Impact of the social deprivation on the psychosocial difficulties of pediatric cancer survivors: a prospective multicentric study

Abstract

Background The posttreatment period is a key part of the management of pediatric cancer care. At this period, psychosocial effects (scholarly and psychological difficulties) have been described in pediatric cancer patients and can be prognostic for the success of social reintegration. Psychosocial effects and their impact may be related to the household’s socioeconomic background. The aim of this study was to estimate psychosocial difficulties during the posttreatment period based on a social deprivation score. Design This study is based on a prospective multicentric study database, and focused on the children who had received psychosocial evaluation during their follow-up after cancer treatment since 01/01/2013. We retrieved data on their learning and psychological difficulties. Socioeconomic status of the household was estimated by a social deprivation score. Results 1003 patients were analyzed. Learning difficulties at school were noted in 22% of patients. A greater social deprivation was significantly associated with learning difficulty (OR=1.09 per unit of the deprivation score). Tumor relapse, treatment with hematopoietic stem cell transplantation, and diagnosis of a CNS tumor remained significant risk factors. In the subgroup analysis of children with CNS tumors, learning difficulties were increased and associated with greater social deprivation. By contrast, psychological difficulties were not associated with the deprivation score. Conclusion There is a link between SE status and learning difficulties in survivors of childhood cancer. Further investigations should be carried out to confirm these results for children with CNS tumors, which is the population of the greatest concern.

SCHOOL DIFFICULTIES in Children Cancer Survivors: A Narrative Review and a Teacher Point-of-View

“…A strong link between SES and academic achievement is already known [53]. On a geographical scale evaluated by a deprivation score, the probability of presenting with school difficulties during the post-cancer period was significantly associated with social deprivation, an observation also retrieved in the CNS-tumors group [20,54]. At the individual scale, school difficulties are associated with the parental level of education, the family structure and ethnicity [13][14][15].…”

“…The prevalence of these difficulties varies between studies and countries, and such a variation can be explained by the differences in the national educational systems of each country [9]. Nevertheless, from 22% to 41% of CCSs reported school difficulties [18][19][20].…”

“…In addition, treatments induce physical health problems, notably asthenia and discomfort [19]. These consequences remove the child from school during active treatment, and absenteeism is reported as the most important problem associated with school difficulties [11,18,[20][21][22]. This absenteeism represents a significant loss of time in school, and may be increased in case of severe diseases or relapses, which require longer and more intensive treatments in hospital [23,24].…”

“…These difficulties can be potentiated by absenteeism, CCSs with CNS tumors miss significantly more school than survivors with other tumors do [11,19]. In this population, young age at diagnosis may be a prognosis [6,10,30], and age thresholds from six to nine years have been proposed as predictive factors for cognitive impairment [10,20,30]. In the long term, the risk of unemployment in adulthood is important, CCSs with CNS tumors are five times more likely to be unemployed [11,36,37].…”

“…All aggressions of the cerebral tissue are at risk of cognitive consequences, and this explains the risk associated with CNSdirected therapies [7,13,20,21,36]. Cranial radiation therapy is well known to be dangerous on cognition, but also growth, sensorial and endocrine functions, notably for young children [38][39][40][41].…”