Utilization of special education services and educational attainment among long-term survivors of childhood cancer

A report from the childhood cancer survivor study

Authors


  • The following CCSS Institutions and Investigators participated in the Childhood Cancer Survivor Study. University of California-San Francisco, San Francisco, CA: Arthur Ablin, M.D. (Institutional Principal Investigator); University of Alabama, Birmingham, AL: Roger Berkow, M.D. (Institutional Principal Investigator); International Epidemiology Institute, Rockville, MD: John Boice, Sc.D. (member of the CCSS Steering Committee); University of Washington, Seattle, WA: Norman Breslow, Ph.D. (member of the CCSS Steering Committee); UT-Southwestern Medical Center at Dallas, TX: George R. Buchanan, M.D. (Institutional Principal Investigator) and Kevin Oeffinger, M.D. (member of the CCSS Steering Committee); Dana-Farber Cancer Institute, Boston, MA: Lisa Diller, M.D. (Institutional Principal Investigator), Holcombe Grier, M.D. (former Institutional Principal Investigator), and Frederick Li, M.D. (member of the CCSS Steering Committee); Texas Children's Center, Houston, TX: Zoann Dreyer, M.D. (Institutional Principal Investigator); Children's Hospital and Medical Center, Seattle, WA: Debra Friedman, M.D., M.P.H. (Institutional Principal Investigator) and Thomas Pendergrass, M.D. (former Institutional Principal Investigator); Roswell Park Cancer Institute, Buffalo, NY: Daniel M. Green, M.D. (Institutional Principal Investigator and member of the CCSS Steering Committee); Hospital for Sick Children, Toronto, Ontario, Canada: Mark Greenberg, M.B., Ch.B. (Institutional Principal Investigator); St. Louis Children's Hospital, St. Louis, MO: Robert Hayashi, M.D. (Institutional Principal Investigator) and Teresa Vietti, M.D. (former Institutional Principal Investigator); St. Jude Children's Research Hospital, Memphis, TN: Melissa Hudson, M.D. (Institutional Principal Investigator and member of the CCSS Steering Committee); University of Michigan, Ann Arbor, MI: Raymond Hutchinson, M.D. (Institutional Principal Investigator); Stanford University School of Medicine, Stanford, CA: Michael P. Link, M.D. (Institutional Principal Investigator) and Sarah S. Donaldson, M.D. (member of the CCSS Steering Committee); Children's Hospital of Philadelphia, Philadelphia, PA: Anna Meadows, M.D. (Institutional Principal Investigator and member of the CCSS Steering Committee) and Bobbie Bayton (member of the CCSS Steering Committee); Children's Hospital, Oklahoma City, OK: John Mulvihill, M.D. (member of the CCSS Steering Committee); Children's Hospital, Denver, CO: Brian Greffe, M.D. (Institutional Principal Investigator) and, Lorrie Odom, M.D. (former Institutional Principal Investigator); Children's Health Care-Minneapolis, Minneapolis, MN: Maura O'Leary, M.D. (Institutional Principal Investigator); Columbus Children's Hospital, Columbus, OH: Amanda Termuhlen, M.D. (Institutional Principal Investigator), Frederick Ruymann, M.D. (former Institutional Principal Investigator) and Stephen Qualman, M.D. (member of the CCSS Steering Committee); Children's National Medical Center, Washington, DC: Gregory Reaman, M.D. (Institutional Principal Investigator) and Roger Packer, M.D. (member of the CCSS Steering Committee); Children's Hospital of Pittsburgh, Pittsburgh, PA: A. Kim Ritchey, M.D. (Institutional Principal Investigator) and Julie Blatt, M.D. (former Institutional Principal Investigator); University of Minnesota, Minneapolis, MN: Leslie L. Robison, Ph.D. (Institutional Principal Investigator and member of the CCSS Steering Committee), Ann Mertens, Ph.D. (member of the CCSS Steering Committee), Joseph Neglia, M.D., M.P.H. (member of the CCSS Steering Committee), Mark Nesbit, M.D. (member of the CCSS Steering Committee), and Stella Davies, M.D., Ph.D. (member of the CCSS Steering Committee); Children's Hospital, Los Angeles, CA: Kathy Ruccione, R.N., M.P.H. (Institutional Principal Investigator); Memorial Sloan-Kettering Cancer Center, New York, NY: Charles Sklar, M.D. (Institutional Principal Investigator and member of the CCSS Steering Committee); National Cancer Institute, Bethesda, MD: Malcolm Smith, M.D. (member of the CCSS Steering Committee) and Peter Inskipp, Ph.D. (member of the CCSS Steering Committee); Mayo Clinic, Rochester, MN: W. Anthony Smithson, M.D. (Institutional Principal Investigator) and Gerald Gilchrist, M.D. (former Institutional Principal Investigator); The University of Texas M. D. Anderson Cancer Center, Houston, TX: Louise Strong, M.D. (Institutional Principal Investigator and member of the CCSS Steering Committee) and Marilyn Stovall, Ph.D. (member of the CCSS Steering Committee); Riley Hospital for Children, Indianapolis, IN: Terry A. Vik, M.D. (Institutional Principal Investigator) and Robert Weetman, M.D. (former Institutional Principal Investigator); Fred Hutchinson Cancer Center, Seattle, WA: Yutaka Yasui, Ph.D. (Institutional Principal Investigator and member of the CCSS Steering Committee) and John Potter, M.D., Ph.D. (former Institutional Principal Investigator and member of the CCSS Steering Committee); University of California-Los Angeles, Los Angeles, CA: Lonnie Zeltzer, M.D. (Institutional Principal Investigator and member of the CCSS Steering Committee).

Abstract

BACKGROUND

The objective of the current report was to compare the self-reported rates of special education (SE) and educational attainment among specific groups of childhood cancer survivors and a random sample of sibling controls.

METHODS

The Childhood Cancer Survivor Study is a retrospective cohort of individuals who were diagnosed with a cancer in childhood and survived at least 5 years postdiagnosis. This analysis includes 12,430 survivors and 3410 full siblings. Reported use of SE services and educational attainment were analyzed within subgroups defined by type of cancer, age at diagnosis, and type of treatment.

RESULTS

The use of SE services was reported in 23% of survivors and 8% of siblings, with the greatest differences observed among survivors who were diagnosed before age 6 years, most notably survivors of central nervous system (CNS) tumors (odds ratio [OR], 18.8; 95% confidence interval [95%CI], 15.01–23.49), leukemia (OR, 4.4; 95%CI, 3.75–5.16), and Hodgkin disease (OR, 4.4; 95%CI, 2.64–7.24). It was found that intrathecal methotrexate (IT MTX) and cranial radiation (CRT), administered alone or in combination, significantly increased the likelihood that a survivor would use SE (IT MTX only: OR, 1.3; 95%CI, 1.09–1.78; CRT only: OR, 7.2; 95%CI, 6.14–8.39; IT MTX and CRT combined: OR, 2.6; 95%CI, 2.30–2.95). A positive dose response was identified between higher doses of CRT and use of SE. It was determined that survivors of leukemia (OR, 1.6; 95%CI, 1.23–2.16), CNS tumors (OR, 2.7; 95%CI, 1.92–3.81), non-Hodgkin lymphoma (OR, 1.8; 95%CI, 1.15–2.78), and neuroblastoma (OR, 1.7; 95%CI, 1.14–2.61) were significantly less likely to finish high school compared with siblings; however, when survivors received SE services, risk estimates approximated those of the sibling SE population.

CONCLUSIONS

Children who are diagnosed with cancer should be followed closely during and after treatment to identify early signs of learning disabilities and to maximize intervention strategies for the successful completion of scholastic goals. Cancer 2003;97:1115–26. © 2003 American Cancer Society.

DOI 10.1002/cncr.11117

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