title: Educational attainment among adult survivors of childhood cancer in Great Britain: a population-based cohort study.
abstract: BACKGROUND
  Previous studies of educational attainment among childhood cancer survivors were small, had contradictory findings, and were not population based. This study investigated educational attainment in a large population-based cohort of survivors of all types of childhood cancer in Great Britain.
  
  
  METHODS
  Four levels of educational attainment among 10,183 cancer survivors--degree, teaching qualification, advanced (A') levels, and ordinary (O') levels--were compared with expected levels in the general population. A questionnaire was used to obtain educational attainment data for survivors, and comparable information for the general population was available from the General Household Survey. Factors associated with level of educational attainment achieved by cancer survivors were identified using multivariable logistic regression together with likelihood ratio tests. Logistic regression adjusting for age and sex was used for comparisons with the general population. All statistical tests were two-sided.
  
  
  RESULTS
  Childhood cancer survivors had lower educational attainment than the general population (degree: odds ratio [OR] = 0.77, 99% confidence interval [CI] = 0.68 to 0.87; teaching qualification: OR = 0.85, 99% CI = 0.77 to 0.94; A'level: OR = 0.85, 99% CI = 0.78 to 0.93; O'level: OR = 0.81, 99% CI = 0.74 to 0.90; P < .001, all levels). Statistically significant deficits were restricted to central nervous system (CNS) neoplasm and leukemia survivors. For leukemia, only those treated with radiotherapy were considered. Odds ratios for achievement by irradiated CNS tumor survivors were 50%-74% of those for cranially irradiated leukemia or nonirradiated CNS tumor survivors. Survivors at greater risk of poorer educational outcomes included those treated with cranial irradiation, diagnosed with a CNS tumor, older at questionnaire completion, younger at diagnosis, diagnosed with epilepsy, and who were female.
  
  
  CONCLUSIONS
  Specific groups of childhood cancer survivors achieve lower-than-expected educational attainment. Detailed educational support and implementation of regular cognitive assessment may be indicated for some groups to maximize long-term function.
authors.affiliation: Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Bldg, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. e.r.lancashire@bham.ac.uk
authors.forename: E R
authors.initials: ER
authors.lastname: Lancashire
authors.forename: C
authors.initials: C
authors.lastname: Frobisher
authors.forename: R C
authors.initials: RC
authors.lastname: Reulen
authors.forename: D L
authors.initials: DL
authors.lastname: Winter
authors.forename: A
authors.initials: A
authors.lastname: Glaser
authors.forename: M M
authors.initials: MM
authors.lastname: Hawkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001932:Brain Neoplasms / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016371:Cranial Irradiation / Q000009:adverse effects*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult