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Scholastic Achievements of Childhood Leukemia Patients: A Nationwide, Register-Based Study

Arja H. Harila-Saari, Päivi M. Lähteenmäki, Eero Pukkala, Pentti Kyyrönen, Marjatta Lanning, Risto Sankila

From the Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu; Department of Pediatrics and Adolescence, Turku University Hospital, Turku; Finnish Cancer Registry, Helsinki; and the School of Public Health, University of Tampere, Tampere, Finland

Address reprint requests to Arja Harila-Saari, MD, PhD, Department of Pediatrics and Adolescence, Oulu University Hospital, PO BOX 23, 90029 OYS, Oulu, Finland; e-mail: arja.harila-saari{at}oulu.fi

Purpose Studies concerning the scholastic achievement of survivors of childhood leukemia have yielded controversial results. We studied the school marks of childhood leukemia survivors in a register-based study.

Patients and Methods Three hundred seventy-one patients with a diagnosis of leukemia before the age of 16 years who were born between 1974 and 1986 and alive on their 16th birthday were identified from the Finnish Cancer Registry. Five matched controls were sought for each patient from the Population Register Center of Finland. Information on the ninth-grade school report was obtained from Statistics Finland. The overall mark average and the marks (scale 4 to 10) for mother tongue, foreign language, mathematics, and physical education were compared between the patients and controls.

Results The ninth-grade school report was obtained by 97.6% of the patients and 98.5% of the controls. The patients whose treatment included cranial irradiation had a lower overall mark average (mean difference, –0.24; 95% CI, –0.33 to –0.15) and lower marks for all assessed school subjects compared with their controls. Of the patients treated with chemotherapy alone, only the females with leukemia diagnosed before 7 years of age had lower school marks than their controls. The biggest difference was observed in the marks for foreign language among the irradiated females diagnosed at a young age (mean difference, –1.0; 95% CI, –1.25 to –0.74).

Conclusion Leukemia treatment that includes cranial irradiation impairs scholastic achievement. It is noteworthy that treatment of leukemia with chemotherapy alone impairs school performance only in females diagnosed before school age.

Supported by grants from the Nona and Kullervo Väre Foundation, Finland; Foundation for Pediatric Research, Finland; and the Finnish Cancer Society and Cancer Society of Northern Finland.

Presented in part at the Annual Meeting of the Nordic Society of Paediatric Haematology and Oncology, Lillehammer, Norway, May 8-11, 2005, and the International Society of Paediatric Oncology Annual Congress, Oslo, Norway, September 16-19, 2005.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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