Educational outcomes in childhood cancer survivors: A Scotland-wide record-linkage study of 766,217 schoolchildren

BACKGROUND: A cancer diagnosis during childhood greatly disrupts the lives of those affected, causing physical and psychological challenges. We aim to investigate educational outcomes among schoolchildren with a previous cancer diagnosis compared to their peers. METHODS: Individual records from four national education databases and three national health databases were linked to construct a cohort of all singleton schoolchildren born in Scotland attending Scottish local-authority schools between 2009–2013. Pupils previously diagnosed with any cancer, haematological cancers, and central nervous system (CNS) cancers, were compared to their unaffected peers with respect to five educational outcomes: special educational need (SEN), absenteeism, school exclusion, academic attainment, and unemployment. Analyses were adjusted for sociodemographic and maternity factors and chronic conditions. RESULTS: Of 766,217 pupils, 1,313 (0.17%) had a previous cancer diagnosis. Children with any cancer had increased odds of SEN (OR 3.26, 95% CI 2.86–3.71), absenteeism (IRR 1.82, 95% CI 1.70–1.94), and low attainment (OR 2.15, 95% CI 1.52–3.03) compared to their peers. Similar findings were observed for haematological (SEN OR 2.62, 95% CI 2.12–3.24; absenteeism IRR 2.04, 95% CI 1.85–2.25; low attainment OR 2.17, 95% CI 1.31–3.61) and CNS (SEN OR 6.44, 95% CI 4.91–8.46; absenteeism IRR 1.75, 95% CI 1.51–2.04; low attainment OR 3.33, 95% CI 1.52–7.30) cancers. Lower exclusions were observed among children with any cancer (IRR 0.51, 95% CI 0.31–0.83) and CNS cancer (IRR 0.20, 95% CI 0.06–0.61). No associations were observed with unemployment. CONCLUSIONS: This study highlights the wider impacts of childhood cancer on educational outcomes. These children need to be supported, as poor educational outcomes can further impact later health.