Psychiatric disorders in childhood cancer survivors in Denmark, Finland, and Sweden: a register-based cohort study from the SALiCCS research programme
Menée dans trois pays nordiques (Danemark, Finlande et Suède) à partir de données portant sur 88 630 témoins en population et sur 18 621 patients ayant survécu 5 ans à un cancer pédiatrique diagnostiqué avant l'âge de 20 ans sur la période 1974-2011, cette étude analyse le risque de troubles psychiatriques
Background : A childhood cancer diagnosis and treatment-induced somatic late effects can affectthe long-term mental health of survivors. We aimed to explore whether childhood cancersurvivors are at higher risk of psychiatric disorders later in life than their siblingsand 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 availablein Finland. Data on ethnicity were not collected. Survivors were compared with theirsiblings and randomly selected individuals from the general population who were matchedto the survivors by year of birth, sex, and geographical region. We followed up ourstudy population from 5 years after the childhood cancer diagnosis or correspondingcalendar date for matched individuals (the index date) until Aug 11, 2017, and assessedinformation 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 sameage as their sibling survivor when diagnosed with cancer.
Findings : The study population included 18 621 childhood cancer survivors (9934 [53·3%] malesand 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 hospitalcontact by 30 years of age between Jan 1, 1979, and Aug 11, 2017, was 15·9% (95% CI15·3–16·5) 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, survivorswere 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). Thehigher risk persisted at the age of 50 years. Survivors had a higher burden of recurrentpsychiatric hospital contacts and had more hospital contacts for different psychiatricdisorders than their siblings and the matched individuals.
Interpretation : Childhood cancer survivors are at higher long-term risk of psychiatric disorders thantheir siblings and matched individuals from the general population. To improve mentalhealth and the overall quality of life after childhood cancer, survivorship care shouldinclude a focus on early signs of mental health problems, especially among high-riskgroups of survivors
The Lancet Psychiatry , résumé, 2020