title: Long-term outcomes of childhood cancer survivors in Sweden: a population-based study of education, employment, and income.
abstract: BACKGROUND
  Studies of different national populations were indispensable for estimating the impact of illness-related disability on social outcomes in adult childhood cancer survivors. The effects of childhood cancer on educational attainment, employment, and income in adulthood in a Swedish setting were studied.
  
  
  METHODS
  The study population was a national cohort of 1.46 million Swedish residents, including 1716 survivors of childhood cancer diagnosed before their 16th birthday, followed up in 2002 in registries at >25 years of age. Main outcomes were educational attainment, employment, and net income. Markers of persistent disability were considered, and outcomes were analyzed with multivariate linear and logistic regression models adjusted for age, sex, and socioeconomic indicators of the childhood households.
  
  
  RESULTS
  Non-central nervous system (CNS) cancer survivors had similar education, employment, and income as the general population in adjusted models, whereas survivors of CNS tumors more often had no more than basic (< or =9 years) education (relative risk [RR], 1.80 [95% confidence interval (95% CI), 1.45-2.23]), less often attained education beyond secondary school (RR, 0.69 [95% CI, 0.58-0.81]), and less often were employed (RR, 0.85 [95% CI, 0.77-0.94]). Predicted net income from work was lower in CNS tumor survivors (P <.001) than in the general population, even after the exclusion of individuals who received economic disability compensation.
  
  
  CONCLUSIONS
  CNS tumor survivors had poorer social outcomes compared with the general population, whereas outcomes for survivors of other childhood cancers were similar to the general population. Established late effects highlighted the importance of improved, safer pediatric CNS tumor treatment protocols and surveillance that identified individual needs for preventive and remedial measures.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. krister.boman@ki.se
authors.forename: Krister K
authors.initials: KK
authors.lastname: Boman
authors.forename: Frank
authors.initials: F
authors.lastname: Lindblad
authors.forename: Anders
authors.initials: A
authors.lastname: Hjern
mesh_terms: D000328:Adult; D016543:Central Nervous System Neoplasms / Q000191:economics; D002648:Child; D004522:Educational Status; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007182:Income; D008297:Male; D009369:Neoplasms / Q000191:economics / Q000628:therapy*; D011159:Population Surveillance; D012923:Social Class; D017741:Survivors / Q000706:statistics & numerical data*; D013548:Sweden