Background

A childhood cancer diagnosis and treatment-induced somatic late effects can affect the long-term mental health of survivors. We aimed to explore whether childhood cancer survivors are at higher risk of psychiatric disorders later in life than their siblings and the general population.

Methods

In this register-based cohort study (part of the Socioeconomic Consequences in Adult Life after Childhood Cancer [SALiCCS] research programme), we included 5-year survivors of childhood cancer diagnosed before 20 years of age between Jan 1, 1974 and Dec 31, 2011, in Denmark, Finland, and Sweden. In Denmark and Sweden, 94·7% of individuals were born in a Nordic country (ie, Denmark, Finland, Iceland, Norway, or Sweden); similar information was not available in Finland. Data on ethnicity were not collected. Survivors were compared with their siblings and randomly selected individuals from the general population who were matched to the survivors by year of birth, sex, and geographical region. We followed up our study population from 5 years after the childhood cancer diagnosis or corresponding calendar date for matched individuals (the index date) until Aug 11, 2017, and assessed information on hospital contacts for any and specific psychiatric disorders. For siblings, the index date was defined as 5 years from the date on which they were of the same age as their sibling survivor when diagnosed with cancer.

Findings

The study population included 18 621 childhood cancer survivors (9934 [53·3%] males and 8687 [46·7%] females), 24 775 siblings (12 594 [50·8%] males and 12 181 [49·2%] females), and 88 630 matched individuals (47 300 [53·4%] males and 41 330 [46·6%] females). The cumulative incidence proportion of having had a psychiatric hospital contact by 30 years of age between Jan 1, 1979, and Aug 11, 2017, was 15·9% (95% CI 15·3–16·5) for childhood cancer survivors, 14·0% (13·5–14·5) for siblings, and 12·7% (12·4–12·9) for matched individuals. Despite a small absolute difference, survivors were at higher relative risk of any psychiatric hospital contact than their siblings (1·39, 1·31–1·48) and matched individuals (hazard ratio 1·34, 95% CI 1·28–1·39). The higher risk persisted at the age of 50 years. Survivors had a higher burden of recurrent psychiatric hospital contacts and had more hospital contacts for different psychiatric disorders than their siblings and the matched individuals.

Interpretation

Childhood cancer survivors are at higher long-term risk of psychiatric disorders than their siblings and matched individuals from the general population. To improve mental health and the overall quality of life after childhood cancer, survivorship care should include a focus on early signs of mental health problems, especially among high-risk groups of survivors.

Funding

NordForsk, Aarhus University, Swedish Childhood Cancer Foundation, Danish Health Foundation, and Swiss National Science Foundation.

中文翻译：

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丹麦、芬兰和瑞典儿童癌症幸存者的精神疾病：来自 SALiCCS 研究计划的基于注册的队列研究

背景

儿童癌症诊断和治疗引起的躯体晚期效应会影响幸存者的长期心理健康。我们旨在探讨儿童癌症幸存者是否比他们的兄弟姐妹和一般人群在晚年面临更高的精神疾病风险。

方法

在这项基于登记册的队列研究（儿童癌症后成人生活的社会经济后果 [SALiCCS] 研究计划的一部分）中，我们纳入了在 1974 年 1 月 1 日至 12 月 31 日之间在 20 岁之前诊断出的儿童癌症的 5 年幸存者， 2011 年，在丹麦、芬兰和瑞典。在丹麦和瑞典，94·7% 的人出生在北欧国家（即丹麦、芬兰、冰岛、挪威或瑞典）；芬兰没有类似的信息。没有收集有关种族的数据。幸存者与他们的兄弟姐妹进行比较，并从一般人群中随机选择与幸存者的出生年份、性别和地理区域相匹配的个体。我们从儿童癌症诊断后 5 年或匹配个体的相应日历日期（索引日期）到 2017 年 8 月 11 日对我们的研究人群进行了随访，并评估了任何和特定精神疾病的医院联系信息。对于兄弟姐妹，索引日期定义为从他们被诊断患有癌症时与兄弟姐妹幸存者同龄之日起的 5 年。

发现

研究人群包括 18 621 名儿童癌症幸存者（9934 [53·3%] 名男性和 8687 名 [46·7%] 名女性）、24 775 名兄弟姐妹（12 594 [50·8%] 名男性和 12 181 [49·2%] ] 女性），以及 88 630 名匹配个体（47 300 [53·4%] 名男性和 41 330 [46·6%] 名女性）。儿童癌症幸存者在 1979 年 1 月 1 日至 2017 年 8 月 11 日期间曾与精神病院接触的累计发病率为 15·9%（95% CI 15·3–16·5），兄弟姐妹为 14·0% (13·5–14·5)，匹配个体为 12·7% (12·4-12·9)。尽管绝对差异很小，但幸存者在任何精神病院接触的相对风险高于其兄弟姐妹（1·39、1·31–1·48）和匹配个体（风险比 1·34，95% CI 1·28– 1·39)。较高的风险在 50 岁时持续存在。

解释

与他们的兄弟姐妹和普通人群中的匹配个体相比，儿童癌症幸存者患精神疾病的长期风险更高。为了改善儿童癌症后的心理健康和整体生活质量，幸存者护理应包括关注心理健康问题的早期迹象，尤其是在高危幸存者群体中。

资金

NordForsk、奥尔胡斯大学、瑞典儿童癌症基金会、丹麦健康基金会和瑞士国家科学基金会。