Hospitalization for medical conditions in adolescent and young adult cancer survivors: a nationwide cohort study using the Netherlands Cancer Registry.

PURPOSE: To examine the long-term risk of hospitalization for medical conditions in adolescent and young adult (AYA) cancer survivors compared to a cancer-free AYA cohort.

METHODS

Retrospective cohort study of 42,653 ≥ 2-year cancer survivors diagnosed at ages 18-39 (1993-2016) in the Netherlands Cancer Registry, and 169,342 matched cancer-free controls (1:4 by age, sex and municipality). Hospitalizations for relevant medical conditions were identified through national hospital admission data. Survivors and controls were followed through December 2021. Hospitalization incidence rate ratios (IRRs) and cumulative incidences were calculated, with IRRs stratified by tumour type and therapy (chemotherapy, radiotherapy).

RESULTS

AYA cancer survivors had a significantly increased IRR of hospitalization for any medical condition (adjusted IRR 1.73; 95% CI 1.64 to 1.82), as well as for most individual conditions. The cumulative incidence of hospitalization for any medical condition was 25.4% at 25 years post-index, with most individual conditions below 5%. Most tumour subgroups had significantly increased IRRs compared to controls, with the highest IRRs observed for Hodgkin lymphoma and leukaemia. In general, elevated IRRs were more pronounced among survivors who received chemotherapy or radiotherapy.

CONCLUSIONS

AYA cancer survivors have an increased risk of hospitalization for most medical conditions compared to AYAs without a cancer history, though absolute long-term risk is low. As hospital admissions reflect only part of the clinical and societal burden, the findings may underestimate the total impact of late effects.

IMPLICATIONS FOR CANCER SURVIVORS: AYA cancer survivors may benefit from long-term, risk-based survivorship care focused on early detection and management of late effects, especially after chemotherapy and radiotherapy.