Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Nina Kadan-Lottick


Despite remarkable advances in cure rates, childhood acute lymphoblastic leukemia (ALL) may continue to result in considerable family strain. We sought to 1) measure incidence of divorce, reduced career opportunities, changes to work hours, home relocation, and changes to family planning at one year after ALL diagnosis 2) identify family and patient factors associated with these events. We conducted a prospective cohort study of 159 children with average risk-ALL enrolled and treated on COG protocol AALL0331 at 31 selected sites. In the first year of ALL treatment, 46% of parents lost a job, 13% divorced/separated, 22% decided not to have more children, 51% declined occupational opportunities, 68% decreased work hours, and 27% of families relocated homes. In adjusted analyses, no unifying factors were associated with all family events. Relocation correlated with less maternal education (OR: 4.27 [95% CI: 1.43-12.82]). Declining parental opportunities associated with family income <$50,000 (OR: 4.25 [95% CI: 1.50-12.02]) and child <5 years old (OR: 4.21 [95% CI: 1.73-10.25]). Deciding not to have more children correlated with smaller family size 2-3 vs.4-5 (OR: 3.62 [95% CI: 1.10-11.96]). In summary, childhood ALL still confers a substantial family burden, especially in the earlier stages of treatment.


This is an Open Access Thesis.

Open Access

This Article is Open Access