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Abstract
PurposeChildren and young adults (CYA) are at risk of late morbidity following cancer treatment, with risk varying by disease type and treatment received. Risk-stratified levels of aftercare which stratify morbidity burden to inform the intensity of long-term follow-up care, are well established for survivors of cancer under the age of 18 years, utilizing the National Cancer Survivor Initiative (NCSI) approach. We investigated the applicability of risk-stratified levels of aftercare in predicting long-term morbidity in young adults (YA), aged 18–29 years.MethodsLong-term CYA survivors followed-up at a regional center in the North of England were risk-stratified by disease and treatments received into one of three levels. These data were linked with local cancer registry and administrative health data (Hospital Episode Statistics), where hospital activity was used as a marker of late morbidity burden.ResultsPoisson modelling with incident rate ratios (IRR) demonstrated similar trends in hospital activity for childhood (CH) and YA cancer survivors across NCSI risk levels. NCSI levels independently predicted long-term hospitalization risk in both CH and YA survivors. Risk of hospitalization was significantly reduced for levels 1 (CH IRR 0.32 (95% CI 0.26–0.41), YA IRR 0.06 (95% CI 0.01–0.43)) and 2; CH IRR 0.46 (95% CI 0.42-0.50), YA IRR 0.49 (95% CI 0.37-0.50)), compared with level 3.ConclusionsThe NCSI pediatric late-effects risk stratification system can be effectively and safely applied to cancer patients aged 18–29, independent of ethnicity or socioeconomic position.Implications for Cancer SurvivorsTo enhance quality of care and resource utilization, long-term aftercare of survivors of YA cancer can and should be risk stratified through adoption of approaches such as the NCSI risk-stratification model.
Highlights
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Over 80% of children and young adults (CYA) diagnosed with cancer aged 0–29 years survive to become longterm (5 years plus) survivors [1, 2]
A total of 808 5-year survivors diagnosed with cancer aged 0– 29 years were included in the study (Fig. 2) (CH: n = 668 survivors, YA: n = 140)
This study reports the first population-based evidence of the applicability of the National Cancer Survivorship Initiative (NCSI) risk-stratification model in predicting late-effect morbidity in cancer survivors diagnosed up to and including the age of 29 years, and to our knowledge, is the first to consider the impact of socio-economic deprivation and ethnicity within NCSI levels
Summary
Over 80% of children and young adults (CYA) diagnosed with cancer aged 0–29 years survive to become longterm (5 years plus) survivors [1, 2]. Up to two-thirds of long-term survivors experience at least one chronic health condition, with 40% experiencing a serious health condition, and a third living with multiple health problems as a consequence of their cancer treatment [3]. The quality of life in cancer survivors varies by disease type, treatment received, and demographic factors. In order to enhance the efficiency and quality of aftercare comprehensive risk-stratified follow-up has been implemented in the UK for all childhood (CH) survivors [4, 5]. In 2001, Wallace et al proposed a three-tier follow-up model for survivors of childhood cancer, stratified by the intensity of cancer
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