Original Article
School Performance of Childhood Cancer Survivors: Mind the Teenagers!

https://doi.org/10.1016/j.jpeds.2010.07.008Get rights and content

Objective

To assess school performance in an unselected group of childhood cancer survivors and study risk factors for impairment.

Study design

Rates of repeating a grade were compared for patients with cancer, their siblings, and the general population. Phone questionnaires were administered to patients about the school career of their child in remission and their siblings. Responses about cancer survivors were compared with those concerning their siblings and various registries provided by the national board of education. The primary outcome was the rate of repeating a grade.

Results

A total of 148 children in remission with a mean age of 15 ± 5.3 years and a mean follow-up period since diagnosis of 6.3 ± 1.3 years were included. More patients than siblings repeated a grade (33% versus 21%; P = .02), with a mean delay since diagnosis of 2 years. Risk factors were an older age at diagnosis, attending a secondary school, low education level of parents, bone marrow transplantation, cerebral surgery, and physical sequelae. In multivariate analysis, risk for repeating was associated with low educational level of the father, attending secondary school at diagnosis, and requiring school-organized educational support on return to school.

Conclusion

After cancer, repeating a grade is not an exceptional occurrence, especially for teenagers; follow-up and supportive interventions before returning to school would be beneficial.

Section snippets

Educational Support

In France, legislation establishes various supports for children who cannot attend school because of extended health problems. As in many other countries, in-hospital school services are provided. In our unit, a referent teacher coordinates teaching with the child's school and gives primary school pupils 1 hour of lessons per day, 4 days a week. For secondary schooling, 4 main subjects (mathematics, native language, foreign language [English, Spanish or German], and history) generally are

Results

Of 186 eligible patients, completed questionnaires were obtained for 148 children (79.6%). Thirty-eight questionnaires could not be filled in because of wrong phone numbers (n = 21), lost medical data (n = 6), inability to contact the family by phone (n = 8), or parents' refusal (n = 2). Participants in the study and non-participants did not differ in age, sex, or time since diagnosis of the disease, but there were more hematologic malignancies and fewer cerebral tumors in the participant than

Discussion

We studied school performance by evaluating the rate of repeating a grade rather than by performing neurocognitive tests. IQ test results are not related to well-being at school.7 The rate of repeating a grade, however, is also a problematic measure because this practice is not common in English-speaking and many other countries, which complicates comparison with published data. We found that survivors of cancer did not repeat a grade more often than the general reference population of the same

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      The primary endpoint was repeating a grade after the AL diagnosis. Patients who stopped attending school (at an establishment or at home) immediately after the diagnosis were also considered to have repeated a grade because of the very small size of this category (n = 2).13 The secondary endpoint took into consideration a broader definition of scholastic difficulties if at least 1 of these events occurred after the AL diagnosis: repeating a grade, changing orientation, or changing to a specialized educational track.

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    The authors declare no conflicts of interest.

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