Childhood Cancer Survivors Are at an Increased Risk for Hospitalization Due to Infection Several Years After Treatment Has Ended

Recent study findings demonstrated that childhood cancer survivors have a significantly increased risk of being hospitalized with an infection years after their treatment has ended, compared with those without a cancer history.

“Although these treatment protocols are lifesaving, they have undesirable consequences, including prolonged delays in immune reconstitution, leaving patients vulnerable to infection well beyond chemotherapy,” the authors wrote in their research, which was published in the Journal of Clinical Oncology. “As a result, infections remain a significant cause of morbidity and mortality for the estimated 500,000 survivors of childhood cancer in the United States.”

Although there are data from previous studies detailing the infection risk in children immediately following completion of treatment, there is very limited information on the risk for infection that leads to hospitalization among long-term childhood cancer survivors.

The researchers analyzed data of patients in Washington state who were diagnosed with cancer before the age of 20 and lived for at least five years. The survivors (who were divided into two categories: those with a history of blood cancer and those with a history of non-hematologic cancer) were compared to healthy individuals of the same age and sex.

The main goal of the study was to compare incidence of infection associated with hospitalization or death occurring five or more years from the time of cancer diagnosis. The investigators reported the incidence rate per 1,000 person-years, which calculated the total sum of time patients spent in the hospital compared to the total sum of time that patients’ data was observed.

At five years, the infection-related hospitalization rate for cancer survivors was 12.6 per 1,000 person-years, compared to 2.4 per 1,000 person-years in the healthy group. Patients with blood cancers had an even higher rate of hospitalizations as a result of infection, at 18.5 per 1,000 person-years.

Bacterial infections were the most common cause of infection-related hospitalizations in both cancer survivor groups. Regarding organs affected, blood cancer survivors most commonly went to the hospital due to respiratory infections, while non-hematologic cancer survivors had a similar rate of respiratory and genitourinary infections. Both groups commonly experienced sepsis, a potentially life-threatening complication that comes as a result of the body’s extreme response to an infection.

Infection-related hospitalization rates tended to decrease by the 10-year mark for both of the cancer groups, though survivors still had a higher rate compared to the control group that did not have a history of cancer — a finding that was consistent with prior research, according to the study authors.

READ MORE: Adherence to Follow-Up Care in Childhood Cancer Survivors Continues to Be Subpar, Highlighting Need for More Resources to Increase Engagement

With these findings, the researchers emphasized that it is crucial for cancer survivors and their loved ones to understand the symptoms of infections and not to hesitate to talk to their clinicians if they believe they may have an infection.

“It is imperative that patients and their caregivers are appropriately counseled about this long-term risk so that they may seek timely medical attention for infectious symptoms, rather than assuming that their infectious symptoms can be managed with a similar approach used for otherwise healthy children and adolescents,” the authors wrote.

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