Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Cancer. 2010 Mar 1;116(5):1385-91. doi: 10.1002/cncr.24840.
Studies of different national populations were indispensable for estimating the impact of illness-related disability on social outcomes in adult childhood cancer survivors. The effects of childhood cancer on educational attainment, employment, and income in adulthood in a Swedish setting were studied.
The study population was a national cohort of 1.46 million Swedish residents, including 1716 survivors of childhood cancer diagnosed before their 16th birthday, followed up in 2002 in registries at >25 years of age. Main outcomes were educational attainment, employment, and net income. Markers of persistent disability were considered, and outcomes were analyzed with multivariate linear and logistic regression models adjusted for age, sex, and socioeconomic indicators of the childhood households.
Non-central nervous system (CNS) cancer survivors had similar education, employment, and income as the general population in adjusted models, whereas survivors of CNS tumors more often had no more than basic (< or =9 years) education (relative risk [RR], 1.80 [95% confidence interval (95% CI), 1.45-2.23]), less often attained education beyond secondary school (RR, 0.69 [95% CI, 0.58-0.81]), and less often were employed (RR, 0.85 [95% CI, 0.77-0.94]). Predicted net income from work was lower in CNS tumor survivors (P <.001) than in the general population, even after the exclusion of individuals who received economic disability compensation.
CNS tumor survivors had poorer social outcomes compared with the general population, whereas outcomes for survivors of other childhood cancers were similar to the general population. Established late effects highlighted the importance of improved, safer pediatric CNS tumor treatment protocols and surveillance that identified individual needs for preventive and remedial measures.
研究不同国家的人群对于评估疾病相关残疾对成年癌症患儿社会结局的影响至关重要。本研究旨在探讨瑞典人群中儿童癌症对成年后教育程度、就业和收入的影响。
研究人群为 146 万瑞典居民的全国队列，包括 1716 名 16 岁生日前确诊的儿童癌症幸存者，在 25 岁以上时通过登记处进行随访。主要结局为教育程度、就业和净收入。考虑了持续性残疾的标志物，并通过调整年龄、性别和儿童家庭社会经济指标的多变量线性和逻辑回归模型分析了结局。
非中枢神经系统（CNS）癌症幸存者在调整模型中的教育程度、就业和收入与普通人群相似，而 CNS 肿瘤幸存者受教育程度通常低于 9 年（相对风险 [RR]，1.80 [95%置信区间 95%CI，1.45-2.23]），接受高中以上教育的比例较低（RR，0.69 [95% CI，0.58-0.81]），就业比例较低（RR，0.85 [95% CI，0.77-0.94]）。即使排除接受经济残疾补偿的个体，CNS 肿瘤幸存者的工作预测净收入仍低于普通人群（P <.001）。
与普通人群相比，CNS 肿瘤幸存者的社会结局较差，而其他儿童癌症幸存者的结局与普通人群相似。已确定的晚期效应强调了改进、更安全的小儿 CNS 肿瘤治疗方案和监测的重要性，以确定个体预防和补救措施的需求。
