Impact of treatment for childhood acute lymphoblastic leukemia on later education, paid labor, and sickness- or activity compensation: A registry study from Sweden

Acute lymphoblastic leukemia (ALL) in childhood now carries survival rates above 90%, yet treatment may result in late effects that influence later educational and labor market outcomes. Previous studies have shown inconsistent results, and few have used population-based registry data with matched controls while distinguishing between different treatment intensities. The aim of this study was to assess post-compulsory educational and labor market outcomes among children treated for ALL categorized into standard-risk (SR) and high-risk (HR) treatment groups. We conducted a nationwide registry-based cohort study including 490 survivors, and 2212 matched population controls. Educational outcomes included attendance in the final year of upper secondary school, enrollment in municipal adult education, attendance at folk high schools, and participation in tertiary education. Labor market outcomes included ever having participated in paid labor and ever having received sickness or activity compensation. Differences were analyzed using logistic regression, and all analyses were adjusted for maternal educational level. Analyses were made for the entire cohort, by sex and by risk group. We found no statistically significant differences between survivors and controls for any post-compulsory educational outcome in any of the analyses. In contrast, we found that survivors overall were significantly less likely to have participated in paid labor (OR 0.72; 95% CI 0.54-0-95) and significantly more likely to have received sickness or activity compensation compared with controls (OR 2.87; 95% CI 1.82-4.53). In subgroups these disparities were concentrated in the HR group. In conclusion, survivors of childhood ALL participated in post-compulsory education at rates similar to their peers, but experienced challenges in entering the workforce. Our subgroup analysis identified that this labor market impairment was primarily experienced by survivors treated with high-intensity therapy. Our findings highlight the need for targeted long-term support strategies to reduce labor market impairment especially among survivors exposed to more intensive treatment.