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Int J Cancer. 2020 Feb 1;146(3):819-828. doi: 10.1002/ijc.32341. Epub 2019 Apr 29.

Hospital admission for neurologic disorders among 5-year survivors of noncentral nervous system tumors in childhood: A cohort study within the Adult Life after Childhood Cancer in Scandinavia study.

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Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Sciences, Lund University, Lund, Sweden.
Pediatric Oncology and Hematology, Skåne University Hospital, Lund, Sweden.
Icelandic Cancer Registry, Reykjavik, Iceland.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Finnish Cancer Registry, Helsinki, Finland.
Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.
Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health, Aarhus University Hospital, Aarhus, Denmark.


Large, comprehensive studies of the risk for neurologic disorders among long-term survivors of noncentral nervous system (CNS) childhood cancers are lacking. Thus, the aim of our study was to assess the lifetime risk of Nordic non-CNS childhood cancer survivors for neurologic disorders. We identified 15,967 5-year survivors of non-CNS childhood cancer diagnosed in Denmark, Iceland, Finland and Sweden in 1943-2008, and 151,118 matched population comparison subjects. In-patient discharge diagnoses of neurologic disorders were used to calculate relative risks (RRs) and absolute excess risks (AERs). A neurologic disorder was diagnosed in 755 of the survivors while 370 were expected, yielding a RR of 2.0 (95% confidence interval (CI) 1.9-2.2). The highest risks were found among survivors of neuroblastoma (4.1; 95% CI 3.2-5.3) and leukemia (2.8; 95% CI 2.4-3.2). The AER decreased from 331 (278-383) excess neurologic disorders per 100,000 person-years 5-9 years after diagnosis to 82 (46-118) ≥ 20 years after diagnosis. Epilepsy was the most common diagnosis (n = 229, 1.4% of all survivors), and significantly increased risks were seen among survivors of eight out of 12 types of childhood cancer. Survivors of neuroblastoma had remarkably high risks (RR ≥ 10) for hospitalization for paralytic syndromes and hydrocephalus, while survivors of leukemia had additional high risks for dementia and encephalopathy. In conclusion, survivors of non-CNS childhood cancer are at high risk for neurologic disorders, especially within the first decade after diagnosis. Therefore, intensive follow-up to identify those who require close management is needed.


childhood cancer; cohort study; late effects; neurologic disorders


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