Early Survivorship Outcomes in Childhood Cancer Survivors: School Reintegration, Nutritional Status, and Revaccination

Abstract

BACKGROUND: With improving survival in childhood cancer, the focus is shifting toward early survivorship, a critical period for recovery and transition to long-term care. Data from low- and middle-income countries (LMICs) on outcomes during this phase remain limited. METHODS: We conducted a retrospective study of childhood cancer survivors (aged 5-18 years) enrolled in a dedicated survivorship clinic at a tertiary cancer center in India between 2013 and 2024. Early survivorship was defined as the period within 5 years of diagnosis following treatment completion. Primary outcomes included school rejoining and academic performance; secondary outcomes included nutritional status (underweight and overweight) and revaccination. Multivariable logistic regression was used to identify predictors of outcomes. RESULTS: A total of 596 survivors were included (mean age 14.3 years; 70% male). School rejoining was high (568/587, 96.8%); however, 50 (8.8%) of those who rejoined subsequently dropped out. Good academic performance was associated with lower odds of school dropout (OR 0.42, 95% CI 0.20-0.88; p = 0.02), while treatment period, socioeconomic status, diagnosis, and maternal education were not significantly associated. Overweight increased significantly across treatment periods (2014-2016: OR 2.17, p = 0.047; 2017-2020: OR 2.63, p = 0.004), with a concurrent decline in underweight. Higher socioeconomic status was associated with lower odds of underweight (OR 0.45, p = 0.001). No independent predictors of revaccination were identified. CONCLUSIONS: Early survivorship in this LMIC cohort is characterized by high school re-entry but incomplete educational retention, alongside a transition from undernutrition to increasing overweight. These findings highlight the need for structured, multidisciplinary follow-up models during early survivorship to support sustained educational engagement, nutritional health, and preventive care.