Educational and occupational outcomes of childhood cancer survivors 30 ă years after diagnosis: a French cohort study

International audienceBackground: Although survival from childhood cancer has increased, ă little is known on the long-term impact of treatment late effects on ă occupational attainment or work ability. ă Methods: A total of 3512 five-year survivors treated before the age of ă 19 years in 10 French cancer centres between 1948 and 2000 were ă identified. Educational level, employment status and occupational class ă of survivors were assessed by a self-reported questionnaire. These ă outcome measures were compared with sex-age rates recorded in the French ă population, using indirect standardisation. Paternal occupational class ă was also considered to control for the role of survivors' socioeconomic ă background on their achievement. Multivariable analyses were conducted ă to explore clinical characteristics associated with the outcomes. ă Results: A total of 2406 survivors responded to the questionnaire and ă survivors aged below 25 years were included in the current analysis. ă Compared with national statistics adjusted on age and sex, male ă survivors were more likely to be college graduates (39.2% vs 30.9% ă expected; P<0.001). This higher achievement was not observed either for ă leukaemia or central nervous system (CNS) tumour survivors. ă Health-related unemployment was higher for survivors of CNS tumour ă (28.1% vs 4.3%; P<0.001) but not for survivors of other diagnoses. ă Survivors of non-CNS childhood cancer had a similar or a higher ă occupational class than expected. ă Conclusions: Survivors treated for CNS tumour or leukaemia, especially ă when treatment included cranial irradiation, might need support ă throughout their lifespan

Cause-specific mortality and second cancer incidence after non-Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study

Second primary malignancies and premature death are a concern for patients surviving treatment for childhood lymphomas. We assessed mortality and second malignant neoplasms (SMNs) among 1082 5-year survivors of non-Hodgkin lymphoma (NHL) in the Childhood Cancer Survivor Study, a multi-institutional North American retrospective cohort study of cancer survivors diagnosed from 1970 to 1986. Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) were calculated using US population rates. Relative risks for death and solid tumor SMNs were calculated based on demographic, clinical, and treatment characteristics using Poisson regression models. There were 87 observed deaths (SMR = 4.2; 95% CI, 1.8-4.1) with elevated rates of death from solid tumors, leukemia, cardiac disease, and pneumonia. Risk for death remained elevated beyond 20 years after NHL. Risk factors for death from causes other than NHL included female sex (rate ratio [RR] = 3.4) and cardiac radiation therapy exposure (RR = 1.9). There were 27 solid tumor SMNs (SIR = 3.9; 95% CI, 2.6-5.7) with 3% cumulative incidence between 5 and 20 years after NHL diagnosis. Risk factors were female sex (RR = 3.1), mediastinal NHL disease (RR = 5.2), and breast irradiation (RR = 4.3). Survivors of childhood NHL, particularly those treated with chest RT, are at continued increased risk of early mortality and solid tumor SMNs