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DISABILITIES AMONG SCHOOL-AGE CANCER SURVIVORS
An estimated 5.5 percent of school-age children and adolescents (age 5 to 17) in the general population have chronic health conditions or impairments that contribute to an inability to attend school at all (0.6 percent), a need for special school or classes (3.7 percent), or a limitation in the amount of school attendance (1.2 percent) (Wenger,1995). There are few estimates of the proportion of survivors of childhood cancer with limitations that may affect school performance. Educational outcomes among survivors of acute lymphoblastic leukemia (ALL) and central nervous system (CNS) tumors have been assessed because they are generally exposed to treatments that can affect neurocognitive function (see Chapter 4). These cancers make up about 50 to 60 percent of newly diagnosed cases of childhood cancer and so, represent a significant share of the survivorship population. The largest study of educational outcomes to date suggests that ALL survivors have lower grades, enroll in special education or learning disability programs at three to four times the rate of their siblings, and when enrolled in such programs, spend a longer time in them as compared with their siblings. ALL survivors are also at higher risk of missing school for long periods and of repeating a year of school. On the other hand, most ALL survivors had rates of high school graduation, college entry, and college graduation that were similar to those of their brothers and sisters. Only survivors treated with 24 Gy of cranial radiation and those diagnosed at a preschool age were at higher risk for poor educational performance (Haupt et al., 1994) (see Chapter 4 and Table 4.3 for details of this study). The cohort of survivors treated in the 1970s and 1980s were at especially high risk for school-related problems because many of them were treated with 24 Gy of radiation. Few children with ALL now receive doses of cranial radiation this high, but the effects on school performance of treatment regimens common in the 1990s that relied on higher doses of chemotherapy have not yet been determined.
Among the general population, an estimated 11.2 percent of school-age children (age 6 to 17) are enrolled in federally sponsored special education programs (Department of Education, 2001).1 Roughly 30 to 40 percent of
The percentage of school-age children enrolled in federally sponsored special education programs (11.2 percent) is higher than the earlier mentioned estimate of children and adolescents with a chronic health condition or impairment and a disability related to schooling (5.5 percent). Many children enrolled in special education programs have learning disabilities that may not have been considered a chronic health condition or impairment in the survey from which the lower estimate was derived.