Social, Academic Trouble Can Follow Childhood Cancer

But a focus on education may limit these aftereffects, experts say

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By Alan Mozes
HealthDay Reporter

MONDAY, Sept. 12, 2005 (HealthDay News) -- As they enter adolescence, long-term survivors of childhood cancer are twice as likely as their healthy counterparts to develop ongoing social, physical, and educational problems, a new study finds.

Children diagnosed with brain tumors, leukemia, or neuroblastoma -- a cancer affecting nervous tissue that is one of the most common among babies and young children -- are at particularly high risk of facing behavioral difficulties, the researchers said.

The study also found that children whose cancer treatment involved cranial radiation therapy (CRT) were more likely to have trouble building friendships, attaining a high level of self-esteem, managing stress and performing well at school as they aged.

"The implications are very important because when children are survivors and they're not doing very well in school or in relationships, it's a very pessimistic outcome," said study lead author Maru Barrera of the psychology department and the oncology and hematology program at The Hospital for Sick Children in Toronto, Canada.

Reporting in the Oct. 15 issue of the journal Cancer, Barrera and her colleagues analyzed data from written questionnaires administered between 1997 and 2000 to the parents of 800 Canadian boys and girls under 17 years of age.

All the children had been diagnosed with cancer between 1981 and 1990 and had survived their initial diagnosis for at least five years. On average, cancer diagnoses were made at 2 years of age, with post-diagnosis survival approaching 10 years.

In addition, the same survey was completed by the parents of more than 900 boys and girls with no history of cancer.

Barrera and her team found that, according to their parents, children who had survived cancer experienced more health problems, stress, academic problems, and social isolation than children with no history of cancer.

The cancer group also had lower self-esteem when compared with the healthy group.

In terms of school performance, 46 percent of the cancer survivors had a history of academic problems compared with 23 percent of the healthy children. This finding applied to both boys and girls.

About 20 percent of the childhood cancer survivors had attended a learning-disabled program, and a similar number had repeated or failed a grade. This compared with just seven percent and nine percent, respectively, among the healthy kids.

The cancer-survivor group was also found to be much more likely to obtain lower than average or failing grades in all basic subjects than were the healthy children.

In terms of social skills, the parents reported that children who had survived cancer were more likely than the healthy children to have no close friends (19 percent versus eight percent) while being less likely to confide in friends (58 percent versus 67 percent). This problem was especially pronounced in boys and younger children, the researchers added.

Overall, educational and social setbacks were greatest among children who had battled leukemia, brain cancer, or neuroblastoma. The fewer than 10 percent of survivors who had been treated with CRT alone were at the greatest risk of both academic and social obstacles -- while a combined treatment of CRT and the chemotherapy medication intrathecal methotrexate (IT MTX) was associated only with educational difficulties, the study found.

On a positive note, the researchers observed that those childhood cancer survivors whose parents had achieved higher levels of education were more likely to fare well both socially and academically. As well, survivors with higher self-esteem were also more likely to avoid such behavioral pitfalls.

The researchers expressed hope that as new treatment innovations lead to improved cancer survival rates, a greater understanding of the behavioral problems associated with childhood cancer might lead to better follow-up care -- care that specifically addresses the educational rehabilitation and social-skill needs of long-term survivors.

"There is something we can do as a society to counter the effects of cancer," said Barrera. "These were young survivors that still have possibilities, and as a society we can still intervene to help them so we can maximize their educational and social outcomes."

Dr. Edward C. Halperin, a professor in the departments of radiation oncology and pediatrics at Duke University Medical Center in Durham, N.C., agreed the picture for childhood cancer survivors is not all bleak.

"You have to remember it's not a sad story," he said. "No one gets the long-term side effects of surviving cancer unless they survive. So we're fortunate these children are living. And this issue is not surprising. Long-term adult survivors also have problems they need to learn to deal with. So some say part of the price of a cure is to learn to live with, and ameliorate and deal with, the long-term consequences of cancer survival."

Nevertheless, Halperin considers the issue to be "a matter of considerable public health concern."

"These children spend an exceptional amount of time in hospital, and so they're not building social relationships with other children and they're missing out on the childhood experiences of their peers," he pointed out. "This has an effect on intellectual function, growth, hormone function, their frequency of marriage, their employability, their insurability -- a growing list of problems."

Barrera said that one way to address these problems might be to emphasize the apparent benefits that academic achievement can confer on esteem building.

"We know that education makes a difference," she said. "Parents who have higher educational attainment generally encourage higher education in their children. And if the parents aren't doing that, then schools themselves can step in. This can foster higher self-esteem, and we found that if the children had higher self-esteem then the outcomes for them will be better."

More information

For more on childhood cancers, check with the National Cancer Institute.

SOURCES: Maru Barrera, Ph.D., department of psychology and the oncology and hematology program, The Hospital for Sick Children, Toronto, Canada; Edward C. Halperin, M.D., vice dean, school of medicine and professor, departments of radiation oncology and pediatrics, Duke University Medical Center, Durham, N.C.; Oct. 15, 2005, Cancer

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