School attendance in childhood cancer survivors.

Abstract

9581 Background: Although school absenteeism is expected in children undergoing cancer therapy, little is known about school attendance in childhood cancer survivors (CCS). Methods: We approached consecutive CCS (≥8 years) attending the Hospital for Sick Children’s AfterCare Clinic and obtained absenteeism rates for CCS and their closest in age sibling (if available) using school report cards for the 2008-09 academic year. Absenteeism was compared to a population control group of 167,752 students in the Toronto District School Board (TDSB). The Child Vulnerability Scale and the Pediatric Quality of Life Inventory (PedsQL) were administered. CCS’ treatment was assigned an intensity score (1-4) using the Intensity of Treatment Rating Scale 2.0. One sample t-tests and nonparametric tests were used to compare absenteeism rates. Univariate and multiple regression analyses were used to assess variables associated with days absent. Results: A total of 131 CCS (median age 13.4 years; range 8.0-19.2) at a median of 9.4 years (range 4.3-17.3) from diagnosis, along with 78 siblings (median age 13 years; range 7-18) participated. CCS and their siblings missed significantly more school than the TDSB control population (mean±SD: 11.0±9.4 and 9.9±9.8 vs. 5.0±5.6 days, for both, p<0.0001). There was no difference in absenteeism between matched CCS-sibling pairs (11.1±9.9 vs. 9.9±9.8 days, p=0.38). Absenteeism in CCS was significantly associated with higher treatment intensity (p=0.01) and diagnosis (p=0.03). Brain tumor CCS missed more school than solid tumor or leukemia/lymphoma CCS (mean±SD: 18.6±3.1 vs. 12.7±1.6 vs. 10.5±2.0 days). Older age at study and a low PedsQL Physical Health Summary Score (HSS) were associated with increased absenteeism, but did not reach statistical significance (for both, p=0.08). Parent’s perception of their child’s vulnerability (p=0.55) and a low PedsQL Psychosocial HSS (p =0.23) were not associated with absenteeism. Conclusions: CCS and their siblings miss more school than the general population. Brain tumor survivors and those with more intense therapy are at most risk. Care givers, educators and health care providers must work to minimize school absenteeism in CCS.