PURPOSE: Using the International Standard Classification of Education (ISCED), we examined the educational and vocational pathways of two comparable, parental cohorts: childhood cancer survivors (CCS) and their siblings. Both cohorts had previously entered parenthood. The aim of the study was to elucidate whether childhood cancer and treatment affect the educational pathways chosen by parents who are former patients. METHODS: We analysed data that was collected from childhood cancer survivors and their siblings regarding their offspring's health within the FeCt Multicentre Offspring Study (conducted 2013-2016). We evaluated and compared the professional pathways of (i) all participating survivors and all participating siblings and those of (ii) survivors and their biological siblings. RESULTS: Overall information on parental gender, age, and education were available from 1077 survivors and 246 siblings (group (i)). The majority of participants were female with a mean age of 35.2 (survivor) and 37.9 (sibling) years at time of survey. For subgroup (ii), analysis information was available on 191 survivors and 210 siblings. Fathers achieved university degrees significantly more often than mothers (p = 0.003 (i), p < 0.001 (ii)). The distribution of professional education was not significantly different between cancer survivors and siblings in either cohort (i) or (ii). CONCLUSIONS: Regarding our research on the educational and vocational trajectory of CCS, patients can be reassured that family planning and vocational education are well compatible. Inequalities regarding gender-specific educational pathways remain to be addressed. IMPLICATIONS FOR CANCER SURVIVORS: CCS should monitor their fertility status regularly and, if necessary, cryopreserve germ cells or tissue in order to optimize their family planning. Educational opportunities should be pursued as desired and with confidence. Local as well as European aftercare programs can assist with family planning and education.

Berlin Institute of Health Berlin Germany

Department of Health Sciences and Health Policy University of Lucerne Lucerne Switzerland

Department of Hematology Oncology and Cancer Immunology Corporate Member of Freie Universität Berlin Humboldt Universität Zu Berlin and Berlin Institute of Health Charité Universitätsmedizin Berlin Germany Berlin Germany

Department of Pediatric Oncology and Hematology Corporate Member of Freie Universität Berlin Humboldt Universität Zu Berlin and Berlin Institute of Health Charité Universitätsmedizin Berlin Germany Augustenburger Platz 1 13353 Berlin Germany

Medical University Graz Graz Austria

Medical University Wroclaw Wroclaw Poland

University Hospital Brno Brno Czech Republic

University Hospital Motol Prague Czech Republic

See more in PubMed

Balcerek, M., Borgmann-Staudt, A., Beckmann, M., Hinz, S., Jantke, A., Kliesch, S. & Dittrich, R. (2020). Beeinträchtigung der Gonadenfunktion nach Chemo- und Strahlentherapie im Kindes- und Jugendalter: Risiken, Diagnostik, Prophylaxe- und Behandlungsmöglichkeiten. Gesellschaft für Pädiatrische Onkologie und Hämatologie. Verfügbar unterhttps://www.awmf.org/uploads/tx_szleitlinien/025-034l_S1_Beeinträchtigung_Gonadenfunktion_Chemo_Strahlentherapie_Kindesalter_2020-08.pdf.

Balcerek M, Reinmuth S, Hohmann C, Keil T, Borgmann-Staudt A. Suspected infertility after treatment for leukemia and solid tumors in childhood and adolescence. Dtsch Arztebl Int. 2012;109(7):126–131. doi: 10.3238/arztebl.2012.0126. PubMed DOI PMC

Barakat LP, Alderfer MA, Kazak AE. Posttraumatic growth in adolescent survivors of cancer and their mothers and fathers. J Pediatr Psychol. 2006;31(4):413–9. 10.1093/jpepsy/jsj058. PubMed

Borgmann-Staudt, A. (2022). FeCt, Nachkommenstudie 2010 und 2013–2019. Charité - Universitätsmedizin Berlin. Verfügbar unter. https://kinderonkologie.charite.de/forschung/ag_borgmann_staudt/fect_nachkommenstudie_20102013_19/.

Bundesministerium für Familie, Senioren, Frauen und Jugend Berlin. (2005). Das subjektive Zeitfenster für die Elternschaft. Institut für Demoskopie Allensbach. Verfügbar unter. https://www.ifd-allensbach.de/fileadmin/studien/6653_Subjektive_Zeitfenster.pdf

Erdmann, F., Kaatsch, P., Grabow, D. & Spix, C. (2020). Deutsches Kinderkrebsregister DKKR - Jahresbericht 2019. Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI) an der Johannes Gutenberg Universitätsmedizin in Mainz. Verfügbar unter. https://www.kinderkrebsregister.de/typo3temp/secure_downloads/42507/0/1c5976c2ab8af5b6b388149df7182582a4cd6a39/Buch_DKKR_Jahresbericht_2019_komplett.pdf.

Green D, Kawashima T, Stovall M, Leisenring W, Sklar C, Mertens A, Donaldson S, Byrne J, Robison L. Fertility of female survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2009;27(16):2677–2685. doi: 10.1200/JCO.2008.20.1541. PubMed DOI PMC

Harila-Saari A, Lähteeninäki P, Pukkala E, Kyyrönen P, Lanning M, Sankila R. Scholastic achievements after childhood leukemia patients: a nationwide, register-based study. J Clin Oncol. 2007;25(23):3518–3524. doi: 10.1200/JCO.2006.09.4987. PubMed DOI

Hohmann C, Borgmann-Staudt A, Rendtorff R, Reinmuth S, Holzhausen S, Willich SN, et al. Patient counselling on the risk of infertility and its impact on childhood cancer survivors: results from a national survey. J Psychosoc Oncol. 2011;29(3):274–85. 10.1080/07347332.2011.563344. PubMed

Hudson M, Mertens A, Yasui Y, Hobbie W, Chen H, Gurney J, Yeazel M, Recklitis C, Marina N, Robison L, Oeffinger K. Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. JAMA. 2003;290(12):1583–1592. doi: 10.1001/jama.290.12.1583. PubMed DOI

Hudson M, Ness K, Gurney J, Mulrooney D, Chemaitilly W, Krull K, Green D, Armstrong G, Nottage K, Jones K, Sklar C, Srivastava D, Robison L. Clinical ascertainment of health outcomes among adults treated for childhood cancer. JAMA. 2013;309(22):2371–2381. doi: 10.1001/jama.2013.6296. PubMed DOI PMC

IBM SPSS Statistics. (2017). Verallgemeinerte Schätzungsgleichungen. Verfügbar unter. https://www.ibm.com/docs/de/spssstatistics/25.0.0?topic=SSLVMB_25.0.0/spss/advanced/idh_idd_gee_repeated.html.

Jacob, M., Weiss, F. (2011). Class origin and young adults’ re-enrollment. Research in Social Startification and Mobility, 29(4), 415–426. htps://nbn-resolving.org/urn:nbn:de:0168-ssoar-437898

Lauricella, G. & Ferrari, L. (2022). Eltern in Europa: Wer bleibt bei den Kindern?. European Data Journalism Network. Verfügbar unter. https://www.europeandatajournalism.eu//ger/Nachrichten/Daten-Nachrichten/Eltern-in-Europa-Wer-bleibt-bei-den-Kindern?msclkid=1b464649b5e011ecba079bf4320a5c3f

Lancashire E, Frobisher C, Reulen R, Winter D, Glaser A, Hawkins M. Educational attainment among adult survivors of childhood cancer in Great Britain: a population-based cohort study. J Natl Cancer Inst. 2010;102(4):254–270. doi: 10.1093/jnci/djp498. PubMed DOI

Lehmann V, Chemaitilly W, Lu L, Green DM, Kutteh WH, Brinkman TM, et al. Gonadal functioning and perceptions of infertility risk among adult survivors of childhood cancer: a report from the St Jude Lifetime Cohort Study. J Clin Oncol. 2019;37(11):893–902. 10.1200/JCO.18.00965. PubMed PMC

Long K, Marsland A, Alderfer M. Cumulative family risk predicts sibling adjustment to childhood cancer. Cancer. 2013;119(13):2503–2510. doi: 10.1002/cncr.28077. PubMed DOI PMC

OECD Education at a glance 2021: OECD indicators. OECD Publishing, Paris, 2021 doi: 10.1787/b35a14e5-en. DOI

Oktay K, Harvey BE, Partridge AH, Quinn GP, Reinecke J, Taylor HS, et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2018;36(19):1994–2001. 10.1200/JCO.2018.78.1914. PubMed

Melin J, Madanat-Harjuoja L, Hirvonen E, Seppa K, Malila N, Pitkaniemi J, Gissler M, Tiitinen A. Use of fertility drugs in early-onset female cancer survivors-a Finnish register-based study on 8,929 survivors. Int J Cancer. 2020;146(3):829–838. doi: 10.1002/ijc.32346. PubMed DOI

Otth, M., Michel, G., Gerber, N., Stücklin, A., Bueren, A. & Scheinemann, K. (2022a). Educational attainment and employment outcome of survivors of pediatric CNS tumors in Switzerland - a report from the Swiss Childhood Cancer Survivor Study. Children(Basel). 9(3):S. 411. 10.3390/children9030411. PubMed PMC

Otth M, Denzler S, Diesch-Furlanetto T, Scheinemann K. Cancer knowledge and health-consciousness in childhood cancer survivors following transition into adult care—results from the ACCS project. Front Oncol. 2022 doi: 10.3389/fonc.2022.946281. PubMed DOI PMC

Pfitzer C, Orawa H, Balcerek M, Langer T, Dirksen U, Keslova P, Zubarovskaya N, Schuster FR, Jarisch A, Strauss G, Borgmann-Staudt A. Dynamics of fertility impairment and recovery after allogeneic haematopoietic stem cell transplantation in childhood and adolescence: results from a longitudinal study. J Cancer Res Clin Oncol. 2015;141(1):135–142. doi: 10.1007/s00432-014-1781-5. PubMed DOI PMC

Robison LL, Hudson MM. Survivors of childhood and adolescent cancer: life-long risks and responsibilities. Nat Rev Cancer. 2014;14(1):61–70. 10.1038/nrc3634. PubMed PMC

Robert Koch Institut. (2015). KIGGS Basiserhebung (2003–2006). Verfügbar unter. https://www.rki.de/SharedDocs/Kontaktformulare/K/KiGGS-Frageboegen/Integrator_Betr.html.

Richard G, Tedeschi G, Calhoun G. Posttraumatic growth: conceptual foundations and empirical evidence. Psychol Inq. 2004;15(1):1–18. doi: 10.1207/s15327965pli1501_01. DOI

Seitz D, Hagmann D, Besier T, Dieluweit U, Debatin K-J, Grabow D, Kaatsch P, Henrich G, Goldbeck L. Life satisfaction in adult survivors of cancer during adolescence: what contributes to the latter satisfaction with life? Qual Life Res. 2011;20(2):225–236. doi: 10.1007/s11136-010-9739-9. PubMed DOI

Shin H, Bartlett R, Gagne J. Health-related quality of life among survivors of cancer in adolescence: an integrative literature review. J Pediatr Nurs. 2019;44:97–106. doi: 10.1016/j.pedn.2018.11.009. PubMed DOI

Giwercman, A., Ishiguro, H., Jahnukainen, K., Kenney, L., Loohen, J., Meacham, L., Neggers, S., Nussey, S., Petersen, C., … Green, D. (2017). Recommendations for gonadotoxicity surveillance in male childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium. Lancet Oncol., 18(2), S. 75–90. 10.1016/S1470-2045(17)30026-8. PubMed

Schuster S, Hahn B, Beck J, Calaminus G, Timmermann B, Zehnhoff-Dinnesen A, et al. Langzeit - Nachsorge von krebskranken Kindern, Jugendlichen und jungen Erwachsenen – Vermeiden, Erkennen und Behandeln von Spätfolgen. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). 2021. https://register.awmf.org/assets/guidelines/025-003l_S1_Langzeit-Nachsorge-von-krebskranken-Kindern-Jugendlichen-jungen-Erwachsenen%E2%80%93Vermeiden-Erkennen-Behandeln-Spaetfolgen_2021-05.pdf. Accessed 25 Nov 2022.

Sommerhäuser G, Borgmann-Staudt A, Schilling R, Frey E, Hak J, Janhubová V, et al. Health of children born to childhood cancer survivors: participant characteristics and methods of the Multicenter Offspring Study. Cancer Epidemiol. 2021;75. 10.1016/j.canep.2021.102052. PubMed

Statista. Europäische Union: Anteil der erwachsenen Bevölkerung in den Mitgliedstaaten mit einem Bildungsabschluss im Tertiärbereich, aufgeschlüsselt nach Geschlecht im Jahr 2020. 2022. https://de.statista.com/statistik/daten/studie/1099110/umfrage/bevoelkerungsanteil-in-den-eu-laendern-mit-hochschulabschluss/#professional. Accessed 25 Nov 2022.

Statistisches Bundesamt. Bevölkerung im Alter von 15 Jahren und mehr nach allgemeinen und beruflichen Bildungsabschlüssen nach Jahren. 2020. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bildung-Forschung-Kultur/Bildungsstand/Tabellen/bildungsabschluss.html. Accessed 25 Nov 2022.

Statistisches Bundesamt. Bevölkerung (ab 15 Jahren): Deutschland, Jahre (bis 2019), Geschlecht, Altersgruppen, Allgemeine Schulausbildung. 2022. https://www-genesis.destatis.de/genesis/online?sequenz=tabelleErgebnis&selectionname=12211-9012&transponieren=true#abreadcrumb. Accessed 25 Nov 2022.

Sylvest R, Vassard D, Schmidt L, Schmiegelow K, Macklon KT, Forman JL, et al. Family formation and socio-economic status among 35-year-old men who have survived cancer in childhood and early adulthood: a register-based cohort study. Oncology Res and Treat. 2021;45(3):1–9. 10.1159/000520365. PubMed

United Nations Educational, Scientific and Cultural Organization. International Standard Classification of Education ISCED 2011. UNESCO Institute for Statistics. 2012. http://uis.unesco.org/sites/default/files/documents/international-standard-classification-of-education-isced-2011-en.pdf. Accessed 25 Nov 2022.

Wirtschaftskammer Österreich. (2022). Arbeitslosenquoten. Verfügbar unter. http://wko.at/statistik/eu/europa-arbeitslosenquoten.pdf.

Zeltzer L, Lu Q, Leisenring W, Tsao J, Recklitis C, Armstrong G, Mertens A, Robison L, Ness K. Psychosocial outcomes and health-related quality of life in adult childhood cancer survivors: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev. 2008;17(2):435–446. doi: 10.1158/1055-9965.EPI-07-2541. PubMed DOI

Zynda A, Reinmuth S, Pfitzer C, Hohmann C, Keil T, Borgmann-Staudt A. Childhood leukemia and its impact on graduation and having children: results from a national survey. Leuk Lymphoma. 2012;53(12):2419–2422. doi: 10.3109/10428194.2012.688965. PubMed DOI