慢性健康状况与学业成就：一份儿童癌症幸存者研究报告。
Chronic Health Conditions and Academic Achievement: A Childhood Cancer Survivor Study Report.
作者信息
Bashore Lisa, Peterson Rachel K, Li Chenghong, Liu Wei, Wang Mingjuan, Jiwani Zahra M, McDonald Aaron J, Lupo Philip J, King Allison, Srivastava Deokumar, Leisenring Wendy M, Howell Rebecca M, Gibson Todd M, Oeffinger Kevin, Armstrong Gregory T, Bowman W Paul, Krull Kevin R, Edelstein Kim
机构信息
Cook Children's Health Care System, Fort Worth, TX.
Texas Christian University, Fort Worth, TX.
出版信息
JCO Oncol Pract. 2025 Sep 8:OP2500414. doi: 10.1200/OP-25-00414.
PURPOSE
To examine associations between special education, chronic health conditions (CHCs), and college graduation in survivors of childhood cancer and their siblings.
METHODS
Childhood Cancer Survivor Study participants included 23,082 5-year survivors (53.7% male; median [IQR] age at diagnosis, 6 [3-13] years; age at evaluation, 31.0 [24-39] years; treated between 1970 and 1999) and 5,037 siblings (47.7% male; 36.0 [28-44] years at evaluation). Special education use, reasons for special education, CHCs, and college graduation were self-reported. Primary cancer diagnosis and treatment exposures were abstracted from medical records. Comparisons between survivors and siblings were made using chi-square statistics; demographic and treatment factors associated with outcomes were examined using modified Poisson regression models.
RESULTS
More survivors reported special education use than siblings (26.5% 8.6%; relative risk [RR], 2.55 [95% CI, 2.32 to 2.80]). Of those survivors and siblings who had special education services, use was highest between kindergarten and fifth grade (64.4% of survivors and 71.9% of siblings in kindergarten-fifth grade, 14.4% of survivors and 12.5% of siblings in sixth-eighth grade, and 9.2% of survivors and 9.0% of siblings in ninth-12th grade), and primarily attributable to learning and concentration problems. Despite receiving special education, survivors were less likely to graduate college compared with siblings requiring special education (RR, 0.76 [95% CI, 0.66 to 0.88]). Risk for not graduating college included history of CNS tumor (RR, 1.47 [95% CI, 1.40 to 1.55]), cranial irradiation (20-29 Gy, RR, 1.16 [95% CI, 1.09 to 1.25]; 30-49 Gy, RR, 1.37 [95% CI, 1.26 to 1.49]; ≥50 Gy, RR, 1.35 [95% CI, 1.28 to 1.42]), or the presence of a severe, disabling or life-threatening CHC (Common Terminology Criteria for Adverse Events grade 3-4, RR, 1.15 [95% CI, 1.07 to 1.24]).
CONCLUSION
Cognitive problems and CHCs increase risk for not graduating college; these problems are not alleviated by special education.
目的
研究儿童癌症幸存者及其兄弟姐妹的特殊教育、慢性健康状况（CHC）与大学毕业之间的关联。
方法
儿童癌症幸存者研究的参与者包括23,082名5年幸存者（男性占53.7%；诊断时的中位年龄[四分位间距]为6岁[3 - 13岁]；评估时年龄为31.0岁[24 - 39岁]；于1970年至1999年间接受治疗）以及5,037名兄弟姐妹（男性占47.7%；评估时年龄为36.0岁[28 - 44岁]）。特殊教育的使用情况、特殊教育的原因、慢性健康状况以及大学毕业情况均为自我报告。原发性癌症诊断和治疗暴露信息从医疗记录中提取。使用卡方统计对幸存者和兄弟姐妹进行比较；使用修正泊松回归模型检查与结果相关的人口统计学和治疗因素。
结果
报告使用特殊教育的幸存者比兄弟姐妹更多（26.5%对8.6%；相对风险[RR]为2.55[95%置信区间，2.32至2.80]）。在那些接受特殊教育服务的幸存者和兄弟姐妹中，幼儿园至五年级的使用率最高（幼儿园至五年级的幸存者中占64.4%，兄弟姐妹中占71.9%；六年级至八年级的幸存者中占14.4%，兄弟姐妹中占12.5%；九年级至十二年级的幸存者中占9.2%，兄弟姐妹中占9.0%），且主要归因于学习和注意力问题。尽管接受了特殊教育，但与需要特殊教育的兄弟姐妹相比，幸存者大学毕业的可能性较小（RR为0.76[95%置信区间，0.66至0.88]）。大学未毕业的风险因素包括中枢神经系统肿瘤病史（RR为1.47[95%置信区间，1.40至1.55]）、颅脑照射（20 - 29 Gy，RR为1.16[95%置信区间，1.09至1.25]；30 - 49 Gy，RR为1.37[95%置信区间，1.26至1.49]；≥50 Gy，RR为1.35[95%置信区间，1.28至1.42]），或存在严重、致残或危及生命的慢性健康状况（不良事件通用术语标准3 - 级，RR为1.15[95%置信区间，1.07至1.24]）。
结论
认知问题和慢性健康状况增加了大学未毕业的风险；特殊教育并不能缓解这些问题。
Zotero 插件