Survivors of childhood, adolescent, and young adult cancers are more likely to have lower levels of educational achievement and to be unemployed, according to a recent international review.
“Educational achievement and employment outcomes are critical indicators of the long-term quality of life for survivors,” the authors write. That is why the research team encourages oncologists and other clinicians to “be aware of the risk of educational and employment problems, implement regular surveillance, and refer survivors to specialists if problems are identified.”
The analysis, conducted by the International Late Effects of Childhood Cancer Guideline Harmonization Group, appeared online April 18 in Cancer.
As oncology treatments continue to improve, the population of young people surviving cancer has steadily grown. Data show that almost 85% children, adolescents, and young adults (CAYA) survive cancer. That corresponds to more than 1 million survivors of CAYA cancer in North America and Europe.
Despite these promising survival odds, less is known about the long-term quality of life among survivors, including educational achievement and employment.
In a review of 82 relevant studies from 17 countries, Katie A. Devine, MPH, PhD, Rutgers Cancer Institute of New Jersey, New Brunswick, and colleagues found that overall survivors of CAYA cancers are more likely to have lower educational achievement compared with siblings, peers, or the general population. As a group, CAYA cancer survivors are also at greater risk for delays completing their education and repeating a grade compared with controls.
Disease-related risk factors for lower educational achievement include a primary diagnosis of a central nervous system (CNS) tumor, diagnosis at a younger age, an upper extremity sarcoma tumor (vs a lower extremity sarcoma), a history of caner relapse as well as late effects of cancer, including impaired neurocognitive functioning, psychological distress, and visual or hearing problems.
Treatment-related risk factors for lower educational attainment include brain radiotherapy, amputation for sarcoma, treatment with alkylating agents, and intensive care unit stay.
Survivors of CAYA cancers also face a greater likelihood of unemployment than control groups, with lower educational level and female sex being two key demographic risk factors. Clinical risk factors for unemployment included a primary CNS tumor, second malignancy or recurrence, longer time since diagnosis and late effects — such as impaired neurocognitive functioning, psychological distress, and physical disability.
Recommendations for Monitoring
Based on the review, Devine and colleagues developed “internationally harmonized” surveillance guidelines for education and employment in survivors of CAYA cancer.
The group unanimously endorsed the importance of raising awareness about the risk for poor educational outcomes and unemployment among healthcare professionals as well as survivors and families. The team also agreed that schools and teachers should be viewed as “important partners” in the surveillance and support of survivors’ educational progress.
Assessments of education should begin at cancer diagnosis when disruptions are common, while assessments of employment should begin during adolescence when individuals may begin planning their career path.
According to the authors, early evaluation of education and employment will help “establish a relative baseline from which to identify future problems.”
The team also recommends ongoing surveillance of employment status because the risk of experiencing late effects or other health issues increases over time and could negatively affect a survivor’s ability to work.
These assessments are recommended for all survivors at routine follow-up visits or general medical checkups, even in the absence of key risk factors. However, the group says there is not enough evidence to support a particular method of assessment for either education or employment.
The authors also did not find studies that evaluated interventions to improve education and employment outcomes in survivors of CAYA cancers, which they say should be a research priority going forward.
“We encourage the development and scientific evaluation of interventions to improve educational and employment outcomes among CAYA survivors at risk,” Devine and colleagues write. “Effective interventions will need to be tailored to the unique needs of each patient and to the local resources available.”
This work was supported by the Krebsliga Zentralschweiz, the Swiss National Science Foundation, and the European Union’s Seventh Framework Programme for Research, Technological Development, and Demonstration. Devine reports no relevant disclosures. A complete list of author disclosures is available in the original article.
Cancer. Published online April 18, 2022. Source.