Childhood Cancer Survivorship: Improving Care and Quality of Life

TABLE 4.3 Enrollment in Special Education Programs Among Survivors of Childhood Acute Lymphoblastic Leukemia Relative to Sibling Controls, by Time from Diagnosis^a

	Before diagnosis		After diagnosis
Educational Outcome	Event rate^b	RR^c	Event rate^b	RR^c
Special education
Total	3.8	1.4	9.5	3.4*
Age at diagnosis, y
0-5			12.3	4.5*
≥6			7.7	2.8*
Cranial radiation, Gy
None			5.8	2.1
18			7.2	2.6*
24			11.4	4.1*
Intrathecal methotrexate, mg
None			11.5	4.1*
<83			11.2	4.1*
≥83			5.5	2.0*
Learning disabled
Total	5.1	1.4	13.3	3.6*
Age at diagnosis, y
0-5			17.5	4.7*
≥6			10.8	2.9*
Cranial radiation, Gy
None			6.0	1.6
18			5.4	1.4
24			19.6	5.3*
Intrathecal methotrexate, mg
None			12.5	3.3*
<83			18.2	4.9*
≥83			6.9	1.9
Gifted and talented
Total	7.0	1.0	7.0	1.0
Age at diagnosis, y
0-5			4.2	0.6
≥6			8.9	1.2
Cranial radiation, Gy
None			5.7	0.8
18			8.5	1.2
24			6.2	0.9
Intrathecal methotrexate, mg
None			8.0	1.1
<83			5.2	0.7
≥83			9.1	1.3
^aOnly survivors diagnosed before 18 years of age were considered. ^bEvents per 1,000 person-years.

Table of Contents

Front Matter R1-R18

Summary 1-14

1. Introduction 15-19

2. The Epidemiology of Childhood Cancer 20-36

3. The Trajectory of Childhood Cancer Care 37-48

4. Late Effects of Childhood Cancer 49-89

5. Delivering Survivorship Care 90-127

6. Assuring Appropriate Educational Support Services 128-139

7. Employment, Insurance, and Economic Issues 140-165

8. Research Issues 166-187

9. Findings and Recommendations 188-206