Characterizing academic performance in pediatric acute lymphoblastic leukemia with population-based achievement tests

Abstract

Background: Recent shifts from radiation to chemotherapy-based treatment for acute lymphoblastic leukemia (ALL) have contributed to reduced long-term morbidity. Despite this, ALL survivors remain at increased risk for long-term cognitive impairments. Aim: To identify demographic and treatment factors associated with school performance in pediatric survivors of ALL. Methods: We collected standardized test scores for reading, math, and science obtained in a school setting from grades 3–11 in 63 ALL survivors (46.0% boys). Most participants were assessed across multiple grades (median number of grades n = 5, range 1–7), and 269 observations were considered in the analyses. Treatment exposures were extracted from medical records. Socio-economic status was estimated using participation in free/reduced lunch programs at school. Mixed effects linear regression models were conducted to determine factors associated with school performance. Results: ALL survivors' scores were comparable to state norms on reading, math, and science performances. On multivariable analysis, participation in free/reduced lunch programs was significantly associated with lower reading scores (β = −12.52; 95% CI −22.26:−2.77, p =.01). Exposure to radiation during treatment was also associated with lower reading test scores (β = −30.81, 95% CI −52.00:−9.62, p =.01). No significant associations between demographics and treatment parameters were observed for math and science test scores. Conclusions: We utilized population-based achievement tests conducted from grades 3–11 to characterize school performance in ALL survivors. Our results imply that survivors with low socio-economic status and those exposed to radiation during treatment could benefit from early monitoring and intervention to maximize academic success.