title: Non-graduation after comprehensive school, and early retirement but not unemployment are prominent in childhood cancer survivors-a Finnish registry-based study.
abstract: In order to assess neurocognitive and social outcomes after childhood cancer, we explored the educational and vocational attainments of Finnish survivors in comparison to matched population controls.
  
  
  
  From national registries, we identified survivors (n = 3243) born from 1960 to 1992 and aged below 16 at cancer diagnosis (years 1964-2009) as well as their controls (n = 16,215). Data on educational achievements, yearly income, employment status, and retirement were retrieved from Statistics Finland.
  
  
  
  The median (range) age at study was 28 (17-50) years. The proportion of those with no education after comprehensive school was higher than controls for all the diagnostic groups: brain tumor (BT) (33.5 vs 23.0 %), solid tumor (ST) (25.0 vs 21.4 %), and leukemia/NHL (29.2 vs 23.1 %). Odds ratios (OR) for unemployment were not significantly elevated in any survivor group compared to controls, but OR for being retired was elevated in each survivor group (BT 14.8, ST 2.2, leukemia/NHL 4.0). Irradiation significantly increased that OR only in BT survivors. Leukemia/NHL survivors treated after 1992 had lower risk for early retirement (OR 0.6) compared to those diagnosed earlier.
  
  
  
  Survivors had higher frequencies than controls for lacking further education after comprehensive school. Unemployment was not common, but risk for early retirement was significantly increased in each three survivor group.
  
  
  
  Reassuring is that premature retirement was less common during the most recent treatment era. Screening and follow-up of psychosocial performance more effectively might be essential, and there is a need for studies on possibility for effective rehabilitation of the survivors.
authors.affiliation: Department of Pediatrics and Adolescence, Turku University Hospital, Tuijulankatu 24, 20540, Turku, Finland. rijohu@utu.fi.
authors.forename: Ritva
authors.initials: R
authors.lastname: Ahomäki
authors.affiliation: Childhood Cancer Research Unit, Stockholm, Sweden.|Department of Pediatrics and Adolescence, Oulu University Hospital, Astrid Lindgren Children's Hospital, Turku, Finland.
authors.forename: Arja
authors.initials: A
authors.lastname: Harila-Saari
authors.affiliation: The University of Turku, Turun Yliopisto, 20014, Turku, Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Matomäki
authors.affiliation: Department of Pediatrics and Adolescence, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
authors.forename: Päivi M
authors.initials: PM
authors.lastname: Lähteenmäki
mesh_terms: D000293:Adolescent; D000328:Adult; D004493:Education / Q000639:trends*; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D012042:Registries; D012179:Retirement / Q000706:statistics & numerical data*; D017741:Survivors / Q000523:psychology; D014478:Unemployment / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cancer; Childhood; Education; Registry based study; Survivor