Cancer Causes & Control

, Volume 29, Issue 11, pp 1047–1057 | Cite as

Hospitalization and mortality among pediatric cancer survivors: a population-based study

  • Beth A. Mueller
  • David R. Doody
  • Noel S. Weiss
  • Eric J. Chow
Original paper



We examined serious long-term outcomes among childhood cancer survivors using population-based data.


We used 1982–2014 Washington State data to compare hospitalization and/or death (including cause-specific) during up to 27 years follow-up among all 5+ year childhood cancer survivors < 20 years at diagnosis (n = 3,152) and a sample of comparison children within birth cohorts, with assessment by cancer type and child/family characteristics.


During follow-up (9 years median), 12% of survivors had hospitalizations; 4% died. Greatest absolute risks/1,000 person-years were for hospitalization/deaths due to cancers (8.1), infection (6.2), injuries (6.0), and endocrine/metabolic disorders (5.8). Hazard ratios (HR) and 95% confidence intervals (CI) for hospitalization (2.7, 95% CI 2.4–3.0) and any-cause death (14.7, 95% CI 11.3–19.1) were increased, and for all cause-specific outcomes examined, most notably cancer- (35.1, 95% CI 23.7–51.9), hematological- (6.7, 95% CI 5.3–8.5), nervous system- (6.4, 95% CI 5.2–7.8), and circulatory- (5.2, 95% CI 4.1–6.5) related outcomes. Hospitalizations occurred more often among females and those receiving radiation, with modest differences by urban/rural birth residence and race/ethnicity. Cause-specific outcomes varied by cancer type.


This study suggests increased risks for the rarely-studied outcomes of long-term fracture and injury, and confirms increased risks of selected other conditions among survivors. Multi-state pooling of population-based data would increase the ability to evaluate outcomes for uncommon cancer types and by racial/ethnic groups under-represented in many studies.


Childhood cancer Hospitalization Late effects Survivorship Cohort Morbidity 



We would like to acknowledge the Washington State Department of Health for data access and Mr. Bill O’Brien for programming and file management.


Alex’s Lemonade Stand Foundation for Childhood Cancer. Cancer registry support: National Cancer Institute # HHSN261201300012I; Centers for Disease Control and Prevention #DP12-1205 DP003899-02.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10552_2018_1078_MOESM1_ESM.docx (39 kb)
Supplementary material 1 (DOCX 38 KB)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Public Health Sciences DivisionFred Hutchinson Cancer Research Center (FHCRC)SeattleUSA
  2. 2.Department of EpidemiologyUniversity of Washington (UW)SeattleUSA
  3. 3.Clinical Research DivisionFHCRCSeattleUSA
  4. 4.Department of PediatricsSeattle Children’s Hospital, UWSeattleUSA

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