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).