
![Page 11: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/11.jpg)
Specific Aims For Objective 1: Hospitalizations in CCS
To determine: • Average Relative Hospitalization Rates of CCS in
comparison with the reference population
• Hospitalization rates of CCS over time in comparison to a reference population
• Hospitalization characteristics in CCS
• CCS risk groups for hospitalization
![Page 12: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/12.jpg)
Methods: Hospitalization Rates
• Hospitalization rates of CCS vs POPAverage relative hospitalization ratesRates over time
• Poisson regression modelAdjusted for
Gender, year of birth, follow-up time and calendar year
Recurrent events
![Page 13: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/13.jpg)
Methods: Treatment Risk Factor Analysis
• Within CCS• Same Poisson model• Treatment Risk factors:
• Cancer treatments
![Page 14: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/14.jpg)
Results
![Page 15: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/15.jpg)
Average Relative Hospitalization Rates
CCSn
POPn
RHR 95%CI
Outcome
Hospitalizations
All CCS 216 78 2.79 2.40 -3.17
Censoring CCS at recurrence 172 79 2.20 1.93 –2.51
Hospitalization days 840 296 2.84 2.77 –2.92
Hospitalized person 54 39 1.39 1.28 –1.51
![Page 16: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/16.jpg)
Hospitalization Rate Over Time
CCSPOP
![Page 17: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/17.jpg)
Treatment Risk Factors Within CCS
Significant risk factors:
RHR 95%CI
Radiotherapy to head and/or neck, yes vs no 1.71 1.20-1.89
Radiotherapy to thorax and/or abdomen, yes vs no 1.13 1.05-1.52
![Page 18: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/18.jpg)
Objective 2: Hospitalization-related health problems in CCS hospitalizations
![Page 19: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/19.jpg)
Specific Aims For Objective 2: Hospitalization-related health problems
1. Average Relative Hospitalization Rate of hospitalization-related health problems in CCS compared with the reference population
2. Hospitalization rates of hospitalization-related health problems over time compared to a reference population within specific disease groups
3. Risk factors for hospitalization-related health problems (within CCS)
![Page 20: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/20.jpg)
Statistical Analysis
• Longitudinal analysis: CCS vs POP
• Poisson regression model Gender, year of birth and calendar yearRecurrent eventsCensored recurrences
![Page 21: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/21.jpg)
Results
![Page 22: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/22.jpg)
Average Relative Hospitalization Rates
CCSn
POPn RHR 95%CI
Outcome
Neoplasms hospitalizations 269 433 10.7 7.1-16.3
Endocrine disease hospitalizations 74 174 7.3 4.6-11.7
Diseases of the circulatory system hospitalizations
61 300 3.5 2.4-5.1
![Page 23: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/23.jpg)
Discussion & Conclusion
• Childhood cancer survivors have an increased hospitalization rate up to 30 years after primary cancer diagnosis
• Previously described risks in CCS of neoplasms, endocrine and circulatory diseases translate into increased risk of hospitalizations
Implications• High and long-term burden of health conditions• Need for awareness and knowledge among all healthcare professionals• Results can inform follow-up strategies and treatment among CCS and
new childhood cancer patients
![Page 24: Anna Font-Gonzalez PhD Student Emma Children’s Hospital/Academic Medical Center Amsterdam, The Netherlands Burden of disease in childhood cancer survivors](https://reader038.vdocuments.us/reader038/viewer/2022110323/56649d885503460f94a6d414/html5/thumbnails/24.jpg)
Contributers & Acknowledgement
Leontien Kremer CBSHuib Caron Datamanagers Elske Sieswerda SurvivorsRonald Geskus KiKaHans ReitsmaMarcel DijkgraafHeleen van der PalFloor van LeeuwenRichard Heinen