Parent's Cancer May Put Child's Socioeconomic Future at Risk

Kristin Jenkins

August 24, 2018

Having a parent with cancer may put some children and adolescents at significantly increased risk of obtaining poor grades in school, with lower academic attainment compared with peers without parental cancer, and a very low disposable personal income (DPI) by age 30, says a Danish research team.

All of the associations were substantially stronger if the cancer type had a poor 5-year prognosis, or if the parent died, the researchers note.

Children and teens who had a father with cancer had an extended risk of attaining the lowest education level relative to the highest, according to Anne Cathrine Jørgensen, a PhD fellow at the University of Copenhagen in Denmark, and colleagues.

No such associations were observed when the parent's 5-year survival prognosis was good or if the parent was alive by the child's 18th birthday, the researchers note.

The findings come from an observational prospective study of national statistical data in more than 1.15 million Danish children and their parents, published online August 20 in the Journal of Epidemiology & Community Health.

"[T]his study provides evidence that children with parental cancer were negatively affected socioeconomically in terms of lower educational attainment and DPI in young adulthood," the authors write. "These findings may indicate that some children who experience parental cancer would benefit from appropriate support and early educational rehabilitation in teenage years."

When Cancer Patients Are Parents

It is estimated that one in three people will be diagnosed with cancer at some point in their lives and that approximately one in every six cancer survivors live with children 18 years of age or younger, the researchers point out.

"We knew from previous research that children who have had a parent with cancer are more likely to have emotional, social, cognitive and behavioral problems, and that such problems may induce social impairment and impact school performance and learning ability," Jørgensen said in an email.

Finding evidence of negative consequences, such as poorer educational attainment and earning power in early adulthood, "means that the impact of stressful events like parental cancer experience in early life may be prolonged over the life course," she told Medscape Medical News.

The researchers hope to replicate this study in other Scandinavian countries, but nothing further is planned as yet, Jørgensen added.

For their study, the team identified 1,155,214 children registered in the Danish Medical Birth Registry between January 1978 and December 1999. Parental cancer experience in families with children younger than 18 years of age was identified by using linked data from the Danish National Patient Registry.

Similarly, national statistical data for 360,054 children born between 1978 and 1984 were identified in linked Statistics Denmark registers to obtain grade point average (GPA) in ninth grade, educational attainment, and DPI at age 30.

The study showed that approximately 1 in 20 Danish children (4% - 5%) had at least one parent diagnosed with cancer. About 50% of the parents with cancer had a good 5-year prognosis.

Mothers were most commonly diagnosed with cancer of the breast, cervix, uterus, or ovary or melanoma. Fathers were also commonly diagnosed with melanoma or with cancer of the genitourinary, colon, or respiratory system.

After correction for potential confounding factors, such as parents' education, the study showed that children with a history of parental cancer achieved a slightly lower but statistically significant final GPA in ninth grade (at age 15) compared with children without parental cancer.

Children and teens who experienced parental cancer also had a higher risk for low educational attainment (relative risk ratio [RRR], 1.20). In addition, they  had a DPI in the lowest quartile at age 30 (RRR, 1.11) compared with peers who didn't have a parent with cancer. The latter finding was particularly true for children who were younger than age 5 years when the parent was diagnosed.

Analyses across all outcomes showed that when the parent's cancer type had a poor prognosis, the child's risk for low achievement increased (RRR, 1.52). This risk was further amplified if the parent died of cancer (RRR, 1.61).

"In a life course perspective, parental cancer in childhood could be considered as a potential early life stressor that may increase the health vulnerability to later-in-life exposures, expanding the risk of later social disadvantage and poor adult health," the authors say.

The researchers point out that systematic registration of children with a severely ill parent is legally required in Norway, Sweden, and Finland.

Although the Danish Health Authority recommended in 2012 that children with a severely ill parent should be followed closely, a subsequent study in health workers showed this was not being done. "[I]n a Danish context it may be debatable whether the existing recommendations are sufficient or whether further legislation is needed," Jørgensen and colleagues say.

The study was supported by Contingent Life Courses (C-LIFE). Jørgensen and colleagues have disclosed no relevant financial relationships.

J Epidemiol Community Health. Published online August 20, 2018. Full text

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