title: Ninth grade school performance in Danish childhood cancer survivors.
abstract: Childhood cancer survivors can experience learning problems resulting in lower-than-expected attained education as adults. It is unclear whether learning problems manifest already during adolescence.
  
  
  
  We analysed nationwide Danish registries on school grades for Danish children during 2001-2014. Applying a matched design we compared grades of childhood cancer survivors to children without cancer at ninth grade. We estimated grade differences by subject and its correlation to cancer site and age at diagnosis. The available statistical precision allowed for an analysis of more rare cancer sites.
  
  
  
  The total study population was 793 332 children (mean age 15.24 years and 49.7% girls), of whom 1320 were childhood cancer survivors. Lower rank grades were seen in children with cancer in all school subjects but differed substantially according to cancer site. Most affected were survivors of central nervous system (CNS) tumours, neuroblastoma, lymphoma, leukaemia, other malignant neoplasm and germ-cell tumours. Survivors from other cancer types did not obtain lower grades. Lower rank grades were associated with young age at diagnosis.
  
  
  
  The effect of childhood cancer differed substantially between cancer sites. The largest effect was among survivors of CNS tumours and leukaemia diagnosed at a young age, suggesting an association with radiation therapy. However, the majority of cancer survivors fare well. Increasing awareness on children affected by cancer and special accommodations may help maximise the learning potential of those most affected.
authors.affiliation: Unit of Statistics, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark.
authors.forename: Klaus Kaae
authors.initials: KK
authors.lastname: Andersen
authors.affiliation: Unit of Statistics, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark.
authors.forename: Anne Katrine
authors.initials: AK
authors.lastname: Duun-Henriksen
authors.affiliation: Unit of Statistics, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark.
authors.forename: Marie Hoffmann
authors.initials: MH
authors.lastname: Frederiksen
authors.affiliation: Unit of Cancer Survivorship, Childhood Cancer Survivorship Research Group, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark.
authors.forename: Jeanette Falck
authors.initials: JF
authors.lastname: Winther
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D016543:Central Nervous System Neoplasms / Q000453:epidemiology; D003718:Denmark / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006801:Humans; D007938:Leukemia / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D012042:Registries; D012574:Schools / Q000706:statistics & numerical data*; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*