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Non-graduation after comprehensive school, and early retirement but not unemployment are prominent in childhood cancer survivors—a Finnish registry-based study

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Abstract

Background

In order to assess neurocognitive and social outcomes after childhood cancer, we explored the educational and vocational attainments of Finnish survivors in comparison to matched population controls.

Methods

From national registries, we identified survivors (n = 3243) born from 1960 to 1992 and aged below 16 at cancer diagnosis (years 1964–2009) as well as their controls (n = 16,215). Data on educational achievements, yearly income, employment status, and retirement were retrieved from Statistics Finland.

Results

The median (range) age at study was 28 (17–50) years. The proportion of those with no education after comprehensive school was higher than controls for all the diagnostic groups: brain tumor (BT) (33.5 vs 23.0 %), solid tumor (ST) (25.0 vs 21.4 %), and leukemia/NHL (29.2 vs 23.1 %). Odds ratios (OR) for unemployment were not significantly elevated in any survivor group compared to controls, but OR for being retired was elevated in each survivor group (BT 14.8, ST 2.2, leukemia/NHL 4.0). Irradiation significantly increased that OR only in BT survivors. Leukemia/NHL survivors treated after 1992 had lower risk for early retirement (OR 0.6) compared to those diagnosed earlier.

Conclusions

Survivors had higher frequencies than controls for lacking further education after comprehensive school. Unemployment was not common, but risk for early retirement was significantly increased in each three survivor group.

Implications for Cancer Survivors

Reassuring is that premature retirement was less common during the most recent treatment era. Screening and follow-up of psychosocial performance more effectively might be essential, and there is a need for studies on possibility for effective rehabilitation of the survivors.

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References

  1. Bonneau J, Lebreton J, Taque S, Chappe C, Bayart S, Edan C, et al. School performance of childhood cancer survivors: mind the teenagers. J Pediatr. 2011 Jan;158(1):135–41.

    Article  PubMed  Google Scholar 

  2. Harila-Saari AH, Lahteenmaki PM, Pukkala E, Kyyronen P, Lanning M, Sankila R. Scholastic achievements of childhood leukemia patients: a nationwide, register-based study. J Clin Oncol. 2007;25(23):3518–24.

    Article  PubMed  Google Scholar 

  3. Lahteenmaki PM, Sankila R, Pukkala E, Kyyronen P, Harila-Saari A. Scholastic achievement of children with lymphoma or Wilms tumor at the end of comprehensive education—a nationwide, register-based study. Int J Cancer. 2008;123(10):2401–5.

    Article  CAS  PubMed  Google Scholar 

  4. Mitby PA, Robison LL, Whitton JA, Zevon MA, Gibbs IC, Tersak JM, et al. Utilization of special education services and educational attainment among long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer. 2003;97(4):1115–26.

    Article  PubMed  Google Scholar 

  5. Di Pinto M, Conklin HM, Li C, Merchant TE. Learning and memory following conformal radiation therapy for pediatric craniopharyngioma and low-grade glioma. Int J Radiat Oncol Biol Phys. 2012;84(3):e363–9.

    Article  PubMed  Google Scholar 

  6. Shortman RI, Lowis SP, Penn A, McCarter RJ, Hunt LP, Brown CC, et al. Cognitive function in children with brain tumors in the first year after diagnosis compared to healthy matched controls. Pediatr Blood Cancer. 2014 Mar;61(3):464–72.

    Article  PubMed  Google Scholar 

  7. Lancashire ER, Frobisher C, Reulen RC, Winter DL, Glaser A, Hawkins MM. Educational attainment among adult survivors of childhood cancer in Great Britain: a population-based cohort study. J Natl Cancer Inst. 2010;102(4):254–70.

    Article  CAS  PubMed  Google Scholar 

  8. Lorenzi M, McMillan AJ, Siegel LS, Zumbo BD, Glickman V, Spinelli JJ, et al. Educational outcomes among survivors of childhood cancer in British Columbia, Canada: report of the Childhood/Adolescent/Young Adult Cancer Survivors (CAYACS) Program. Cancer. 2009;115(10):2234–45.

    Article  PubMed  Google Scholar 

  9. Lahteenmaki PM, Harila-Saari A, Pukkala EI, Kyyronen P, Salmi TT, Sankila R. Scholastic achievements of children with brain tumors at the end of comprehensive education: a nationwide, register-based study. Neurology. 2007;69(3):296–305.

    Article  CAS  PubMed  Google Scholar 

  10. Koch SV, Kejs AM, Engholm G, Johansen C, Schmiegelow K. Educational attainment among survivors of childhood cancer: a population-based cohort study in Denmark. Br J Cancer. 2004;91(5):923–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Brinkman TM, Reddick WE, Luxton J, Glass JO, Sabin ND, Srivastava DK, et al. Cerebral white matter integrity and executive function in adult survivors of childhood medulloblastoma. Neuro-Oncology. 2012 Sep;14(Suppl 4):iv25–36.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Reddick WE, Taghipour DJ, Glass JO, Ashford J, Xiong X, Wu S, et al. Prognostic factors that increase the risk for reduced white matter volumes and deficits in attention and learning for survivors of childhood cancers. Pediatr Blood Cancer. 2014 Jun;61(6):1074–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Castellino SM, Ullrich NJ, Whelen MJ, Lange BJ. Developing interventions for cancer-related cognitive dysfunction in childhood cancer survivors. J Natl Cancer Inst 2014 Jul 30;106(8):10.1093/jnci/dju186. Print 2014 Aug.

  14. Kadan-Lottick NS, Zeltzer LK, Liu Q, Yasui Y, Ellenberg L, Gioia G, et al. Neurocognitive functioning in adult survivors of childhood non-central nervous system cancers. J Natl Cancer Inst. 2010;102(12):881–93.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Krull KR, Sabin ND, Reddick WE, Zhu L, Armstrong GT, Green DM, et al. Neurocognitive function and CNS integrity in adult survivors of childhood hodgkin lymphoma. J Clin Oncol. 2012;30(29):3618–24.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hawkins MM, Robison LL. Importance of clinical and epidemiological research in defining the long-term clinical care of pediatric cancer survivors. Pediatr Blood Cancer. 2006 Feb;46(2):174–8.

    Article  PubMed  Google Scholar 

  17. Boman KK, Hoven E, Anclair M, Lannering B, Gustafsson G. Health and persistent functional late effects in adult survivors of childhood CNS tumours: a population-based cohort study. Eur J Cancer. 2009 Sep;45(14):2552–61.

    Article  CAS  PubMed  Google Scholar 

  18. Armstrong GT, Reddick WE, Petersen RC, Santucci A, Zhang N, Srivastava D, et al. Evaluation of memory impairment in aging adult survivors of childhood acute lymphoblastic leukemia treated with cranial radiotherapy. J Natl Cancer Inst. 2013;105(12):899–907.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kuehni CE, Strippoli MP, Rueegg CS, Rebholz CE, Bergstraesser E, Grotzer M, et al. Educational achievement in Swiss childhood cancer survivors compared with the general population. Cancer. 2012;118(5):1439–49.

    Article  PubMed  Google Scholar 

  20. Dieluweit U, Debatin KM, Grabow D, Kaatsch P, Peter R, Seitz DC, et al. Educational and vocational achievement among long-term survivors of adolescent cancer in Germany. Pediatr Blood Cancer. 2011 Mar;56(3):432–8.

    Article  PubMed  Google Scholar 

  21. Boman KK, Lindblad F, Hjern A. Long-term outcomes of childhood cancer survivors in Sweden: a population-based study of education, employment, and income. Cancer. 2010;116(5):1385–91.

    Article  PubMed  Google Scholar 

  22. Ellenberg L, Liu Q, Gioia G, Yasui Y, Packer RJ, Mertens A, et al. Neurocognitive status in long-term survivors of childhood CNS malignancies: a report from the Childhood Cancer Survivor Study. Neuropsychology. 2009 Nov;23(6):705–17.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Crom DB, Lensing SY, Rai SN, Snider MA, Cash DK, Hudson MM. Marriage, employment, and health insurance in adult survivors of childhood cancer. J Cancer Surviv. 2007 Sep;1(3):237–45.

    Article  PubMed  Google Scholar 

  24. Pang JW, Friedman DL, Whitton JA, Stovall M, Mertens AC, Robison LL, et al. Employment status among adult survivors in the Childhood Cancer Survivor Study. Pediatr Blood Cancer. 2008 Jan;50(1):104–10.

    Article  PubMed  Google Scholar 

  25. de Boer AG, Verbeek JH, van Dijk FJ. Adult survivors of childhood cancer and unemployment: a metaanalysis. Cancer. 2006;107(1):1–11.

    Article  PubMed  Google Scholar 

  26. Kirchhoff AC, Krull KR, Ness KK, Armstrong GT, Park ER, Stovall M, et al. Physical, mental, and neurocognitive status and employment outcomes in the childhood cancer survivor study cohort. Cancer Epidemiol Biomark Prev. 2011 Sep;20(9):1838–49.

    Article  Google Scholar 

  27. Reimers TS, Ehrenfels S, Mortensen EL, Schmiegelow M, Sonderkaer S, Carstensen H, et al. Cognitive deficits in long-term survivors of childhood brain tumors: identification of predictive factors. Med Pediatr Oncol. 2003 Jan;40(1):26–34.

    Article  PubMed  Google Scholar 

  28. Armstrong GT, Conklin HM, Huang S, Srivastava D, Sanford R, Ellison DW, et al. Survival and long-term health and cognitive outcomes after low-grade glioma. Neuro-Oncology. 2011 Feb;13(2):223–34.

    Article  PubMed  Google Scholar 

  29. Packer RJ, Sutton LN, Atkins TE, Radcliffe J, Bunin GR, D'Angio G, et al. A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: 2-year results. J Neurosurg. 1989 May;70(5):707–13.

    Article  CAS  PubMed  Google Scholar 

  30. Netson KL, Conklin HM, Wu S, Xiong X, Merchant TE. Longitudinal investigation of adaptive functioning following conformal irradiation for pediatric craniopharyngioma and low-grade glioma. Int J Radiat Oncol Biol Phys. 2013;85(5):1301–6.

    Article  PubMed  Google Scholar 

  31. Ottaviani G, Robert RS, Huh WW, Palla S, Jaffe N. Sociooccupational and physical outcomes more than 20 years after the diagnosis of osteosarcoma in children and adolescents: limb salvage versus amputation. Cancer. 2013;119(20):3727–36.

    Article  PubMed  Google Scholar 

  32. Kunin-Batson A, Kadan-Lottick N, Neglia JP. The contribution of neurocognitive functioning to quality of life after childhood acute lymphoblastic leukemia. Psychooncology. 2014. Feb 4.

  33. Conklin HM, Krull KR, Reddick WE, Pei D, Cheng C, Pui CH. Cognitive outcomes following contemporary treatment without cranial irradiation for childhood acute lymphoblastic leukemia. J Natl Cancer Inst. 2012;104(18):1386–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Waber DP, Queally JT, Catania L, Robaey P, Romero I, Adams H, et al. Neuropsychological outcomes of standard risk and high risk patients treated for acute lymphoblastic leukemia on Dana-Farber ALL consortium protocol 95-01 at 5 years post-diagnosis. Pediatr Blood Cancer. 2012 May;58(5):758–65.

    Article  PubMed  Google Scholar 

  35. Zynda A, Reinmuth S, Pfitzer C, Hohmann C, Keil T, Borgmann-Staudt A. Childhood leukemia and its impact on graduation and having children: results from a national survey. Leuk Lymphoma. 2012 Dec;53(12):2419–22.

    Article  PubMed  Google Scholar 

  36. Holmqvist AS, Wiebe T, Hjorth L, Lindgren A, Ora I, Moell C. Young age at diagnosis is a risk factor for negative late socio-economic effects after acute lymphoblastic leukemia in childhood. Pediatr Blood Cancer. 2010 Oct;55(4):698–707.

    Article  PubMed  Google Scholar 

  37. Bisen-Hersh EB, Hineline PN, Walker EA. Effects of early chemotherapeutic treatment on learning in adolescent mice: implications for cognitive impairment and remediation in childhood cancer survivors. Clin Cancer Res. 2013;19(11):3008–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Zou P, Li Y, Conklin HM, Mulhern RK, Butler RW, Ogg RJ. Evidence of change in brain activity among childhood cancer survivors participating in a cognitive remediation program. Arch Clin Neuropsychol. 2012 Dec;27(8):915–29.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hardy KK, Willard VW, Allen TM, Bonner MJ. Working memory training in survivors of pediatric cancer: a randomized pilot study. Psychooncology. 2013 Aug;22(8):1856–65.

    Article  PubMed  Google Scholar 

  40. Moore IM, Hockenberry MJ, Anhalt C, McCarthy K, Krull KR. Mathematics intervention for prevention of neurocognitive deficits in childhood leukemia. Pediatr Blood Cancer. 2012 Aug;59(2):278–84.

    Article  PubMed  Google Scholar 

  41. Hardy KK, Willard VW, Bonner MJ. Computerized cognitive training in survivors of childhood cancer: a pilot study. J Pediatr Oncol Nurs. 2011 Jan-Feb;28(1):27–33.

    Article  PubMed  Google Scholar 

  42. Patel SK, Katz ER, Richardson R, Rimmer M, Kilian S. Cognitive and problem solving training in children with cancer: a pilot project. J Pediatr Hematol Oncol. 2009 Sep;31(9):670–7.

    Article  PubMed  Google Scholar 

  43. Wenninger K, Helmes A, Bengel J, Lauten M, Volkel S, Niemeyer CM. Coping in long-term survivors of childhood cancer: relations to psychological distress. Psychooncology. 2013 Apr;22(4):854–61.

    Article  PubMed  Google Scholar 

  44. Howarth RA, Adamson AM, Ashford JM, Merchant TE, Ogg RJ, Schulenberg SE, et al. Investigating the relationship between COMT polymorphisms and working memory performance among childhood brain tumor survivors. Pediatr Blood Cancer. 2014 Jan;61(1):40–5.

    Article  PubMed  Google Scholar 

  45. Dumas A, Cailbault I, Perrey C, Oberlin O, De Vathaire F, Amiel P. Educational trajectories after childhood cancer: when illness experience matters. Soc Sci Med. 2015 Jun;135:67–74.

    Article  CAS  PubMed  Google Scholar 

  46. .Berbis J, Reggio C, Michel G, Chastagner P, Bertrand Y, Kanold J, et al. Employment in French young adult survivors of childhood leukemia: an LEA study (for Leucemies de l'Enfant et de l’Adolescent-childhood and adolescent leukemia). J Cancer Surviv. 2016. May 17.

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Authors and Affiliations

  1. Department of Pediatrics and Adolescence, Turku University Hospital, Tuijulankatu 24, 20540, Turku, Finland

    Ritva Ahomäki

  2. Childhood Cancer Research Unit, Stockholm, Sweden

    Arja Harila-Saari

  3. Department of Pediatrics and Adolescence, Oulu University Hospital, Astrid Lindgren Children’s Hospital, Turku, Finland

    Arja Harila-Saari

  4. The University of Turku, Turun Yliopisto, 20014, Turku, Finland

    Jaakko Matomäki

  5. Department of Pediatrics and Adolescence, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland

    Päivi M. Lähteenmäki

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  1. Ritva Ahomäki
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Correspondence to Ritva Ahomäki.

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Ahomäki, R., Harila-Saari, A., Matomäki, J. et al. Non-graduation after comprehensive school, and early retirement but not unemployment are prominent in childhood cancer survivors—a Finnish registry-based study. J Cancer Surviv 11, 284–294 (2017). https://doi.org/10.1007/s11764-016-0574-z

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  • DOI: https://doi.org/10.1007/s11764-016-0574-z

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