title: Young age at diagnosis is a risk factor for negative late socio-economic effects after acute lymphoblastic leukemia in childhood.
abstract: BACKGROUND
  The increasing number of survivors after childhood cancer requires characterization of the late complications of these diseases and their treatment. We examined a large number of possible socio-economic late effects following treatment for acute lymphoblastic leukemia (ALL) in order to identify factors leading to a poor outcome.
  
  
  METHODS
  All individuals who had been diagnosed with ALL and who were alive in January 2007 (n = 213; men = 107) were identified from a database of all patients with cancer before the age of 18 in Southern Sweden from 1970 to 1999. For each subject, 50 matched controls were identified from the Swedish Population Register. Information on marital status, children, education, employment, income, and support from the community was obtained from Statistics Sweden.
  
  
  RESULTS
  At the ages of 25 and 30, survivors of ALL had attained a lower level of education than controls. At the age of 30, they were less often employed (70% vs. 82%, P = 0.019), less often married (19% vs. 32%, P = 0.019), and had children to a lesser extent (31% vs. 47%, P = 0.011) than controls. We identified young age at diagnosis as a risk factor for adverse outcome in the majority of the socio-economic variables studied, apart from the known risk of cranial irradiation treatment. Furthermore, female survivors had a greater risk of achieving a lower level of education than both male survivors and controls.
  
  
  CONCLUSIONS
  Young age at diagnosis, as well as treatment with cranial irradiation, is a risk factor for socio-economic late effects after treatment for ALL in childhood.
authors.affiliation: Division of Pediatric Oncology and Hematology, Department of Clinical Sciences, Lund University Hospital, Lund University, Lund, Sweden. anna.sallfors-holmqvist@med.lu.se
authors.forename: Anna Sällfors
authors.initials: AS
authors.lastname: Holmqvist
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiebe
authors.forename: Lars
authors.initials: L
authors.lastname: Hjorth
authors.forename: Anna
authors.initials: A
authors.lastname: Lindgren
authors.forename: Ingrid
authors.initials: I
authors.lastname: Øra
authors.forename: Christian
authors.initials: C
authors.lastname: Moëll
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation; D004522:Educational Status; D004651:Employment; D005260:Female; D006801:Humans; D007182:Income; D007223:Infant; D008297:Male; D008393:Marriage; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D012959:Socioeconomic Factors