title: Surviving a childhood cancer: impact on education and employment.
abstract: Long-term consequences of childhood cancer encompass adverse psychosocial effects that may severely limit the opportunity to live a satisfying and productive life. We assessed the social integration of adults cured of a cancer in their first 14 years of life by record linkage between the population-based Childhood Cancer Registry of Piedmont and the Turin Longitudinal Study. We compared education and employment outcomes within the cohort of survivors and between the cohort of survivors and their peers in the general population through logistic regression. Individuals cured of a childhood tumour have a higher risk of not obtaining educational qualifications [odds ratio (OR) 0.67 (95% confidence interval 0.40-1.11) for compulsory school, OR 0.81 (0.61-1.07) for higher education] or employment, OR 0.66 (0.45-0.98), than the general population. This problem is particularly severe for individuals cured of a central nervous system neoplasm: OR 0.56 (0.31-1.01) for higher education and OR 0.28 (0.13-0.58) for employment. Within-cohort comparisons show that men are less likely to obtain educational goals than women, OR 0.72 (0.40-1.29), but more likely to be employed, OR 2.18 (0.90-5.28); parental education (university qualifications) is positively associated with the success of the child's education, OR 9.54 (2.60-35.02), but not with their employment status, OR 1.02 (0.21-4.85). Strategies should be put in place to mitigate the risk of adverse psychosocial effects from the beginning of treatment to cure and beyond to offer those suffering a cancer at a young age the possibility of full integration into society.
authors.affiliation: aChildhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and City of Health and Science University Hospital of Turin bDepartment of Clinical and Biological Sciences, University of Turin, Torino cRegional Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Maule
authors.forename: Daniela
authors.initials: D
authors.lastname: Zugna
authors.forename: Enrica
authors.initials: E
authors.lastname: Migliore
authors.forename: Daniela
authors.initials: D
authors.lastname: Alessi
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Roberta
authors.initials: R
authors.lastname: Onorati
authors.forename: Nicolás
authors.initials: N
authors.lastname: Zengarini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costa
authors.forename: Teresa
authors.initials: T
authors.lastname: Spadea
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004522:Educational Status; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D011379:Prognosis; D017741:Survivors / Q000523:psychology*; D055815:Young Adult