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Childhood cancer survivors have special needs

Posted on 01/01/2009 12:00am

BC Cancer Agency study finds students treated for brain tumours did worse on tests in math and reading

By Pamela Fayerman, Vancouver Sun



METRO VANCOUVER - Six weeks of radiation meant to destroy a tumour in Kyle Karamos' brain helped him survive cancer. But it also caused some learning problems - one of the added challenges for childhood cancer survivors, a new study has found.

"After my treatment, I found it was harder to retain material, especially in biology, and I found I needed to reread things because I got distracted so easily," said the Grade 12 Maple Ridge student.

The B.C. Cancer Agency study, published in the journal Cancer, compared 782 childhood cancer survivors diagnosed between 1975 and 1995 to 8,386 other B.C. school children, all of whom attended schools from 1995 to 2004.

They looked at how many repeated grades, at results from Foundation Skills Assessments (FSA) and Grade 12 provincial exams and at how many had special-education designations.

They found brain tumour survivors did worse on FSA tests in math and reading and noted that children who survived another type of cancer, leukemia, showed a tendency to also have lower FSA scores.

Survivors of all other types of cancer did not show significant differences in FSA scores, but all kinds of cancer survivors were three times more likely than the regular population to receive special education.

Cancer survivors, who were a mean age of 4.6 years when first diagnosed, often had more physical, visual and hearing disability impairments as complications of treatment, but they did not have a higher rate of grade repetition. Indeed, the rates between the cancer and non-cancer groups were similar, at about 22 per cent. Another positive finding was that there were no significant differences in achievements on Grade 12 provincial exams between the study groups.

Lead investigator Mary McBride and radiation oncologist Dr. Karen Goddard said in an interview that radiation treatment has helped improve childhood survival outcomes (to 80 per cent in the past decade) but it is also a leading culprit as far as educational difficulties go.

"The age at diagnosis is also a factor because the brain is always developing until about age five so it is really vulnerable to damage from radiation up to that point," McBride said, adding that it also depends where the tumour is located. If the radiation is delivered to the front of the brain, children may have more learning difficulties.

Karamos said he was first diagnosed with a brain tumour in 2005 when he was in Grade 9.

He had surgery, followed by chemotherapy and radiation, and missed most of that school year. The following year, doctors detected another two tumours that required further surgery and a different chemotherapy regimen for two more years.

He said he's grateful to teachers at his high school for recognizing he needed a little help like extra time for tests. To help him understand what he's reading, he's learned to take his books into a quiet room.

Goddard said the study is important because it emphasizes the need to search for less damaging treatments and to deliver targeted radiation to the tumour, without harming healthy brain tissue. But when tumours are large and aggressive, such targeted radiation treatment is not an option.

McBride said all cancer survivors who need learning support should be identified quickly so they can get help before problems mount. There are about 2,600 childhood cancer survivors (all types) living in B.C. About 150 children under age 15 get cancer each year.

Apart from the effects of radiation, McBride conceded that children battling cancer may suffer academically because of the emotional toll and because they miss so much school when they are enduring the most intense part of their treatments.

The study was funded by the Canadian Cancer Society (CCS) and involved researchers from the Cancer Agency, Child & Family Research Institute at BC Children's Hospital and the University of B.C.

It is now online but will appear in the May 15 edition of Cancer.

Said Barbara Kaminsky, CEO of the CCS, BC and Yukon:

"The Canadian Cancer Society was delighted to fund this important research. It is not good enough to just improve survival rates. We need to ensure that as many cancer patients as possible become more than cancer survivors; rather, we hope to have post-cancer thrivers."

Sun Health Issues Reporter

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