Elsevier

The Journal of Pediatrics

Volume 205, February 2019, Pages 168-175.e2
The Journal of Pediatrics

Original Articles
Adolescence and Socioeconomic Factors: Key Factors in the Long-Term Impact of Leukemia on Scholastic Performance—A LEA Study

https://doi.org/10.1016/j.jpeds.2018.09.047Get rights and content

Objective

To evaluate the association between medical and social environmental factors and the risk of repeating a grade in childhood leukemia survivors.

Study design

A cross-sectional study of childhood leukemia survivors, recruited through the LEA cohort (Leucémie de l'Enfant et de l'Adolescent [French Childhood Cancer Survivor Study for Leukemia]) in 2014. An adjusted logistic regression model was used to identify variables linked to repeating a grade after the diagnosis among the survivors, and the rates of repeating a grade were compared between the survivors and their siblings using a multilevel logistic regression model.

Results

The mean age at inclusion of the 855 participants was 16.2 ± 7.0 years, and the mean duration of follow-up from diagnosis to evaluation was 10.2 ± 6.2 years. After disease onset, 244 patients (28.5%) repeated a grade, with a median interval of 4 years (IQR, 2-8 years). Independent factors associated with repeating a grade were male sex (OR, 1.78; 95% CI, 1.21-2.60), adolescence (OR, 2.70; 95% CI, 1.63-4.48), educational support during the treatment period (OR, 3.79; 95% CI, 2.45-5.88), low parental education level (OR, 2.493; 95% CI, 1.657-3.750), and household financial difficulties (OR, 2.62; 95% CI, 1.607-4.28). Compared with siblings, survivors were at greater risk of repeating a grade (OR, 1.87; 95% CI, 1.48-2.35).

Conclusions

The most vulnerable patients seemed to be adolescents and those with parents of low socioeconomic status. Improving the schooling career of leukemia survivors will require that the medical community more carefully consider the social status of patients.

Section snippets

Methods

The LEA project is a French multicenter prospective long-term follow-up program involving all childhood AL survivors treated before age 18 years in the participating centers (currently 16 academic hospitals) since 1980. The program has been described in detail previously.16 In brief, patients are included 1 year after the completion of chemotherapy or after hematopoietic stem cell transplantation (HSCT), and assessments are performed every 2 years up to the age 20 years and every 4 years

Results

Of the 1225 patients evaluated in the LEA cohort in 2014, 22 met at least 1 of the exclusion criteria. Of the 1203 eligible patients, 866 completed the questionnaire (72.0%). The responding and nonresponding groups did not differ with respect to sex, current age and age at diagnosis, type of leukemia, history of relapse, or irradiation received, but a history of transplantation was more common in the nonresponders (24.4% vs 18.2%; P = .02). Among the respondents, 11 patients were excluded from

Discussion

This study reports long-term schooling of leukemia survivors, whereas previous studies investigating schooling have used a national cohort of cancer survivors (not only leukemia survivors).1, 7 For example, Zynda et al reported German leukemia survivors, but with a lower rate of participation (64%).9

In our study, after leukemia, 28.5% of patients repeated a grade, with a median interval of 4 years. This rate was significantly higher than that for their siblings who shared the same socioeconomic

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    Funded by the French National Clinical Research Program, the French National Cancer Institute, the French National Research Agency, the French League Against Cancer, the Cancéropôle of Provence-Alpes-Côte d'Azur, the Regional Council of Provence-Alpes-Côte d'Azur, the Hérault and Bouches-du-Rhone Departmental Committees of the League Against Cancer and the French Institute for Public Health Research. The authors declare no conflicts of interest.

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    Contributed equally.

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