Education, employment, insurance, and marital status among 694 survivors of pediatric lower extremity bone tumors: a report from the childhood cancer survivor study.
BACKGROUND
With increasing numbers of childhood cancer survivors, direct sequelae of cancer therapy and psychosocial outcomes are becoming more important. The authors described psychosocial outcomes (education, employment, health insurance, and marriage) for survivors of pediatric lower extremity bone tumors.


METHODS
The long-term follow-up study of the Childhood Cancer Survivor Study is a multiinstitutional cohort study comprising 14,054 individuals who have survived for 5 or more years after treatment for cancer diagnosed during childhood or adolescence. Baseline demographic and medical information were obtained. Six hundred ninety-four survivors had osteosarcoma or Ewing sarcoma of the lower extremity or pelvis and were classified by amputation status and by age at diagnosis. The median age at diagnosis was 14 years old with a median of 16 years of follow up since diagnosis. Demographic characteristics were used to analyze the rates of psychosocial outcomes.


RESULTS
Amputation status and age at diagnosis did not significantly influence any of the measured psychosocial outcomes. Education was a significant positive predictor of employment, having health insurance, and being currently in their first marriage. Male gender predicted ever being employed and female gender predicted having health insurance and marriage. When compared with siblings, amputees had significant deficits in education, employment, and health insurance.


CONCLUSIONS
Overall, no differences between amputees and nonamputees were found. However, gender and education play a prominent role. When compared with siblings, amputees in this cohort may benefit from additional supports.
Nagarajan
Rajaram
R
Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA. nagar003@umn.edu
Neglia
Joseph P
JP
Clohisy
Denis R
DR
Yasui
Yutaka
Y
Greenberg
Mark
M
Hudson
Melissa
M
Zevon
Michael A
MA
Tersak
Jean M
JM
Ablin
Arthur
A
Robison
Leslie L
LL
D000293:Adolescent; D000328:Adult; D000674:Amputees / Q000523:psychology / Q000706:statistics & numerical data; D001859:Bone Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D002140:California / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D004493:Education; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007348:Insurance, Health; D035002:Lower Extremity; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D012516:Osteosarcoma / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000628:therapy; D010388:Pelvis; D010414:Pennsylvania / Q000453:epidemiology; D011788:Quality of Life; D012512:Sarcoma, Ewing / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000628:therapy; D012737:Sex Factors; D035781:Siblings; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data*; D013714:Tennessee / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology