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Serious Morbidity and Financial Outcomes Among Pediatric Cancer Survivors

Fred Hutchinson Cancer Research Center
Beth Mueller, PhD
Grant Type: 
Epidemiology Grants
Year Awarded: 
Type of Childhood Cancer: 
General Pediatric Cancer
Project Description: 


Childhood cancer survival rates have improved markedly, with an estimated >325,000 survivors in the U.S. today. However, survivors have an increased risk of later adverse health outcomes such as cardiopulmonary disease, second cancers, and possibly fractures, likely due to the effects of chemotherapy, radiation exposure, or other therapies. As the number of survivors continues to increase, it is important to characterize the spectrum of adverse health and financial outcomes they experience in order to develop appropriate follow-up strategies and learn how to decrease subsequent morbidity. Few population-based outcome studies have focused on children, and most have included only specific cancer types.

Project Goal

We propose to use existing datasets (cancer, hospital, and vital records registries) in a comprehensive cohort study of ~3000 childhood cancer survivors (5+ years after diagnosis), comparing their levels of major health outcomes and indicators of health-related financial status to those of a general population cohort. Outcomes include hospitalization rates/reasons for hospitalizations or death; total and per-event hospital charges and lengths of stay; and changes in health insurance over time (to Medicaid or no insurance) indicating a possible reduction in family financial status as a result of childhood cancer. These datasets exist in many states, so our project may establish an infrastructure for a future, larger pooled effort with greater ability to assess differences across cancer types, patient characteristics, and treatments. These results will also help provide a baseline for measuring changes in cancer care practices and resource utilization as health care delivery and funding change over time.


“Childhood cancer survival rates have improved dramatically, however we are just beginning to understand the extent to which subsequent serious health problems may occur in children who have undergone cancer treatment. With the support of the Alex’s Lemonade Stand Foundation, our study will measure the burden of major adverse outcomes such as cardiopulmonary disease and fracture among childhood cancer survivors, using innovative methods that include populations historically underrepresented in research studies. With the growing number of survivors, a better understanding of possible adverse long term outcomes of treatments will help to develop appropriate screening and follow-up, and to develop treatments that minimize subsequent morbidity.”  ~ Beth Mueller, Ph.D.