Health status and academic performance in offspring of central nervous system tumor survivors

Abstract: Background: An increasing number of patients with central nervous system (CNS) tumor could survive to reproductive age and successfully have children, especially patients diagnosed at a younger age. However, it is largely unknown whether the history of CNS tumor and its treatments might affect their children. We aimed to explore the health status and school performance in offspring of survivors with CNS tumor before age of 20, including preterm birth, somatic and psychiatric diseases, and academic performance.Methods: By linking several nationwide registers in Sweden, we identified children whose parents were previously diagnosed with CNS tumor in childhood or adolescence. Children, whose parents did not have CNS tumor, were matched randomly with a 5:1 ratio to generate the reference group. Outcomes included preterm birth, overall somatic diseases, mental disorders and final grade achieved after completing the compulsory years of education at age of 16. Odds ratio (OR), relative risk (RR), absolute excess risk (AER) or hazard ratio (HR) was calculated in this project.Results: In Paper I, a total of 95 children among 1369 offspring of CNS tumor survivors were born preterm. As compared with 6845 comparison children, children of survivors were at an increased likelihood to be born preterm (adjusted OR=1.29, 95%CI=1.01-1.65). In Paper II and Paper III, after removing children dying within three months after birth, 1364 children born from survivors were included to estimate the risk of somatic or mental diseases. These children were not associated with a higher risk of overall somatic diseases (RR=1.02, 95% CI=0.98-1.07) or psychiatric diseases (adjusted HR=1.10, 95%CI=0.94, 1.28). In Paper IV, among these children of CNS tumor survivors, 655 children had the record of final grade which was used to measure academic performance. They experienced 1.39 times higher risk of achieving a poor academic performance as compared to the reference (95%CI=1.10-1.76). Conclusions: Offspring of survivors with CNS tumor below age of 20 were at an increased risk of being born preterm and getting poor academic achievement. However, overall physical or mental health was comparable between these children and the general population.