Childhood cancer survivors face more social, school difficulties

Children who survive cancer are more likely than children without cancer to have social and educational problems as they grow up, according to the first large, nation-wide study of the issue published in the October 15 issue of the journal Cancer.

Dr. Maru Barrera of the Hospital for Sick Children in Toronto and her team also found that children with higher self esteem and those with more highly educated parents were less likely to experience such difficulties.

The study, Dr. Barrera told Reuters Health, “points out some ways in which with educational rehabilitation and social skills training programs we could perhaps prevent or reduce some of those educational problems and social problems in children.”

Radiation treatment and some types of chemotherapy, as well as central nervous system tumors and leukemia, have been tied to learning problems, Dr. Barrera and her team note in their report. They set out to look at a wider range of cancer types and to identify factors that might protect children from developing social and educational problems, as well as predisposing factors.

The researchers matched 800 cancer survivors 17 years old or younger to 923 children of the same age and sex who were never diagnosed with cancer. Parents of study participants completed a survey about their children’s educational and social development.

Twenty-one percent of the cancer survivors had repeated a grade, compared to 9 percent of the control group. Survivors were also more than twice as likely to attend a learning disability or special education program.

While 23 percent of healthy kids’ parents reported that they had problems in school or other academic difficulties, 46 percent of cancer survivors’ parents did. Cancer survivors appeared to fare worst in math, followed by English and science.

The researchers used friendships to evaluate kids’ social development, and found the cancer survivors again had more difficulty. While 19 percent of the cancer survivors had no close friends, according to their parents, 8 percent of the control children did. Cancer survivors were also somewhat less likely to use friends as confidants, with 58 percent doing so compared to 67 percent of children who never had cancer.

The risk of social and educational problems was particularly high for children who had tumors of the brain or spine, leukemia, or neuroblastoma. Children who had received radiation focused on the cranial area were also at greater risk, while children with higher self-esteem and those whose parents’ education had extended past secondary school were less likely to have social and educational problems.

A wide variety of factors could be responsible for the deficits seen in the cancer survivors, the researchers note—the disease itself, brain damage caused by radiation or certain types of chemotherapy, and even having to miss school for treatment.

“It appears that the poorer social and educational outcomes of the survivors are the results of a multitude of disease, treatment, and situational factors,” they write.

“Clearly what the study does show is that it is important to identify those survivors who are at the highest risk for educational and social outcomes, and then design programs to help them reduce the poor outcomes,” Dr. Barrera told Reuters Health.

Kids who survive cancer face a number of challenges to their self-esteem, she noted—some may become very thin due to treatment, while others may gain weight. Children can lose their hair and may require surgery that can be disfiguring.

“It is very important that parents, health-care professionals, teachers and the educational system help them develop a good self concept, a good self perception, so that they can thrive,” Barrera concluded.

SOURCE: Cancer 2005;104.

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