To the Editor.
—As educational specialists working with individuals treated for childhood cancer, we applaud the aims of Dr Haupt and colleagues1 in their important large-scale investigation of acute lymphoblastic leukemia (ALL) survivors' educational outcomes. However, we have concerns about several methodological issues and assumptions that bring the study's conclusions into question.While ALL is predominantly a disease of young childhood, subjects' median age was 0.2 year at diagnosis, suggesting an atypical sample or poorer survival of younger children on earlier protocols. Age-related findings may have also been obscured by the study's age groupings for data analysis.Measures of scholastic achievement were subjective and did not consider factors such as the rigor of individual academic programs. Was the reliability of subjects' self-report verified? Clinically, discrepancies have been found between self-reported grades and written documentation of actual school achievement. Among the approximately 15% of potential subjects not participating in the
Challinor J, Karl D. Educational Attainment in Survivors of ALL. JAMA. 1995;274(14):1134. doi:10.1001/jama.1995.03530140046027