Children who survive cancer face educational difficulties and social isolation

A new study finds children who survive cancer have about twice the rate of educational and social problems compared to children without a history of cancer.

The study, published in the October 15, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society, finds children with brain tumors, neuroblastoma, or leukemia and children treated with cranial radiation therapy (CRT) are at greatest risk for educational difficulties and social isolation.

As therapies for childhood cancers have become more complex and aggressive, children have benefited with increased cure rates and longer survival. Increasingly, researchers are studying the long-term outcomes of these treatments and unearthing troubling findings for these children's development. Though studies are small and limited to leukemias and central nervous system tumors, the findings suggest increased risk of some secondary cancers and decreased quality of life and psychosocial adjustment.

In the first large Canadian study of the long-term effects of childhood cancer and its treatments on survivors' educational and social development, Maru Barrera, Ph.D. from The Hospital of Sick Children in Toronto and her colleagues surveyed the parents of 800 still school age cancer survivors and 923 age- and gender-matched cancer-free subjects (controls).

The researchers found that survivors had more difficulties in school and suffered more often from social isolation. Academically, 46 percent of survivors reported academic problems compared to only 23 percent of controls. Compared to controls, cancer survivors more often repeated a grade (21 percent vs. 9 percent); attended learning disability (19 percent vs. 7 percent) or special education programs (20 percent vs. 8 percent). Children with brain cancers, leukemia, and neuroblastoma and those treated with CRT or combined CRT and intrathecal methotrexate (IT MTX) were more likely to report educational difficulties.

Socially, cancer survivors reported no close friends (19 percent vs. 8 percent) and less often used friends as confidants (58 percent vs. 67 percent). Children with brain tumors were more likely to report difficulties with friendships. Children with leukemia or neuroblastoma are also at greater risk for social adjustment difficulties, which has not been previously reported. Also previously not reported, children treated with CRT alone were at greater risk of developing social problems.

Dr. Barrera concludes, "Child and adolescent survivors of childhood cancer were more likely to experience educational difficulties and less likely to have close friends or use friends as confidants than population controls of the same age and gender." The authors conjecture that "the poorer social and educational outcomes of the survivors are the result of a multitude of disease, treatment and situational factors."