Learning difficulties at school
Learning difficulties at school were self-reported by 224 children (22%) (Table 2). Greater social deprivation was significantly associated with a learning difficulty at school; however, the increased geographic distance evaluated by the total travel time was not. Additionally, tumor relapse, treatment with hematopoietic stem cell transplantation (HSCT), and the diagnosis of a CNS tumor remained significant risk factors. A significant interaction was found between the centers and the tumor type, notably for CNS tumors (p<0.001). Three-hundred seventy-one children received a specific assistance with academic support, of which 74% reported difficulties at school. Academic support was mainly provided for children with CNS tumors (p < 0.001). Children with CNS tumors benefited from 52% of the academic supports retrieved for the entire population. Although learning difficulties were significantly associated with greater social deprivation, the probability of benefitting from a support was not. However, there was an important correlation between the learning disabilities and academic support (R2 = 0.79).
Over time, two factors were significantly associated with the probability of having a learning difficulty at school. First, CNS tumors were a significant risk factor in comparison with other types of tumors, with a hazard ratio of 4.48 (CI: 2.79 – 7.21) (Figure 2A). Second, the tumor relapse was a significant risk factor, with a hazard ratio of 1.80 (CI: 1.05 – 3.09) (Figure 2B).
Ninety-two children with a CNS tumor reported a learning disability at school (46%). The risk factors that were significantly associated were greater social deprivation, tumor relapse, treatment by chemotherapy, and an increased delay in the consultation. In contrast, the surgical management was protective (Table 3). Neither the type of tumor nor its localization had a significant impact on the risk of having a learning difficulty. The probability of benefiting from academic support was not influenced by the EDI score in this population. In children who declared learning disabilities, 19% of them did not receive support. Over time, only treatment by chemotherapy remained a risk factor for learning difficulty at school, with a hazard ratio of 2.54 (CI: 1.52 – 4.23).
Seventy-eight children with blood disorders reported a learning difficulty at school (17%). The risk factors were tumor relapse and management by HSCT (Supplemental appendix 1). An increased delay in the consultation and female sex were protective factors. Female sex remained the only significant and protective factor against developing a learning disability over time (HR = 0.37, CI: 0.19 – 0.73). However, a trend was observed with tumor relapse status (p=0.09).