Utilization of special education services and educational attainment among long-term survivors of childhood cancer - A report from the Childhood Cancer Survivor Study
Utilization of special education services and educational attainment among long-term survivors of childhood cancer - A report from the Childhood Cancer Survivor Study
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DOI：
10.1002/cncr.11117
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发表时间：
2003-02-15
期刊：
影响因子：
6.2
通讯作者：
Mertens, AC
中科院分区：
文献类型：
--
作者：
Mitby, PA;Robison, LL;Mertens, AC
背景资料。本报告的目的是比较特定的儿童癌症幸存者群体和随机抽样的兄弟姐妹对照的特殊教育(SE)和教育程度的自报率。方法：儿童癌症幸存者研究是对儿童时期被诊断为癌症并在确诊后至少5年存活的个人进行的回顾性队列研究。这项分析包括12430名幸存者和3410名完整的兄弟姐妹。结果：23%的幸存者和8%的兄弟姐妹报告了使用SE服务的情况，其中最大的差异是在6岁之前被确诊的幸存者，最显著的是中枢神经系统肿瘤的幸存者(优势比[OR]，18.8；95%的可信区间[95%CI]，15.01-23.49)，白血病(OR，4.4；95%可信区间3.75~5.16)和何杰金氏病(OR 4.4；95%可信区间2.64~7.24)。研究发现，鞘内注射甲氨蝶呤(IT MTX)和头颅放射治疗(CRT)单独或联合使用SE的可能性显著增加(单独使用IT MTX：OR，1.3；95%CI，1.09-1.78；仅使用CRT：OR，7.2；95%CI，6.14-8.39；IT MTX和CRT联合使用：OR：2.6；95%CI，2.30-2.95)。在较高剂量的CRT和使用SE之间发现了积极的剂量反应。与兄弟姐妹相比，白血病(OR，1.6；95%CT，1.23-2.16)、中枢神经系统肿瘤(OR，2.7；95%CI，1.92-3.81)、非霍奇金淋巴瘤(OR 1.8；95%CI，1.15-2.78)和神经母细胞瘤(OR，1.7；95%CI，1.14-2.61)的幸存者完成高中学业的可能性显著降低；然而，当幸存者接受SE服务时，风险估计与兄弟姐妹SE人群的风险估计相似。结论：被诊断为癌症的儿童在治疗期间和治疗后应密切跟踪，以确定学习障碍的早期迹象，并最大限度地采取干预策略，成功完成学业目标。
BACKGROUND. The objective of the current report was to compare the self-reported rates of special education (SE) and educational attainment among specific groups of childhood cancer survivors and a random sample of sibling controls.METHODS. The Childhood Cancer Survivor Study is a retrospective cohort of individuals who were diagnosed with a cancer in childhood and survived at least 5 years postdiagnosis. This analysis includes 12,430 survivors and 3410 full siblings. Reported use of SE services and educational attainment were analyzed within subgroups defined by type of cancer, age at diagnosis, and type of treatment.RESULTS. The use of SE services was reported in 23% of survivors and 8% of siblings, with the greatest differences observed among survivors who were diagnosed before age 6 years, most notably survivors of central nervous system (CNS) tumors (odds ratio [OR], 18.8; 95% confidence interval [95%CI], 15.01-23.49), leukemia (OR, 4.4; 95%CI, 3.75-5.16), and Hodgkin disease (OR, 4.4; 95% CI, 2.64-7.24). It was found that intrathecal methotrexate (IT MTX) and cranial radiation (CRT), administered alone or in combination, significantly increased the likelihood that a survivor would use SE (IT MTX only: OR, 1.3; 95%CI, 1.09-1.78; CRT only: OR, 7.2; 95%CI, 6.14-8.39; IT MTX and CRT combined: OR, 2.6; 95%CI, 2.30-2.95). A positive dose response was identified between higher doses of CRT and use of SE. It was determined that survivors of leukemia (OR, 1.6; 95%Ct, 1.23-2.16), CNS tumors (OR, 2.7; 95%CI, 1.92-3.81), non-Hodgkin lymphoma (OR, 1.8; 95% CI, 1.15-2.78), and neuroblastoma (OR, 1.7; 95%C1, 1.14-2.61) were significantly less likely to finish high school compared with siblings; however, when survivors received SE services, risk estimates approximated those of the sibling SE population.CONCLUSIONS. Children who are diagnosed with cancer should be followed closely during and after treatment to identify early signs of learning disabilities and to maximize intervention strategies for the successful completion of scholastic goals.