Long-term Morbidity and Socioeconomic Outcome among Nordic Childhood Cancer Survivors

• Main Author: Sällfors-Holmqvist, Anna
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: Paediatrics, Faculty of Medicine, Lund University 2015
• Subjects: Pediatrics; Childhood cancer survivors; late complications; morbidity; late socioeconomic effects; Iceland
• Online Access: https://lup.lub.lu.se/record/5276436

Survival after childhood cancer has improved dramatically during the past four decades, resulting in a five-year survival rate of 80% in children recently treated for cancer in the Nordic countries. However, these advances in treatment and survival has come at a price, and many survivors face significant treatment-induced sequelae, most of which only become clinically apparent many years after the child has been cured. Previous studies have highlighted the need for better characterization of these late complications and their risk factors, in order to improve the basis for individual patient counselling and optimal long-term follow-up care. The main objective of the studies presented in this thesis was to investigate some of the diseases that contribute to long-term morbidity in childhood cancer survivors, as well as the late socioeconomic effects after treatment for acute lymphoblastic leukaemia (ALL) in childhood. All the studies presented in this thesis are population-based, retrospective cohort studies. Studies I and II are register-based studies of late socioeconomic effects and hospital-related morbidity, respectively, among 213 five-year survivors of ALL in the southern region of Sweden, compared to a population comparison cohort. Studies III–V included 33,160 one-year survivors of childhood cancer diagnosed between the start of cancer registration in the 1940s and 1950s up to and including 2008, identified in the national cancer registries of Denmark, Finland, Iceland, Norway and Sweden, and 212,892 comparison subjects, selected from national population registers. The study subjects in Studies III–V were linked to the national hospital registers and standardized hospitalization rate ratios and absolute excess risks of specific diseases were calculated. ALL survivors were married, had children, attained a high level of education and were employed to a lesser extent than the comparison subjects. Young age at diagnosis and cranial radiotherapy were risk factors for these negative late socioeconomic effects. ...