Educational and occupational outcomes of childhood cancer survivors 30 years after diagnosis: a French cohort study.
Although survival from childhood cancer has increased, little is known on the long-term impact of treatment late effects on occupational attainment or work ability.



A total of 3512 five-year survivors treated before the age of 19 years in 10 French cancer centres between 1948 and 2000 were identified. Educational level, employment status and occupational class of survivors were assessed by a self-reported questionnaire. These outcome measures were compared with sex-age rates recorded in the French population, using indirect standardisation. Paternal occupational class was also considered to control for the role of survivors' socioeconomic background on their achievement. Multivariable analyses were conducted to explore clinical characteristics associated with the outcomes.



A total of 2406 survivors responded to the questionnaire and survivors aged below 25 years were included in the current analysis. Compared with national statistics adjusted on age and sex, male survivors were more likely to be college graduates (39.2% vs 30.9% expected; P<0.001). This higher achievement was not observed either for leukaemia or central nervous system (CNS) tumour survivors. Health-related unemployment was higher for survivors of CNS tumour (28.1% vs 4.3%; P<0.001) but not for survivors of other diagnoses. Survivors of non-CNS childhood cancer had a similar or a higher occupational class than expected.



Survivors treated for CNS tumour or leukaemia, especially when treatment included cranial irradiation, might need support throughout their lifespan.
CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.|Social and Human Sciences Research Unit, Gustave Roussy, 94805 Villejuif, France.
Agnes
A
Dumas
Department of Paediatric Haematology-Oncology, CHU Saint-Etienne, 42270 Saint-Priest-en-Jarez, France.|Rhône-Alpes Childhood Cancer Registry, 42000 Saint-Etienne, France.|Laboratory SNA-EPIS EA4607, Jean Monnet University), 42000 Saint-Etienne, France.
Claire
C
Berger
Quality of Life Research Unit (EA3279), APHM, Aix Marseille University, 13385 Marseille, France.
Pascal
P
Auquier
Quality of Life Research Unit (EA3279), APHM, Aix Marseille University, 13385 Marseille, France.|Department of Paediatric Haematology-Oncology, La Timone, 13005 Marseille, France.
Gérard
G
Michel
Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805 Villejuif, France.
Brice
B
Fresneau
CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.|Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.|Paris XI University.
Rodrigue Sètchéou
RS
Allodji
CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.|Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.|Paris XI University.
Nadia
N
Haddy
CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.|Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.|Paris XI University.
Carole
C
Rubino
Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.
Gilles
G
Vassal
Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805 Villejuif, France.
Dominique
D
Valteau-Couanet
Department of Paediatric Haematology-Oncology, CHU Saint-Etienne, 42270 Saint-Priest-en-Jarez, France.
Sandrine
S
Thouvenin-Doulet
Rhône-Alpes Childhood Cancer Registry, 42000 Saint-Etienne, France.|Laboratory SNA-EPIS EA4607, Jean Monnet University), 42000 Saint-Etienne, France.
Léonie
L
Casagranda
Department of Paediatric Oncology, Institut Curie, 75005 Paris, France.
Hélène
H
Pacquement
CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.|Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805 Villejuif, France.
Chiraz
C
El-Fayech
Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805 Villejuif, France.
Odile
O
Oberlin
CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.|Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.|Paris XI University.
Catherine
C
Guibout
CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.|Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.|Paris XI University.
Florent
F
de Vathaire
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005602:France; D006281:Health Occupations / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D017063:Outcome Assessment, Health Care; D011795:Surveys and Questionnaires; D017741:Survivors