Utilisation of healthcare in children born to lymphoma survivors in Sweden

Authors

  • Joshua P. Entrop Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden https://orcid.org/0000-0003-1614-8096
  • Viktor Wintzell Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
  • Caroline E. Dietrich Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
  • Ingrid Glimelius Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
  • Tarec C. El-Galaly Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Hematology, Aarhus University Hospital
  • Karin E. Smedby Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
  • Sandra Eloranta Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden

DOI:

https://doi.org/10.2340/1651-226X.2025.43950

Keywords:

Lymphoma, Offspring, Healthcare utilisation, Cancer survivorship, Tree-Based Scan Statistics

Abstract

Background and purpose: Advances in lymphoma treatment lead to a growing population of lymphoma survivors in childbearing ages who might be concerned about the impact of their disease on their children’s health. In this study, we aim to explore healthcare utilisation patterns that were associated with parental history of lymphoma.

Patients/material and methods: Children born to lymphoma survivors (diagnosed over the period 2000–2018) were identified by linking the Swedish Cancer Register to national population registers. Each child born to a lymphoma survivor was matched on maternal age at childbirth to five children born to lymphoma-free parents. Information on in- and outpatient diagnoses and drug dispensations up to age five were obtained for all children.

Results: We identified a total of 1,424 children born to lymphoma survivors and 7,120 matched children born to lymphoma-free parents. Children born to lymphoma survivors had a 8% higher healthcare utilisation rate (rate ratio: 1.08, 95% confidence intervals: 1.06–1.10) than other children. The panorama of diseases requiring healthcare utilisation was diverse and only one disease (International Classification of Diseases-10: H66, otitis media, unspecified) and one drug cluster (Anatomical Therapeutic Chemical: J07BC20, combination vaccine against hepatitis A and hepatitis B) was associated with a systematic difference (p < 0.05) when applying tree-based scan statistics.

Interpretation: Children born to lymphoma survivors had slightly increased healthcare utilisation during early childhood. However, no strong or consistent disease- or drug-specific clusters explained this increase. Findings therefore suggest that the elevated healthcare use may reflect heightened health-seeking behaviour among cancer survivors, rather than underlying morbidity in their children. These results provide reassurance for lymphoma survivors considering parenthood.

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References

Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375–90.

https://doi.org/10.1182/blood-2016-01-643569 DOI: https://doi.org/10.1182/blood-2016-01-643569

Larønningen S, Arvidsson G, Bray F, Dahl-Olsen E, Engholm G, Ervik M, et al. NORDCAN: cancer incidence, mortality, prevalence and survival in the Nordic countries: Association of the Nordic Cancer Registries. Cancer Registry of Norway. Version 9.4 (29.08.2024). Association of the Nordic Cancer Registries. Cancer Registry of Norway. Available from: https://nordcan.iarc.fr/

Danckert B, Ferlay J, Engholm G, Hansen HL, Johannesen TB, Khan S, et al. NORDCAN: cancer incidence, mortality, prevalence and survival in the Nordic countries: Association of the Nordic Cancer Registries [Internet]. Danish Cancer Society. [updated 2019 Mar 26]. Version 8.2. Available from: http://www.ancr.nu

Ekberg S, Smedby KE, Glimelius I, Nilsson-Ehle H, Goldkuhl C, Lewerin C, et al. Trends in the prevalence, incidence and survival of non-Hodgkin lymphoma subtypes during the 21st century – a Swedish lymphoma register study. Br J Haematol. 2020;189(6):1083–92.

https://doi.org/10.1111/bjh.16489 DOI: https://doi.org/10.1111/bjh.16489

Nilsson J, Jervaeus A, Lampic C, Eriksson LE, Widmark C, Armuand GM, et al. ‘Will I be able to have a baby?’ Results from online focus group discussions with childhood cancer survivors in Sweden. Hum Reprod. 2014;29(12):2704–11.

https://doi.org/10.1093/humrep/deu280 DOI: https://doi.org/10.1093/humrep/deu280

Harding JE. The nutritional basis of the fetal origins of adult disease. Int J Epidemiol. 2001;30(1):15–23.

https://doi.org/10.1093/ije/30.1.15 DOI: https://doi.org/10.1093/ije/30.1.15

Shliakhtsitsava K, Romero SAD, Dewald SR, Su HI. Pregnancy and child health outcomes in pediatric and young adult leukemia and lymphoma survivors: a systematic review. Leuk Lymphoma. 2018;59(2):381–97.

https://doi.org/10.1080/10428194.2017.1352097 DOI: https://doi.org/10.1080/10428194.2017.1352097

Anderson C, Baggett CD, Engel SM, Getahun D, Cannizzaro NT, Mitra S, et al. Risk of adverse birth outcomes after adolescent and young adult cancer. JNCI Cancer Spectr. 2024;8(1):pkad106.

https://doi.org/10.1093/jncics/pkad106 DOI: https://doi.org/10.1093/jncics/pkad106

Ji J, Huang W, Sundquist J, Sundquist K. Hospitalization rate in offspring of cancer survivors: a national cohort study. J Cancer Surviv. 2019;13(2):187–96.

https://doi.org/10.1007/s11764-019-00741-5 DOI: https://doi.org/10.1007/s11764-019-00741-5

Ekstrom Smedby K, Eloranta S, Wasterlid T, Falini V, Jerlstrom U, Ellin F, et al. The National Swedish Lymphoma Register – a systematic validation of data quality. Acta Oncol. 2024;63:563–72.

https://doi.org/10.2340/1651-226X.2024.40431 DOI: https://doi.org/10.2340/1651-226X.2024.40431

Samuelsen SO. A pseudolikelihood approach to analysis of nested case-control studies. Biometrika. 1997;84(2):379–94.

https://doi.org/10.1093/biomet/84.2.379 DOI: https://doi.org/10.1093/biomet/84.2.379

Statistics Sweden (SCB). Population by age, sex and year. 2024, Solna, Sweden.

Fay MP. Two-sided exact tests and matching confidence intervals for discrete data. R J. 2010;2(1):53–8.

https://doi.org/10.32614/RJ-2010-008 DOI: https://doi.org/10.32614/RJ-2010-008

Cook RJ, Lawless JF. Marginal analysis of recurrent events and a terminating event. Stat Med. 1997;16(8):911–24. DOI: https://doi.org/10.1002/(SICI)1097-0258(19970430)16:8<911::AID-SIM544>3.0.CO;2-I

https://doi.org/10.1002/(SICI)1097-0258(19970430)16:8%3C911::AID-SIM544%3E3.0.CO;2-I

Ghosh D, Lin DY. Nonparametric analysis of recurrent events and death. Biometrics. 2000;56(2):554–62.

https://doi.org/10.1111/j.0006-341X.2000.00554.x DOI: https://doi.org/10.1111/j.0006-341X.2000.00554.x

Kulldorff M, Dashevsky I, Avery TR, Chan AK, Davis RL, Graham D, et al. Drug safety data mining with a tree-based scan statistic. Pharmacoepidemiol Drug Saf. 2013;22(5):517–23.

https://doi.org/10.1002/pds.3423 DOI: https://doi.org/10.1002/pds.3423

Wintzell V, Svanstrom H, Melbye M, Ludvigsson JF, Pasternak B, Kulldorff M. Data mining for adverse events of tumor necrosis factor-alpha inhibitors in pediatric patients: tree-based scan statistic analyses of Danish nationwide health data. Clin Drug Investig. 2020;40(12):1147–54.

https://doi.org/10.1007/s40261-020-00977-5 DOI: https://doi.org/10.1007/s40261-020-00977-5

Kulldorff M, Fang Z, Walsh SJ. A tree-based scan statistic for database disease surveillance. Biometrics. 2003;59(2):323–31.

https://doi.org/10.1111/1541-0420.00039 DOI: https://doi.org/10.1111/1541-0420.00039

Socialstyrelsen. ICD-10 SE [Internet]. Stockholm: Socialstyrelsen [Accessed March 13, 2024]; Available from: https://klassifikationer.socialstyrelsen.se

Williamson TJ, Stanton AL. Adjustment to life as a cancer survivor. In: Feuerstein M, Nekhlyudov L, editors. Handbook of cancer survivorship. Springer Nature; 2018. p. 29–48. DOI: https://doi.org/10.1007/978-3-319-77432-9_3

Caruso R, Nanni MG, Riba MB, Sabato S, Grassi L. The burden of psychosocial morbidity related to cancer: patient and family issues. Int Rev Psychiatry. 2017;29(5):389–402.

https://doi.org/10.1080/09540261.2017.1288090 DOI: https://doi.org/10.1080/09540261.2017.1288090

Glimelius I, Eloranta S, Ekberg S, Chang ET, Neovius M, Smedby KE. Increased healthcare use up to 10 years among relapse-free Hodgkin lymphoma survivors in the era of intensified chemotherapy and limited radiotherapy. Am J Hematol. 2017;92(3):251–8.

https://doi.org/10.1002/ajh.24623 DOI: https://doi.org/10.1002/ajh.24623

Additional Files

Published

2025-11-23

How to Cite

Entrop, J. P., Wintzell, V., Dietrich, C. E., Glimelius, I., El-Galaly, T. C., Smedby, K. E., & Eloranta, S. (2025). Utilisation of healthcare in children born to lymphoma survivors in Sweden. Acta Oncologica, 64, 1600–1606. https://doi.org/10.2340/1651-226X.2025.43950

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