Evaluation of education, work, habits and changes of life in childhood cancer survivors

Survival rates in childhood cancers have increased over 80% in recent years with intensive treatment and supportive care. This increase in survival rates resulted in early and late side effects of treatment. Some of these side effects are changes in habits such as psychological, social, education, work and cigarette-alcohol consumption occurring in patients and their families. In our study, it was aimed to evaluate these changes and to guide the results to support therapies in subsequent patient groups. One hundred and fifty five patients with lymphoma and solid tumors diagnosed and treated by the Department of Pediatric Oncology at Uludağ University Medical Faculty between 01.01.2000 and 31.12.2015 were included in the study. The mean follow-up time was 93 ± 48,8 months and 60% of the patients were male. The mean age at the time of diagnosis was 8,2 ± 5.0 years and the most common diagnosis was lymphomas with a rate of 49%. All patients had systemic chemotherapy and 41,9% of them received radiotherapy. During the study period, 50,3% of the patients were older than 18 years and 3,8% of them were married and 2,53% had children 61,4% of children who had to go to school during the diagnosis-treatment period took a coercibly break for median time of 12 months. The total number of patients who did not attend school or completed school after treatment was found to be 115 27,8% of this group had a regular income. No significant difference in education levels was found between girls and boys and those who received radiotherapy and those who did not. When patients were divided into two groups as patients with lymphoma and solid tumor, there was no significant difference between education levels (pre-university and university). At the time of study, 40% of the patients were attending high school or equivalent school, and 20% were graduates or graduated from university. These data is above the average of our country. 71,5% of the patients who underwent intrathecal treatment and / or received cranial / craniospinal radiotherapy had high school or higher education and this rate was 92,6% in the other patients (p = 0,03). 84% of the patients did not receive psychological support at any time during or after treatment. Those receiving treatment were more likely to receive psychological support in the period following the end of the treatment than during the treatment. There was no statistically significant relationship between receiving psychological support and gender and age.Psychological support rates were significantly higher than those who did not receive radiotherapy(p=0,043) When patients' habits were compared before and after treatment, alcohol and cigarette usage increased significantly after treatment. 12 % of the patients started smoking and 5,8% of them started drinking alcohol after treatment although they did not used before. No significant relationship was found between these habits and gender and treatment approach.Those who had a new sibling during the treatment had lower rates of bad habit. The majority of patients, including children between the ages of seven and ten, thought that they would see themselves in a better place in the future. The ratio of non-educated mothers and fathers were 6,5%; the percentage of mother with a university degree was 3,2%; the rate of father was 11,6% of mother and father (parents of different children) who have never attended school have learned to read and write during the treatment process, 5,1% of mothers and 2,5% of fathers raised their education level in this process 85% of mothers were housewives, and 9,6% of fathers did not have a regular job .about 7,6% of these mothers and 3,1% of fathers who did not have a job, started working after the treatment. In conclusion, our study provides useful information for the survivors of childhood cancers and families to understand the difficulties that they face in integrating into society as their age increases. In addition, the present findings suggest that these patients have significant deficiencies in education and social needs, even if they survive cancer in their childhood and continue their lives. The findings of this study show that in addition to aim survival through treatment, it is necessary to provide early supportive therapies and to maintain this support in the long term in order to improve the academic and social success of these patients and also enhance self-esteem and provide psychosocial support. Key Words: Childhood cancer, survival, late effects