Educational and social late effects of childhood cancer and related clinical, personal, and familial characteristics

Abstract

Background: The objectives of this study were to compare educational and social outcomes for young survivors of childhood cancer with a population control group of individuals who were never diagnosed with cancer and to identify risk and protective factors for these outcomes.

Methods: In this multicenter, Canadian, retrospective cohort study, 800 survivors age 17 years or younger were matched by age and gender with a group of 923 control participants. Using a mailed survey that was completed by parents, educational outcomes were assessed with questions about the child's enrollment in disability or special-education programs, repeating a grade, and academic or other school problems. Using friendships was the measure of social outcomes.

Results: Based on parental reports, significantly more survivors than controls repeated a grade (21% vs. 9%), attended learning-disability (19% vs. 7%) or special-education programs (20% vs. 8%), had educational or other school problems (46% vs. 23%), had no close friends (19% vs. 8%), and were less likely to use friends as confidants (58% vs. 67%). Survivors of central nervous system (CNS) tumors reportedly were more likely than controls to have educational problems and no close friends, followed by survivors of leukemia, and survivors of neuroblastoma. Among survivors, cranial radiation increased the likelihood of having educational difficulties and having no close friends compared with survivors who did not receive cranial radiation. Survivors who reportedly had high self-esteem and whose parents had postsecondary education had fewer educational and social problems.

Conclusions: Children and adolescents who survived cancer, particularly those who had CNS tumors, leukemia, and neuroblastoma, required close monitoring for early educational and social difficulties, and such children should be offered educational rehabilitation and social skills training to maximize their academic and social success.