Original Article
School Attendance in Childhood Cancer Survivors and Their Siblings

https://doi.org/10.1016/j.jpeds.2012.06.066Get rights and content

Objective

To investigate school absenteeism among childhood cancer survivors and their siblings and examine factors related to absenteeism in survivors.

Study design

A cross-sectional study was conducted among consecutive cancer survivors attending a large pediatric cancer survivor clinic. Absenteeism rates were obtained for survivors and their closest in age sibling from school report cards. Absenteeism was compared with a population control group of 167 752 students using 1-sample t tests. The Child Vulnerability Scale, Pediatric Quality of Life Inventory, and Behavior Assessment System for Children were administered to survivors. Univariate and multiple regression analyses assessed variables associated with days absent.

Results

One hundred thirty-one survivors (median age at assessment: 13.4 years, range 8.0-19.2; median age at diagnosis: 9.4 years, range 4.3-17.3) and 77 siblings (median age at assessment: 13 years, age range 7-18) participated. Survivors and siblings missed significantly more school days than the population control group (mean ± SD: 9.6 ± 9.2 and 9.9 ± 9.8 vs 5.0 ± 5.6 days, respectively, P < .0001). Among matched survivor-sibling pairs (N = 77), there was no difference in absenteeism (9.6 ± 9.2 vs 9.9 ± 9.8 days, P = .85). Absenteeism in survivors was significantly associated with a low Pediatric Quality of Life Inventory Physical Health Summary Score (P = .01). Parents' perception of their child's vulnerability and emotional and social functioning were not associated with absenteeism.

Conclusions

Childhood cancer survivors and siblings miss more school than the general population. The only predictor of absenteeism in survivors is poor physical quality of health. More research should be devoted to school attendance and other outcomes in siblings of childhood cancer survivors.

Section snippets

Methods

After obtaining permission from our institution's research ethics board, we performed a cross-sectional study of childhood cancer survivors followed in The Hospital for Sick Children's Oncology AfterCare clinic. The AfterCare clinic follows childhood cancer survivors who are >4 years past their diagnosis, >2 years from the end of their therapy, and in continuous remission. Most survivors are seen on an annual basis. Survivors attending the clinic were considered eligible if they were aged ≥8

Results

Between August 2009 and June 2010, a total of 219 eligible survivors attending the AfterCare clinic were approached to participate in the study. A total of 157 childhood cancer survivors consented to participate in the study. We obtained the final school report card from 131 survivors (59.8%) (Table I). The remaining 26 survivors either provided the incorrect report card (interim report card or wrong academic year) or did not bring their report card to clinic and did not mail it in later. There

Discussion

In this study, a cohort of survivors almost 10 years from diagnosis missed twice as many days as did the general population of school children. It is recommended that all childhood cancer survivors receive regular long-term follow-up care, usually in a specialized survivor clinic.15 However, the need to attend multiple additional subspecialist visits in survivors who have developed late effects of therapy may increase the number of school absences. The creation of multidisciplinary survivor

References (29)

  • B. Fife et al.

    The family’s adaptation to childhood leukemia

    Soc Sci Med

    (1987)
  • A.B. Mariotto et al.

    Long-term survivors of childhood cancers in the United States

    Cancer Epidemiol Biomarkers Prev

    (2009)
  • M.M. Hudson et al.

    Health status of adult long-term survivors of childhood cancer: a report from the childhood cancer survivor study

    JAMA

    (2003)
  • K.C. Oeffinger et al.

    Chronic health conditions in adult survivors of childhood cancer

    N Engl J Med

    (2006)
  • A. Charlton et al.

    Absence from school related to cancer and other chronic conditions

    Arch Dis Child

    (1991)
  • A.F. Mancini et al.

    School-related behavior in children with cancer

    Pediatr Hematol Oncol

    (1989)
  • M. Weitzman et al.

    School absence: a problem for the pediatrician

    Pediatrics

    (1982)
  • J. Reiter-Purtill et al.

    A controlled longitudinal study of the social functioning of children who completed treatment of cancer

    J Pediatr Hematol Oncol

    (2003)
  • O.J. Sahler et al.

    Sibling adaptation to childhood cancer collaborative study: prevalence of sibling distress and definition of adaptation levels

    J Dev Behav Pediatr

    (1994)
  • M.A. Alderfer et al.

    Brief report: Does posttraumatic stress apply to siblings of childhood cancer survivors?

    J Pediatr Psychol

    (2003)
  • M.A. Alderfer et al.

    Psychosocial adjustment of siblings of children with cancer: a systematic review

    Psychooncology

    (2010)
  • M. Barrera et al.

    Cognitive, educational, psychosocial adjustment and quality of life of children who survive hematopoietic SCT and their siblings

    Bone Marrow Transplant

    (2008)
  • B.W. Forsyth et al.

    The child vulnerability scale: an instrument to measure parental perceptions of child vulnerability

    J Pediatr Psychol

    (1996)
  • J.W. Varni et al.

    The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory generic core scales, multidimensional fatigue scale, and cancer module

    Cancer

    (2002)
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    The authors declare no conflicts of interest.

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