title: Utilization of special education services and educational attainment among long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.
abstract: 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%CI, 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%CI, 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.
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School and Cancer Center, Minneapolis, Minnesota.
authors.forename: Pauline A
authors.initials: PA
authors.lastname: Mitby
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: John A
authors.initials: JA
authors.lastname: Whitton
authors.forename: Michael A
authors.initials: MA
authors.lastname: Zevon
authors.forename: Iris C
authors.initials: IC
authors.lastname: Gibbs
authors.forename: Jean M
authors.initials: JM
authors.lastname: Tersak
authors.forename: Anna T
authors.initials: AT
authors.lastname: Meadows
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Lonnie K
authors.initials: LK
authors.lastname: Zeltzer
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004519:Education, Special; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D017741:Survivors