Describing the variation in hospital activity following diagnosis with cancer for childhood and adolescent cancer in Yorkshire

This study aimed to provide a comprehensive assessment of hospital utilisation among children and young people (CYP), addressing recommendations emerging from the Children and Young People’s Health Outcomes Forum that emphasised the importance of improving the health of young people. The burden of care for CYP with cancer on local and national healthcare systems is unknown and lack of data limits the ability to inform and improve service delivery. Therefore, I used a specialist population-based cancer register in CYP from Yorkshire, linked to hospital admissions data, to analyse healthcare utilisation after diagnosis and treatment for cancer. Additionally, clinical and sociodemographic factors that contributed to hospital utilisations during and after treatment were identified and discussed.
The study included 3,151 cases of cancer aged 0-29 years diagnosed in Yorkshire during 1996-2009, and admitted to hospital during 1997-2011. The study observed a steady increase in admissions over the period. Children had higher median number of admissions (median=25, Interquartile range (IQR): 8-44) than teenagers and young adults (TYA) (median=10, IQR: 3-20), and spent longer in hospital on average with median duration of three and one days per 100 person-days respectively. However, TYA with leukaemia experienced longer stays in hospital on average than children, with a median duration of eight and four days, respectively. Factors that influenced the pattern of admissions varied by cancer type, however relapse status, type of initial treatment and year of diagnosis were significantly related to hospitalisation independently. Cancer survivors had a significantly higher risk of morbidity compared with the general population after treatment completion (standardised hospitalisation rate (SHR) = 2.37, 95% CI:2.26-2.49).
Findings from this work demonstrate the variation in hospital activity by cancer type and age group, as well as the independent predictors of hospitalisation. This aids the continued development of high-quality cancer services to meet the needs of young people with regard to short-term and long-term care.