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Survivors of Childhood and Adolescent Cancerous Brain Tumours Have Increased Risk of Psychiatric Hospital Admissions

Individuals who have survived cancerous brain tumours during childhood or adolescence have a significantly increased overall risk of admission to a hospital psychiatric department or a psychiatric facility, compared with rates of hospitalisation for psychiatric disease among the general population.

Lone Ross, MD, PhD, of the Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark, and colleagues identified 3710 individuals from the Danish Cancer Registry who were diagnosed with a cancer prior to age 20 years during the period of January 1, 1943 to December 31, 1990, and were either still alive or born after January 1, 1970. They linked these data with information on all admissions to psychiatric hospitals or psychiatric departments of general hospitals as recorded in the Danish Psychiatric Central Register. Average follow-up of the study cohort was 14.9 years from diagnosis.

Overall, 126 survivors accounted for 217 first admissions for psychiatric disease. Compared with psychiatric patients in the general population, the highest standard hospitalisation ratios were observed for psychoses of somatic cerebral cause (3.0), psychiatric disorders in somatic diseases (2.5), psychiatric disorders in children (2.2), and schizophrenia and related disorders (1.6).

Among the 973 survivors of brain tumours, 51 had one or more psychiatric hospitalisations for a total of 88 admissions. Among this subgroup, the standard hospitalisation ratios for the risk of admission for schizophrenia and related disorders was 2.4, for psychoses of somatic cerebral causes was 7.7, for psychiatric disorders in children was 5.2, and for psychiatric disorders in somatic diseases was 5.1, compared with psychiatric hospitalisations among the general population.

The overall study population, "did not have a significantly altered risk of any other psychiatric diagnose, including affective disorders," the researchers write.

Dr. Ross and colleagues conclude, "The significantly increased risk of any psychiatric hospitalisation after a diagnosis of cancer during childhood or adolescence in our study was confined to the subgroup of survivors who had had brain tumours." They add that, "high hospitalisation rates for psychoses with a somatic component point to a biologic rather than a psychological vulnerability among survivors of cancer."
N Engl J Med 2003;349:650-7.

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