Adverse mental health outcomes in a population‐based cohort of survivors of childhood cancer

• Published in: Cancer Vol. 124; no. 9; pp. 2045 - 2057
• Main Authors: Nathan, Paul C., Nachman, Alex, Sutradhar, Rinku, Kurdyak, Paul, Pole, Jason D., Lau, Cindy, Gupta, Sumit
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2018
• Subjects: Age; Cancer; cancer survivors; Central nervous system; Children; Confidence intervals; Emergency medical services; Health care; Health problems; Health risks; health services; Mental disorders; Mental health; Oncology; pediatric cancer; Risk; Suicide; cancer survivors; health services; mental health; pediatric cancer
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.31279

BACKGROUND The elevated risk for physical late effects in childhood cancer survivors (CCS) is well documented, but their risk for mental health problems is less well described. METHODS The authors assembled a cohort of all 5‐year CCS who were diagnosed before age 18 years and treated in an Ontario pediatric cancer center between 1987 and 2008. Patients were matched to population controls and linked to health administration databases. The authors calculated rates of mental health care visits (family physician, psychiatrist, emergency department, hospitalization) and the risk for a severe mental health event (emergency department, hospitalization, suicide). Outcomes were compared using recurrent event and survival analyses. RESULTS Compared with 20,269 controls, 4117 CCS had a higher rate of mental health visits (adjusted relative rate [RR], 1.34; 95% confidence interval [CI], 1.12‐1.52). Higher rates were associated with female gender (RR, 1.39; CI, 1.10‐1.75; P = .006) and being diagnosed at ages 15 to 17.9 years (compared with ages 0‐4 years: RR, 1.81; 95% CI, 1.17‐2.80; P = .008). Cancer type, treatment intensity, and treatments targeting the central nervous system were not significant predictors. Survivors were at increased risk for a severe event compared with controls (adjusted hazard ratio, 1.13; 95% CI, 1.00‐1.28; P = .045). CCS who were diagnosed with cancer at age 4 years or younger were at greatest risk: 16.3% (95% CI, 13.2%‐19.8%) had experienced a severe event by age 28 years. CONCLUSIONS CCS experienced higher rates of mental health visits and a greater risk for a severe event than the general population. Survivors of adolescent cancer have a higher rate of mental health visits overall, whereas survivors of cancer before age 4 years have a markedly elevated risk of severe events. Cancer 2018;124:2045‐57. © 2018 American Cancer Society. In this population‐based, retrospective cohort study of 4117 childhood cancer survivors and 20,269 controls, rates of mental health care visits and the risk of a severe mental health event (emergency department visit, hospitalization, or suicide) were increased significantly in survivors. There is a need for the expansion of mental health resources for those subgroups of childhood cancer survivors who are at highest risk.