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Liu SM, Brooks ED, Rubin ML, Grosshans DR, Frank SJ, McAleer MF, McGovern SL, Paulino AC, Woodhouse KD. Referral Patterns and Treatment Delays in Medulloblastoma: A Large Academic Proton Center Experience. Int J Part Ther 2020; 7:1-10. [PMID: 33604411 PMCID: PMC7886269 DOI: 10.14338/ijpt-20-00038.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/13/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose Patient travel time can cause treatment delays when providers and families decide to seek proton therapy. We examined whether travel distance or referral pattern (domestic versus international) affects time to radiation therapy and subsequent disease outcomes in patients with medulloblastoma at a large academic proton center. Patients and Methods Children with medulloblastoma treated at MD Anderson (MDA) with a protocol of proton beam therapy (PBT) between January 4, 2007, and June 25, 2014, were included in the analysis. The Wilcoxon rank-sum test was used to study the association between time to start of radiation and distance. Classification- and regression-tree analyses were used to explore binary thresholds for continuous covariates (ie, distance). Failure-free survival was defined as the time interval between end of radiation and failure or death. Results 96 patients were included in the analysis: 17 were international (18%); 19 (20%) were from Houston, Texas; 21 were from other cities inside Texas (21%); and 39 (41%) were from other US states. The median time from surgery to start of radiation was not significantly different for international patients (median = 1.45 months) compared with US patients (median = 1.15 months; P = .13). However, time from surgery to start of radiation was significantly longer for patients residing > 1716 km (> 1066 miles) from MDA (median = 1.31 months) than for patients residing ≤ 1716 km (≤ 1066 miles) from MDA (median = 1.05 months; P = .01). This 1- to 2-week delay (median = 7.8 days) did not affect failure-free survival (hazard ratio = 1.34; P = .43). Conclusion We found that short delays in proton access can exist for patients traveling long distances to proton centers. However, in this study, treatment delays did not affect outcomes. This highlights the appropriateness of PBT in the face of travel coordination. Investment by proton centers in a rigorous intake process is justified to offer timely access to curative PBT.
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Affiliation(s)
- Sean M Liu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric D Brooks
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - M Laura Rubin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristina D Woodhouse
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Tran S, Lim PS, Bojaxhiu B, Teske C, Baust K, Zepter S, Kliebsch U, Timmermann B, Calaminus G, Weber DC. Clinical outcomes and quality of life in children and adolescents with primary brain tumors treated with pencil beam scanning proton therapy. Pediatr Blood Cancer 2020; 67:e28465. [PMID: 32902137 DOI: 10.1002/pbc.28465] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term treatment-related toxicity may substantially impact well-being, quality of life (QoL), and health of children/adolescents with brain tumors (CBTs). Strategies to reduce toxicity include pencil beam scanning (PBS) proton therapy (PT). This study aims to report clinical outcomes and QoL in PBS-treated CBTs. PROCEDURE We retrospectively reviewed 221 PBS-treated CBTs aged <18 years. Overall-free (OS), disease-free (DFS), and late-toxicity-free survivals (TFS), local control (LC) and distant (DC) brain/spinal control were calculated using Kaplan-Meier estimates. Prospective QoL reports from 206 patients (proxies only ≤4 years old [yo], proxies and patients ≥5 yo) were descriptively analyzed. Median follow-up was 51 months (range, 4-222). RESULTS Median age at diagnosis was 3.1 years (range, 0.3-17.7). The main histologies were ependymoma (n = 88; 39.8%), glioma (n = 37; 16.7%), craniopharyngioma (n = 22; 10.0%), atypical teratoid/rhabdoid tumor (ATRT) (n = 21; 9.5%) and medulloblastoma (n = 15; 6.8%). One hundred sixty (72.4%) patients received chemotherapy. Median PT dose was 54 Gy(relative biological effectiveness) (range, 18.0-64.8). The 5-year OS, DFS, LC, and DC (95% CI) were 79.9% (74-85.8), 65.2% (59.8-70.6), 72.1% (65.4-78.8), and 81.8% (76.3-87.3), respectively. Late PT-related ≥G3 toxicity occurred in 19 (8.6%) patients. The 5-year ≥G3 TFS was 91.0% (86.3-95.7). Three (1.4%) secondary malignancies were observed. Patients aged ≤3 years at PT (P = .044) or receiving chemotherapy (P = .043) experienced more ≥G3 toxicity. ATRT histology independently predicted distant brain failure (P = .046) and death (P = .01). Patients aged ≥5 years self-rated QoL higher than their parents (proxy assessment). Both reported lower social functioning and cognition after PT than at baseline, but near-normal long-term global well-being. QoL was well below normal before and after PT in children ≤4 years. CONCLUSIONS The outcome of CBTs was excellent after PBS. Few patients had late ≥G3 toxicity. Patients aged <5 years showed worse QoL and toxicity outcomes.
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Affiliation(s)
- Sebastien Tran
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Pei S Lim
- Department of Radiation Oncology, University College London Hospitals, London, United Kingdom
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Triemli Hospital, Zurich, Switzerland.,Department of Radiation Oncology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Carmen Teske
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Stefan Zepter
- Center for Proton Therapy (CPT), Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy (CPT), Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland
| | - Beate Timmermann
- Department of Particle Therapy, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Damien Charles Weber
- Department of Radiation Oncology, Inselspital, University Hospital Bern, Bern, Switzerland.,Center for Proton Therapy (CPT), Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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53
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Semmel ES, Quadri TR, King TZ. Oral processing speed as a key mechanism in the relationship between neurological risk and adaptive functioning in survivors of pediatric brain tumors. Pediatr Blood Cancer 2020; 67:e28575. [PMID: 32813316 DOI: 10.1002/pbc.28575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Brain tumor (BT) survivors are at risk for difficulties with adaptive functioning (AF). Recent work has associated neurological risk with poorer AF outcomes using the Neurological Predictor Scale (NPS), a quantification of neurological risk factors. Survivors also have poorer attention, processing speed, and working memory, which are all important for AF. The current study examined whether these cognitive constructs explain the relationship between the NPS and AF in survivors. METHODS Ninety-five adult BT survivors and 135 healthy controls were recruited from the Atlanta area. The Oral Symbol Digits Modalities test was used to measure processing speed, Digit Span Backward assessed working memory, and Digit Span Forward measured attention. Informants completed the Scales of Independent Behavior (SIB-R) to measure AF. Group differences and correlations were assessed, and the PROCESS macro for SPSS tested indirect effects. RESULTS Survivors were significantly lower on AF and cognitive measures compared with controls. Attention span and processing speed had significant indirect effects in relationship between NPS and AF individually, but processing speed was the only variable with a significant indirect effect when all cognitive variables were included in the model. The NPS and processing speed together account for approximately 39% of variance in AF outcomes. CONCLUSIONS BT survivors in our sample have lower AF than controls, and processing speed appears to be particularly important in explaining the relationship between neurological risk and AF. In the future, the development of interventions aimed at increasing young adult independence should target both cognitive processing speed and AF skills.
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Affiliation(s)
- Eric S Semmel
- Department of Psychology and Neuroscience Institute, Georgia State University, Atlanta, Georgia
| | - Tobiloba R Quadri
- Department of Psychology and Neuroscience Institute, Georgia State University, Atlanta, Georgia
| | - Tricia Z King
- Department of Psychology and Neuroscience Institute, Georgia State University, Atlanta, Georgia
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Cheung AT, Li WHC, Ho LLK, Xia W, Chan GCF, Chung JOK. Pediatric brain tumor survivors' lived experience of engaging in a musical training program which promoted their psychological well-being: a qualitative study. Support Care Cancer 2020; 29:3145-3154. [PMID: 33068145 DOI: 10.1007/s00520-020-05833-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Musical training has been found to promote psychological well-being and quality of life among pediatric brain tumor survivors. Yet, the essential elements of musical training that influence its efficacy remain unknown. This study aimed to examine the lived experience of engaging in the musical training program from the perspectives of pediatric brain tumor survivors, their parents, and interveners. METHODS We employed a descriptive phenomenological approach. Twenty pediatric brain tumor survivors (aged 8-15 years) who had undergone musical training in a previous trial were selected, along with their parents (13 mothers and 7 fathers) and 7 interveners, to participate in individual semi-structured interviews. Data analysis was conducted according to Colaizzi's descriptive phenomenology method. RESULTS Five main themes emerged from the interviews: overcoming difficulties encountered during the initial phase of the musical training program, improved psychological and emotional well-being, facilitation of participation in musical training program, appreciation of the benefits of joining the musical training program, and expectation of future musical training program. The musical training program improved the psychological and emotional well-being of pediatric brain tumor survivors by promoting positive mood, facilitating emotional management and expression, and enhancing self-confidence. In addition, learning in a supportive environment is crucial in facilitating survivors to overcome adversity during their learning process. CONCLUSION This study addressed a literature gap by exploring how a musical training program promoted psychological well-being among pediatric brain tumor survivors. The study findings inform the importance of tailoring musical training program based on survivors' learning abilities and needs.
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Affiliation(s)
- Ankie Tan Cheung
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, Hong Kong
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, Hong Kong.
| | - Laurie Long Kwan Ho
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, Hong Kong
| | - Wei Xia
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, Hong Kong
| | | | - Joyce Oi Kwan Chung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
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55
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Sharkey CM, Espeleta HC, Traino KA, Roberts CM, Perez MN, Bakula DM, Chaney JM, Alderson RM, Mullins LL. Psychological adjustment outcomes among pediatric brain tumor survivors: A meta-analysis. Pediatr Blood Cancer 2020; 67:e28644. [PMID: 32761992 DOI: 10.1002/pbc.28644] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric brain tumor survivors (PBTS) are at significant risk for psychological adjustment difficulties, including greater depressive and anxious symptomology. Systematic reviews have identified this heightened risk among youth with medical conditions, but these reviews have not been specific to PBTS. Therefore, the current study aimed to directly examine the psychological adjustment of PBTS as compared to healthy peers. PROCEDURE A systematic review and meta-analysis was conducted using PubMed, PsychInfo, and Academic Search Premier databases. The search yielded 2833 articles, with 22 articles meeting inclusion criteria. RESULTS A statistically significant overall medium effect size (Hedge's g = 0.32) indicated that PBTS exhibited poorer overall psychological adjustment relative to healthy comparison groups. Studies that included younger children were associated with larger between-group differences. When evaluating specific outcomes, PBTS had relatively higher levels of depressive symptoms (Hedge's g = 0.36), anxious symptoms (Hedge's g = 0.11), and general distress (Hedge's g = 0.22), but not more externalizing problems. CONCLUSIONS The present study confirmed that PBTS are indeed at greater risk for psychological adjustment difficulties relative to healthy comparison groups. These findings highlight the importance of psychosocial screening among this population. Given that depressive symptoms were the most elevated relative to healthy peers, investigation of such symptomatology among PBTS is particularly important.
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Affiliation(s)
| | - Hannah C Espeleta
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Katherine A Traino
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Caroline M Roberts
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Megan N Perez
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Dana M Bakula
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - John M Chaney
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - R Matt Alderson
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
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Bass JK, Liu W, Banerjee P, Brinkman TM, Mulrooney DA, Gajjar A, Pappo AS, Merchant TE, Armstrong GT, Srivastava D, Robison LL, Hudson MM, Krull KR. Association of Hearing Impairment With Neurocognition in Survivors of Childhood Cancer. JAMA Oncol 2020; 6:1363-1371. [PMID: 32729886 PMCID: PMC7393588 DOI: 10.1001/jamaoncol.2020.2822] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/19/2020] [Indexed: 11/14/2022]
Abstract
Importance Despite advancements in cancer therapy and supportive care, childhood cancer survivors remain at risk for chronic morbidities associated with disease and treatment, such as hearing impairment (HI) and neurocognitive deficits. This study, to our knowledge, is the first to objectively measure hearing and neurocognitive function in a large cohort of long-term survivors of childhood cancer stratified by treatment exposures. Objective To assess the association of HI with neurocognitive function and the factors in HI that mediate neurocognitive outcomes in survivors of childhood cancer. Design, Setting, and Participants Data analyzed in this cross-sectional study were collected for the period April 25, 2007, to June 30, 2017, from participants in the St. Jude Lifetime Cohort Study (SJLIFE), an ongoing study that quantifies the long-term health outcomes of survivors of childhood cancer. Participants included those treated at St. Jude Children's Research Hospital (Memphis, Tennessee) for childhood cancer who survived 5 or more years after their original diagnosis and who were eligible for audiologic and neurocognitive testing. Hearing outcomes were coded using the Chang Ototoxicity Grading Scale. Data analysis was performed from March 22, 2019, to March 5, 2020. Main Outcomes and Measures Hearing and neurocognitive function. Survivors were grouped by hearing sensitivity (normal hearing [Chang grade 0], mild HI [Chang grades 1a, 1b, and 2a], or severe HI [Chang grade ≥2b]) and stratified by treatment exposure (platinum-only exposure group [treated with cisplatin and/or carboplatin chemotherapy], cochlear radiotherapy [RT] exposure group [treated with cochlear RT with or without platinum-based chemotherapy], or no exposure group [no platinum-based chemotherapy or cochlear RT]). Multivariable log-binomial models were adjusted for age at diagnosis, time since diagnosis, sex, and relevant treatment exposures. Results A total of 1520 survivors of childhood cancer were analyzed, among whom 814 were male survivors (53.6%), the median (interquartile range [IQR]) age was 29.4 (7.4-64.7) years, and the median (IQR) time since diagnosis was 20.4 (6.1-53.8) years. Prevalence and risk of severe HI among survivors were higher in survivors in the platinum-only (n = 107 [34.9%]; relative risk [RR], 1.68 [95% CI, 1.20-2.37]) or cochlear RT (n = 181 [38.3%]; RR, 2.69 [95% CI, 2.02-3.57) exposure group compared with those in the no exposure group (n = 65 [8.8%]). Severe HI was associated with deficits in verbal reasoning skills (no exposure group RR, 1.11 [95% CI, 0.50-2.43]; platinum-only exposure group RR, 1.93 [95% CI, 1.21-3.08]; cochlear RT exposure group RR, 2.00 [95% CI, 1.46-2.75]), verbal fluency (no exposure group RR, 1.86 [95% CI, 1.19-2.91]; platinum-only exposure group RR, 1.83 [95% CI, 1.24-2.71]; cochlear RT exposure group RR, 1.45 [95% CI, 1.09-1.94]), visuomotor speed (no exposure group RR, 1.87 [95% CI, 1.07-3.25]; platinum-only exposure group RR, 3.10 [95% CI, 1.92-4.99]; cochlear RT exposure group RR, 1.40 [95% CI, 1.11-1.78]), and mathematics skills (no exposure group RR, 1.90 [95% CI, 1.18-3.04]; platinum-only exposure group RR, 1.63 [95% CI, 1.05-2.53]; cochlear RT exposure group RR, 1.58 [95% CI, 1.15-2.18]), compared with survivors with normal hearing or with mild HI. Conclusions and Relevance Results of this study suggest that severe HI in childhood cancer survivors is associated with neurocognitive deficits independent of the neurotoxic treatment received. Early screening and intervention for HI may facilitate the development and maintenance of neurocognitive function and identify individuals at risk for impairment.
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Affiliation(s)
- Johnnie K. Bass
- Rehabilitation Services, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Wei Liu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Pia Banerjee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Alberto S. Pappo
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Thomas E. Merchant
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Deokumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
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Abstract
Introduction This study assesses the cognitive functions of children with brain tumor, including orientation, spatial perception, praxis, visuomotor constructions and thinking operations. The aim of the study was to assess the cognitive functions of children with brain tumor in the treatment process and the effects of different treatments on cognitive functionality. Method Cognitive functions of children with brain tumor ( n = 102) and children with typical development ( n = 90) were assessed with the Dynamic Occupational Therapy Assessment for Children. Children with brain tumor were divided into four subgroups according to the treatment they received. Multiple comparisons were analyzed using the Kruskal–Wallis test and binary comparisons were analyzed using the Mann–Whitney U test. Results Cognitive functions of children with brain tumor were weaker than children with typical development. Children who received chemotherapy, radiotherapy, surgery and both chemotherapy and radiotherapy had weaker cognitive functions. Conclusions Children with brain tumor whose treatment process is continuing are cognitively affected and their occupational performance in daily living tasks is weakened. In these children, cognitive- and occupation-based early intervention approaches should be developed and implemented. Especially when children start receiving radiotherapy, it may also be useful to start cognitive occupational therapy programs simultaneously for preserving children’s cognitive functionality.
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Affiliation(s)
- Gözde Önal
- Institute of Health Sciences, Occupational Therapy Department, Hacettepe University, Ankara, Turkey
| | - Meral Huri
- Faculty of Health Sciences, Occupational Therapy Department, Hacettepe University, Ankara, Turkey
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Jacola LM, Anghelescu DL, Hall L, Russell K, Zhang H, Wang F, Peters JB, Rossi M, Schreiber JE, Gajjar A. Anesthesia Exposure during Therapy Predicts Neurocognitive Outcomes in Survivors of Childhood Medulloblastoma. J Pediatr 2020; 223:141-147.e4. [PMID: 32532646 PMCID: PMC7387137 DOI: 10.1016/j.jpeds.2020.04.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/11/2020] [Accepted: 04/15/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the contribution of anesthesia exposure during treatment for childhood medulloblastoma to neurocognitive outcomes 3 years after tumor diagnosis. STUDY DESIGN In this retrospective study, anesthesia data were abstracted from medical records for 111 patients treated with risk-adapted protocol therapy at St Jude Children's Research Hospital. Neurocognitive testing data were obtained for 90.9% of patients. RESULTS For the 101 patients (62.4% male) who completed testing, mean age at diagnosis was 10.1 years, and 74.3% were staged to have average-risk disease. Anesthesia exposure during treatment ranged from 1 to 52 events (mean = 19.9); mean cumulative duration per patient was 21.1 hours (range 0.7-59.7). Compared with normative expectations (16%), the group had a significantly greater frequency of at-risk scores (<1 SD) on measures of intelligence (28.7%), attention (35.2%), working memory (26.6%), processing speed (46.7%), and reading (25.8%). Including anesthesia exposure duration to linear regression models accounting for age at diagnosis, treatment intensity, and baseline IQ significantly increased the predicted variance for intelligence (r2 = 0.59), attention (r2 = 0.29), working memory (r2 = 0.31), processing speed (r2 = 0.44), and reading (r2 = 0.25; all P values <.001). CONCLUSIONS In survivors of childhood medulloblastoma, a neurodevelopmentally vulnerable population, greater exposure to anesthesia significantly and independently predicts deficits in neurocognitive and academic functioning. When feasible, anesthesia exposure during treatment should be reduced.
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Affiliation(s)
- Lisa M Jacola
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN.
| | | | | | | | - Hui Zhang
- St. Jude Children’s Research Hospital
| | - Fang Wang
- St. Jude Children’s Research Hospital
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Stadskleiv K, Stensvold E, Stokka K, Bechensteen AG, Brandal P. Neuropsychological functioning in survivors of childhood medulloblastoma/CNS-PNET: The role of secondary medical complications. Clin Neuropsychol 2020; 36:600-625. [PMID: 32729777 DOI: 10.1080/13854046.2020.1794045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the long-term cognitive consequences of malignant pediatric brain tumor and its treatment, and factors explaining variability in cognitive functioning among survivors. Method: A geographical cohort of survivors of pediatric medulloblastoma (MB) and supratentorial primitive neuroectodermal tumor (CNS-PNET), treated between 1974 and 2013, was invited to participate. Of the 63 surviving patients, 50 (79%) consented to participation. The participants were tested with a battery of neuropsychological tests covering a wide age range. Verbal cognition, nonverbal cognition, processing speed, attention, memory, executive functioning, and manual dexterity were assessed. The participants were between 5:5 and 51:11 years of age at time of assessment. Assessments took place on average 19 years after primary tumor resective surgery. Results: One participant had a severe intellectual disability. For the rest, IQ varied from 52 to 125, with a mean score of 88.0 (SD 19.7). Twenty-eight (56%) of the participants had full-scale IQ scores in the age-average range or above. Gender, age at operation, time since operation, the presence of secondary medical complications, and treatment variables explained 46% of the variability in IQ scores, F(4,44) = 9.5, p<.001. The presence of endocrine insufficiency in combination with either epilepsy and/or hydrocephalus was associated with lowered IQ, lowered processing speed, and memory impairments. Conclusion: Patients treated for childhood MB and CNS-PNET have a lifelong risk of medical sequelae, including impaired cognitive functioning. This study adds to the literature by demonstrating the importance of following neuropsychological functioning closely, especially processing speed, learning, and memory, in survivors who have multiple secondary medical complications.
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Affiliation(s)
- Kristine Stadskleiv
- Department of Special Needs Education, University of Oslo, Oslo, Norway.,Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Einar Stensvold
- The Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pediatric Research, Oslo University Hospital, Oslo, Norway.,Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Kjersti Stokka
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway.,Centre for Cancer Biomedicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Long-term cognitive outcome in adult survivors of an early childhood posterior fossa brain tumour. Int J Clin Oncol 2020; 25:1763-1773. [PMID: 32642850 PMCID: PMC7498491 DOI: 10.1007/s10147-020-01725-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/11/2020] [Indexed: 12/05/2022]
Abstract
Purpose Posterior fossa brain tumours (PFT) and their treatment in young children are often associated with subsequent cognitive impairment. However, reported follow-up periods rarely exceed 10 years. This study reports very long-term cognitive consequences of surviving an early childhood PFT. Methods 62 adult survivors of a PFT, ascertained from a national register, diagnosed before 5 years of age, and a sibling control, received a single IQ assessment an average of 32 years (range 18–53) after initial diagnosis, using the Weschler Abbreviated Scale of Intelligence. Regression models were fitted to survivor–sibling pair differences on verbal and performance IQ (VIQ and PIQ) scores to investigate whether increasing time between PFT diagnosis and follow-up IQ assessment contributed to survivor–sibling IQ differences. Results At follow-up, survivors had, on average, VIQ 15 points and PIQ 19 points lower than their siblings. There was no significant effect of time since diagnosis on survivor–sibling VIQ difference. Survivors who received radiotherapy showed no significant effect of time since diagnosis on survivor–sibling PIQ difference. Survivors who did not receive radiotherapy demonstrated a trend for it to reduce. Conclusions VIQ and PIQ deficits persist in adulthood, suggesting the effect of a fixed injury imposing on cognitive development, rather than an ongoing pathological process. Implications for cancer survivors The findings will help parents and others supporting survivors of an early life PFT to identify and plan for possible cognitive outcomes, and highlight the importance of early interventions to optimize cognitive function during the developmental period. Electronic supplementary material The online version of this article (10.1007/s10147-020-01725-7) contains supplementary material, which is available to authorized users.
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Neurodevelopmental Consequences of Pediatric Cancer and Its Treatment: The Role of Sleep. Brain Sci 2020; 10:brainsci10070411. [PMID: 32630162 PMCID: PMC7408401 DOI: 10.3390/brainsci10070411] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
Cognitive impairment is frequent in pediatric cancer, and behavioral and psychological disturbances often also affect children who have survived cancer problems. Furthermore, pediatric tumors are also often associated with sleep disorders. The interrelationship between sleep disorders, neurodevelopmental disorders and pediatric cancer, however, is still largely unexplored. In this narrative review we approach this important aspect by first considering studies on pediatric cancer as a possible cause of neurodevelopmental disorders and then describing pediatric cancer occurring as a comorbid condition in children with neurodevelopmental disorders. Finally, we discuss the role of sleep disorders in children with cancer and neurodevelopmental disorders. Even if the specific literature approaching directly the topic of the role of sleep in the complex relationship between pediatric cancer and neurodevelopmental disorders was found to be scarce, the available evidence supports the idea that in-depth knowledge and correct management of sleep disorders can definitely improve the health and quality of life of children with cancer and of their families.
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Clinical presentation of young people (10-24 years old) with brain tumors: results from the international MOBI-Kids study. J Neurooncol 2020; 147:427-440. [PMID: 32124185 PMCID: PMC7136306 DOI: 10.1007/s11060-020-03437-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/13/2020] [Indexed: 12/22/2022]
Abstract
Introduction We used data from MOBI-Kids, a 14-country international collaborative case–control study of brain tumors (BTs), to study clinical characteristics of the tumors in older children (10 years or older), adolescents and young adults (up to the age of 24). Methods Information from clinical records was obtained for 899 BT cases, including signs and symptoms, symptom onset, diagnosis date, tumor type and location. Results Overall, 64% of all tumors were low-grade, 76% were neuroepithelial tumors and 62% gliomas. There were more males than females among neuroepithelial and embryonal tumor cases, but more females with meningeal tumors. The most frequent locations were cerebellum (22%) and frontal (16%) lobe. The most frequent symptom was headaches (60%), overall, as well as for gliomas, embryonal and ‘non-neuroepithelial’ tumors; it was convulsions/seizures for neuroepithelial tumors other than glioma, and visual signs and symptoms for meningiomas. A cluster analysis showed that headaches and nausea/vomiting was the only combination of symptoms that exceeded a cutoff of 50%, with a joint occurrence of 67%. Overall, the median time from first symptom to diagnosis was 1.42 months (IQR 0.53–4.80); it exceeded 1 year in 12% of cases, though no particular symptom was associated with exceptionally long or short delays. Conclusions This is the largest clinical epidemiology study of BT in young people conducted so far. Many signs and symptoms were identified, dominated by headaches and nausea/vomiting. Diagnosis was generally rapid but in 12% diagnostic delay exceeded 1 year with none of the symptoms been associated with a distinctly long time until diagnosis. Electronic supplementary material The online version of this article (10.1007/s11060-020-03437-4) contains supplementary material, which is available to authorized users.
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63
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Pasqual E, Bosch de Basea M, López-Vicente M, Thierry-Chef I, Cardis E. Neurodevelopmental effects of low dose ionizing radiation exposure: A systematic review of the epidemiological evidence. ENVIRONMENT INTERNATIONAL 2020; 136:105371. [PMID: 32007921 DOI: 10.1016/j.envint.2019.105371] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The neurodevelopmental effects of high doses of ionizing radiation (IR) in children are well established. To what extent such effects exist at low-to-moderate doses is unclear. Considering the increasing exposure of the general population to low-to-moderate levels of IR, predominantly from diagnostic procedures, the study of these effects has become a priority for radiation protection. OBJECTIVES We conducted a systematic review of the current evidence for possible effects of low-to-moderate IR doses received during gestation, childhood and adolescence on different domains of neurodevelopment. DATA SOURCES Searches were performed in PubMed, Scopus, EMBASE and Psychinfo on the 6th of June 2017 and repeated in December 2018. STUDY ELIGIBILITY CRITERIA We included studies evaluating the association between low-to-moderate IR doses received during gestation, childhood and adolescence, and neurodevelopmental functions. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were evaluated using the Cochrane Collaboration's risk of bias tool adapted to environmental sciences. A qualitative synthesis was performed. RESULTS A total of 26 manuscripts were finally selected. Populations analyzed in these publications were exposed to the following sources of IR: atomic bomb (Hiroshima and Nagasaki), diagnostic/therapeutic radiation, and Chernobyl and nuclear weapon testing fallout. There was limited evidence for an association between low-to-moderate doses of IR and a decrease in general cognition and language abilities, that is, a causal interpretation is credible, but chance or confounding cannot not be ruled out with reasonable confidence. Evidence for a possible stronger effect when exposure occurred early in life, in particular, during the fetal period, was inadequate. Evidence for an association between IR and other specific domains, including attention, executive function, memory, processing speed, visual-spatial abilities, motor and socio-emotional development, was inadequate, due to the very limited number of studies found. LIMITATIONS, CONCLUSIONS, AND IMPLICATIONS OF KEY FINDINGS Overall, depending on the domain, there was limited to inadequate evidence for an effect of low-to-moderate IR doses on neurodevelopment. Heterogeneity across studies in terms of outcome and exposure assessment hampered any quantitative synthesis and any stronger conclusion. Future research with adequate dosimetry and covering a range of specific neurodevelopmental outcomes would likely contribute to improve the body of evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER The systematic review protocol was registered in PROSPERO (registration number CRD42018091902).
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Affiliation(s)
- Elisa Pasqual
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Magda Bosch de Basea
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mónica López-Vicente
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Roche J, Câmara-Costa H, Roulin JL, Chevignard M, Frappaz D, Guichardet K, Benkhaled O, Kerrouche B, Prodhomme J, Kieffer-Renaux V, Le Gall D, Fournet N, Roy A. Assessment of everyday executive functioning using the BRIEF in children and adolescents treated for brain tumor. Brain Inj 2020; 34:583-590. [DOI: 10.1080/02699052.2020.1725982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jeanne Roche
- Laboratory of Psychology Pays de la Loire, EA4638, UBL, Angers University, Angers, France
- SMAEC, Resource Centre for Children, Adolescents, Young Adults with Acquired Neurological Injury, Miribel, France
| | - Hugo Câmara-Costa
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Laboratoire d’Imagerie Biomédicale, LIB, Sorbonne Université, Paris, France
| | - Jean-Luc Roulin
- University Grenoble Alpes, University Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Mathilde Chevignard
- Laboratoire d’Imagerie Biomédicale, LIB, Sorbonne Université, Paris, France
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
- GRC 24 HaMCRe, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France
| | - Didier Frappaz
- Institut d’Hématologie et d’Oncologie Pédiatrique, Lyon, France
| | - Karine Guichardet
- Medical Clinic of Paediatrics, HCE, CHU de Grenoble Alpes, Grenoble, France
| | - Ouarda Benkhaled
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Bernadette Kerrouche
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Julie Prodhomme
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Virginie Kieffer-Renaux
- Rehabilitation Department for children with acquired neurological injury, and Outreach team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Didier Le Gall
- Laboratory of Psychology Pays de la Loire, EA4638, UBL, Angers University, Angers, France
- Département de neurologie, CHU d’Angers, Université Bretagne Loire, France
| | - Nathalie Fournet
- University Grenoble Alpes, University Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Arnaud Roy
- Laboratory of Psychology Pays de la Loire, EA4638, UBL, Angers University, Angers, France
- Centre Référent des Troubles d’Apprentissage, Centre de Compétence Nantais de Neurofibromatose, Hôpital Femme-Enfant-Adolescent, CHU de Nantes, Nantes, France
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Tsang DS, Edelstein K. Late effects after childhood brain tumor treatment: it's not just about the radiation. Neuro Oncol 2020; 21:565-567. [PMID: 30918954 DOI: 10.1093/neuonc/noz054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Fan J, Milosevic R, Li J, Bai J, Zhang Y. The impact of neuroimaging advancement on neurocognitive evaluation in pediatric brain tumor survivors: A review. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.1177/2096595820902565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pediatric brain tumors are a type of tumors that are commonly present in children and young adults. With the improvement of treatment, the quality of life, especially the cognitive functioning, is gaining increasingly more attention. Apart from cognitive evaluations, neuroimaging studies begin to play an important part in neurocognitive functioning investigation. In this way, the brain tissue changes caused by tumor variables (including tumor location and tumor size) and treatment variables (including surgery, chemotherapy and radiotherapy) can be detected by neuroimaging. Recent advancement of neuroimaging techniques, such as functional-MRI (fMRI) and diffusion tensor imaging (DTI), made great contributions to understanding cognitive dysfunction and quantifying the effects of tumor variables and treatment variables. In recent years, laminar-fMRI provided a potentially valuable tool for examining the exact origins of neural activity and cognitive function. On the other hand, molecular fMRI might guide diagnosis and treatment of brain disease in the future by using new biomarkers, and DTI can detect white matter changes and obtain some anatomically specific information.
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Affiliation(s)
- Juan Fan
- Yuquan Hosipital, Tsinghua University, Beijing 100040, China
| | | | - Jiefei Li
- Yuquan Hosipital, Tsinghua University, Beijing 100040, China
| | - Jianjun Bai
- Yuquan Hosipital, Tsinghua University, Beijing 100040, China
| | - Yuqi Zhang
- Yuquan Hosipital, Tsinghua University, Beijing 100040, China
- School of Medicine, Tsinghua University, Beijing 100084, China
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67
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Vanclooster S, Van Hoeck K, Peremans L, Bilsen J, Van Der Werff Ten Bosch J, Laureys G, Paquier P, Jansen A. Reintegration into school of childhood brain tumor survivors: a qualitative study using the International Classification of Functioning, Disability and Health – Children and Youth framework. Disabil Rehabil 2020; 43:2610-2620. [DOI: 10.1080/09638288.2019.1708484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | | | - Lieve Peremans
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Johan Bilsen
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Geneviève Laureys
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Philippe Paquier
- Center for Linguistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anna Jansen
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Pediatric Neurology Unit, UZ Brussel, Brussels, Belgium
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68
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Gummersall T, Skaczkowski G, Wilson C. Childhood cancer, age at diagnosis and educational attainment: A meta-analysis. Crit Rev Oncol Hematol 2020; 145:102838. [DOI: 10.1016/j.critrevonc.2019.102838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/25/2019] [Accepted: 11/20/2019] [Indexed: 12/23/2022] Open
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van Kooten JAMC, Maurice-Stam H, Schouten AYN, van Vuurden DG, Granzen B, Gidding C, de Ruiter MA, van Litsenburg RRL, Grootenhuis MA. High occurrence of sleep problems in survivors of a childhood brain tumor with neurocognitive complaints: The association with psychosocial and behavioral executive functioning. Pediatr Blood Cancer 2019; 66:e27947. [PMID: 31418996 DOI: 10.1002/pbc.27947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Survivors of childhood brain tumors are prone to sleep and neurocognitive problems. Effective interventions to improve neurocognitive functioning are largely lacking. In general, sleep problems are negatively related to neurocognitive functioning, but this relationship is unclear in survivors of childhood brain tumors. Therefore, the occurrence of sleep problems, potential risk factors, and the relation between sleep and executive functioning were evaluated. PROCEDURE Baseline data of a randomized controlled trial on the effectiveness of neurofeedback were used. Childhood brain tumor survivors 8-18 years of age with parent-reported neurocognitive complaints ≥2 years after treatment were eligible. Parents completed the Sleep Disturbance Scale for Children. Executive functioning was assessed by parents and teachers (Behavior Rating Inventory of Executive Functioning). Multiple linear regression analyses were used to examine sociodemographic and medical characteristics and emotional difficulties and hyperactivity/inattention (Strength and Difficulties Questionnaire) as potential risk factors for sleep problems, and to assess the association between sleep and executive functioning. RESULTS Forty-eight percent of survivors (n = 82, 7.0 ± 3.6 years post diagnosis, age 13.8 ± 3.2 years) had sleep problems and scored significantly worse than the norm on the subscales Initiating and Maintaining Sleep, Excessive Somnolence, and the total scale (effect sizes 0.58-0.92). Emotional problems and/or hyperactivity/inattention were independent potential risk factors. Sleep problems were associated with worse parent-reported executive functioning. CONCLUSIONS Sleep problems occur among half of childhood brain tumor survivors with neurocognitive problems, and are associated with worse executive functioning. Future studies should focus on the development of sleep interventions for this population, to improve sleep as well as executive functioning.
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Affiliation(s)
- Jojanneke A M C van Kooten
- Department of Pediatric Oncology-Hematology, Amsterdam UMC, VU University, Amsterdam, The Netherlands.,Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Antoinette Y N Schouten
- Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Dannis G van Vuurden
- Department of Pediatric Oncology-Hematology, Amsterdam UMC, VU University, Amsterdam, The Netherlands.,Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Bernd Granzen
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Corrie Gidding
- Department of Pediatric Oncology/Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke A de Ruiter
- Psychosocial Department, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Raphaële R L van Litsenburg
- Department of Pediatric Oncology-Hematology, Amsterdam UMC, VU University, Amsterdam, The Netherlands.,Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Psychosocial Department, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
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Social attainment in survivors of pediatric central nervous system tumors: a systematic review and meta-analysis from the Children's Oncology Group. J Cancer Surviv 2019; 13:921-931. [PMID: 31625086 DOI: 10.1007/s11764-019-00808-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Improved therapies for pediatric central nervous system (CNS) tumors have increased survival rates; however, many survivors experience significant long-term functional limitations. Survivors of pediatric CNS tumors can experience deficits in social attainment. The aim of this review was to systematically amalgamate findings pertaining to social attainment (i.e., educational attainment, marriage, employment outcomes) in survivors of pediatric CNS tumors. METHODS PubMed (web-based), PsycINFO (EBSCO), EMBASE (Ovid), and Web of Science (Thomson Reuters) were used to identify articles published between January 2011 and September 2018. Eligible studies reported outcomes for survivors of pediatric CNS tumors diagnosed before age 21 years and > 5 years from diagnosis and/or > 2 years off therapy. All data were independently abstracted by two reviewers. Random-effects meta-analyses were performed using Review Manager 5.0. RESULTS The search yielded 7021 unique publications. Forty-six were included in the current review. Meta-analyses revealed survivors of CNS tumors were significantly more likely to have completed compulsory education only (OR = 1.87, 95% CI = 1.66, 2.12, p < 0.00001), less likely to be married (OR = 4.70, 95% CI = 3.89, 5.68, p < 0.00001), and more likely to be unemployed (OR = 2.84, 95% CI = 2.62, 3.08, p < 0.00001) compared to non-cancer controls. Cranial radiation therapy, neurocognitive deficits, and younger age at diagnosis were associated with poorer outcomes. Hearing loss and bilateral blindness were also related to poorer outcomes. Sex did not impact social attainment outcomes. CONCLUSIONS Survivors of pediatric CNS tumors are at elevated risk for poor attainment of key adult social outcomes. IMPLICATIONS FOR CANCER SURVIVORS There is a critical need to develop interventions to support survivors in becoming independent and productive adults.
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Pediatric Perceived Cognitive Functioning: Psychometric Properties and Normative Data of the Dutch Item Bank and Short Form. J Int Neuropsychol Soc 2019; 25:845-856. [PMID: 31179957 DOI: 10.1017/s1355617719000572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE With increasing numbers of children growing up with conditions that are associated with acquired brain injury, efficient neuropsychological screening for cognitive deficits is pivotal. Brief self-report measures concerning daily complaints can play an important role in such screening. We translated and adapted the pediatric perceived cognitive functioning (PedsPCF) self- and parent-report item bank to Dutch. This study presents (1) psychometric properties, (2) a new short form, and (3) normative data for the short form. METHODS A general population sample of children and parents was recruited. Dimensionality of the PedsPCF was assessed using confirmatory factor analyses and exploratory bifactor analyses. Item response theory (IRT) modeling was used to evaluate model fit of the PedsPCF, to identify differential item functioning (DIF), and to select items for the short form. To select short-form items, we also considered the neuropsychological content of items. RESULTS In 1441 families, a parent and/or child participated (response rate 66% at family level). Assessed psychometric properties were satisfactory and the predominantly unidimensional factor structure of the PedsPCF allowed for IRT modeling using the graded response model. One item showed meaningful DIF. For the short form, 10 items were selected. CONCLUSIONS In this first study of the PedsPCF outside the United States, studied psychometric properties of the translated PedsPCF were satisfactory, and allowed for IRT modeling. Based on the IRT analyses and the content of items, we proposed a new 10-item short form. Further research should determine the relation of PedsPCF outcomes with neurocognitive measures and its ability to facilitate neuropsychological screening in clinical practice.
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Jones RM, Pattwell SS. Future considerations for pediatric cancer survivorship: Translational perspectives from developmental neuroscience. Dev Cogn Neurosci 2019; 38:100657. [PMID: 31158802 PMCID: PMC6697051 DOI: 10.1016/j.dcn.2019.100657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023] Open
Abstract
Breakthroughs in modern medicine have increased pediatric cancer survival rates throughout the last several decades. Despite enhanced cure rates, a subset of pediatric cancer survivors exhibit life-long psychological side effects. A large body of work has addressed potential mechanisms for secondary symptoms of anxiety, post-traumatic stress, impaired emotion regulation and cognitive deficits in adults. Yet, absent from many studies are the ways in which cancer treatment can impact the developing brain. Additionally, it remains less known whether typical neurobiological changes during adolescence and early adulthood may potentially buffer or exacerbate some of the known negative cancer survivorship outcomes. This review highlights genetic, animal, and human neuroimaging research across development. We focus on the neural circuitry associated with aversive learning, which matures throughout childhood, adolescence and early adulthood. We argue that along with other individual differences, the precise timing of oncological treatment insults on such neural circuitry may expose particular vulnerabilities for pediatric cancer patients. We also explore other moderators of treatment outcomes, including genetic polymorphisms and neural mechanisms underlying memory and cognitive control. We discuss how neural maturation extending into young adulthood may also provide a sensitive period for intervention to improve psychological and cognitive outcomes in pediatric cancer survivors.
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Affiliation(s)
- Rebecca M Jones
- The Sackler Institute for Developmental Psychobiology, Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, United States
| | - Siobhan S Pattwell
- Human Biology Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mailstop C3-168, Seattle, WA 98109, United States.
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Vanclooster S, Bilsen J, Peremans L, Van Der Werff Ten Bosch J, Laureys G, Paquier P, Jansen A. Reintegration Into School After Treatment for a Brain Tumor: The Child's Perspective. Glob Pediatr Health 2019; 6:2333794X19860659. [PMID: 31321257 PMCID: PMC6610440 DOI: 10.1177/2333794x19860659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/02/2019] [Accepted: 06/05/2019] [Indexed: 01/18/2023] Open
Abstract
This multiple case study investigated perspectives of childhood brain tumor
survivors on reintegration into school over a 2-year period. Semistructured
interviews were conducted with 5 children at 3 times to obtain an extensive view
of their overall school experience. Thematic analysis of data resulted in 4
themes: “school life and participation,” “peer relations and friendships,”
“performance and difficulties,” and “support and follow-up.” Childhood brain
tumor survivors consider school attendance as part of a normal disease-free
life. Social contact and friendships represent their main motivating factors for
returning to school. Attitudes and feelings regarding performance, difficulties,
and support vary among survivors and change over time. In conclusion, continuity
in learning and social contact established before the return facilitate the
reintegration process. A comprehensive assessment of their academic and
psychosocial functioning should be organized on reentry. Systematic follow-up by
parents, school staff, and health professionals throughout the child’s school
career is required.
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Affiliation(s)
| | | | - Lieve Peremans
- Vrije Universiteit Brussel, Brussels, Belgium.,University of Antwerp, Antwerp, Belgium
| | | | | | - Philippe Paquier
- Vrije Universiteit Brussel, Brussels, Belgium.,Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Anna Jansen
- Vrije Universiteit Brussel, Brussels, Belgium.,UZ Brussel, Brussels, Belgium
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Vanclooster S, Bilsen J, Peremans L, Van der Werff Ten Bosch J, Laureys G, Willems E, Genin S, Van Bogaert P, Paquier P, Jansen A. Short-term perspectives of parents and teachers on school reintegration of childhood brain tumour survivors. Dev Neurorehabil 2019; 22:321-328. [PMID: 30015543 DOI: 10.1080/17518423.2018.1498553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: To discover short-term changes in perspectives of parents and teachers of childhood brain tumour survivors on school reintegration, in order to reveal similarities and differences between them over time. Methods: Semi-structured interviews were conducted with parents and teachers of five children at the start and the end of a 1-year period following the child's school re-entry. Results: Thematic analysis of data resulted in three main themes: 'the child's performance and wellbeing', 'the school's attitude and approach' and 'communication and working together'. Parental concerns about child-specific changes and the school's approach to the child could either decrease or increase over time. Teachers remained focused on assessing their pupil's learning potential and finding ways of appropriate support. Their different perspectives on communication and working together became more pronounced. Conclusions: This study emphasizes the importance of clear communication and collaboration, coordinated follow-up and availability of healthcare professionals during the child's school reintegration.
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Affiliation(s)
| | - Johan Bilsen
- a Vrije Universiteit Brussel , Brussels , Belgium
| | - Lieve Peremans
- a Vrije Universiteit Brussel , Brussels , Belgium.,b University of Antwerp , Antwerp , Belgium
| | | | | | | | - Sophie Genin
- e Université Libre de Bruxelles , Brussels , Belgium
| | | | - Philippe Paquier
- a Vrije Universiteit Brussel , Brussels , Belgium.,e Université Libre de Bruxelles , Brussels , Belgium.,g Universiteit Antwerpen , Antwerp , Belgium
| | - Anna Jansen
- a Vrije Universiteit Brussel , Brussels , Belgium.,c UZ Brussel , Brussels , Belgium
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Fan J, Milosevic R, Li J, Bai J, Zhang Y. The impact of neuroimaging advancement on neurocognitive evaluation in pediatric brain tumor survivors: A review. BRAIN SCIENCE ADVANCES 2019. [DOI: 10.26599/bsa.2019.9050008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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76
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Status and predictors of planning ability in adult long-term survivors of CNS tumors and other types of childhood cancer. Sci Rep 2019; 9:7290. [PMID: 31086281 PMCID: PMC6514211 DOI: 10.1038/s41598-019-43874-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/02/2019] [Indexed: 11/08/2022] Open
Abstract
Long-term childhood cancer survivors' (CCS) quality of life can be impacted by late effects such as cognitive difficulties. Especially survivors of CNS tumors are assumed to be at risk, but reports of cognitive tests in CCS with survival times >25 years are scarce. We assessed planning ability, a capacity closely related to fluid intelligence, using the Tower of London. We compared 122 CNS tumor survivors, 829 survivors of other cancers (drawn from a register-based sample of adult long-term CCS), and 215 healthy controls (using sex-specific one-way ANOVAs and t-tests). Associations of CCS' planning ability with medical and psychosocial factors were investigated with a hierarchical linear regression analysis. Mean planning ability did not differ between CCS and controls. However, female CNS tumor survivors performed worse than female survivors of other cancers and female controls. CNS tumor survivors of both sexes had a lower socioeconomic status, and fewer of them had achieved high education than other survivors. In the regression analysis, lower status and anxiety symptoms were associated with poor planning, suggesting possible mediators of effects of disease and treatment. The results indicate the necessity to contextualize test results, and to include cognitive and psychological assessments into aftercare.
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Fronto-limbic white matter microstructure, behavior, and emotion regulation in survivors of pediatric brain tumor. J Neurooncol 2019; 143:483-493. [PMID: 31073964 DOI: 10.1007/s11060-019-03180-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE After treatment, pediatric brain tumor survivors (PBTS) face emotional and behavioral challenges, perhaps due to tumor or treatment-related changes in brain structures involved in emotion regulation, including those with fronto-limbic connections. We hypothesized that relative to healthy controls (HCs), PBTS would exhibit greater difficulties with behavior and emotional functioning, and display reduced mean fractional anisotropy (mFA) in white matter tracts with fronto-limbic connections including the cingulum bundle (CB), inferior fronto-occipital fasciculus (IFOF), and uncinate fasciculus (UF). We further predicted that mFA would account for variance in the relationship between group and emotional/behavioral outcome. METHODS Eleven 8-16 year old PBTS and 14 HCs underwent MRI, including diffusion tensor imaging to assess white matter microstructure. Tractography quantified mFA of selected tracts. Parents rated children's emotional and behavioral functioning. RESULTS Compared to HCs, caregivers of PBTS reported poorer behavioral regulation and greater internalizing and externalizing symptoms. Relative to HCs, PBTS had lower mFA within the bilateral CB, IFOF, and UF (ds = 0.59-1.15). Across groups, several medium-to-large correlations linked tract mFA and increased internalizing, externalizing, and poor behavioral regulation. Tract mFA also accounted for significant variance in the group-outcome association. CONCLUSIONS Reduced mFA in fronto-limbic associated tracts may be associated with reduced behavioral regulation following pediatric brain tumor. PBTS with treatment known to impact white matter may be most susceptible. Research with larger, longitudinal samples should clarify this relationship, allow for multiple mediators across time, and consider factors like tumor and treatment type.
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78
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Loughan AR, Braun SE, Lanoye A. Executive dysfunction in neuro-oncology: Behavior Rating Inventory of Executive Function in adult primary brain tumor patients. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:393-402. [PMID: 30714410 DOI: 10.1080/23279095.2018.1553175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adult primary brain tumor (PBT) survivors report persistent cognitive difficulties before, during, and after treatment, which are problematic for everyday functioning. Cognitive domains often affected by cancer treatment appear to be attention and executive functioning (EF). One validated measure developed to assess an individual's EF within daily living is the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A). To date, no published research has investigated the EF profile of PBT patients using the BRIEF-A. Seventy-four PBT patients completed the BRIEF-A. Descriptive analyses were conducted to determine the self-reported EF profile in PBT patients. T-tests preliminarily compared the performance of PBT patients to four other comparison groups: mild cognitive impairment (MCI; n = 23), attention-deficit/hyperactivity disorder-unmedicated (ADHD-U; n = 27), traumatic brain injury (TBI; n = 23), and healthy controls (HC; n = 26). PBT BRIEF-A group means were average across subscales and indexes, yet the prevalence of significant elevations ranged from 12 to 50%. The Metacognition Index demonstrated 38% elevation prevalence compared to 22% in Behavioral Regulation. Approximately 61% of the sample had at least one clinically elevated scaled score. PBT patients reported significantly more EF impairment than HC and significantly less than ADHD-U. No significant differences were found between the PBT and MCI groups or PBT and TBI groups. Despite group means not reaching clinical impairment, a substantial proportion of patients with PBTs endorse executive dysfunction. Elevations were most prominent in metacognitive abilities over behavioral dysregulation. Notably, the EF profile of PBT patients was remarkably similar to that of MCI and TBI, increased when compared to HC, and well below ADHD-U.
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Affiliation(s)
- Ashlee R Loughan
- Department of Neurology Division of Neuro-oncology, Virginia Commonwealth University and Massey Cancer Center McGlothlin Medical Education Center, Richmond, Virginia, USA
| | - Sarah E Braun
- Department of Neurology Division of Neuro-oncology, Virginia Commonwealth University and Massey Cancer Center McGlothlin Medical Education Center, Richmond, Virginia, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Autumn Lanoye
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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O'Connor M, Halkett GK. A systematic review of interventions to reduce psychological distress in pediatric patients receiving radiation therapy. PATIENT EDUCATION AND COUNSELING 2019; 102:275-283. [PMID: 30318385 DOI: 10.1016/j.pec.2018.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Radiation therapy (RT) is a cornerstone for management of pediatric cancer. For younger patients, unintended radiation to critical organs is a concern and children need to remain immobile. Distress in children is common so many centres sedate pediatric patients. Children often are unable to remain still, due to anxiety. Interventions to reduce distress could also reduce sedation rates. The objectives of this systematic review were to: review the interventions used to address pediatric RT patients' distress and anxiety and assess their effectiveness. METHODS A systematic search of qualitative and quantitative studies from 1996 to 2016 was conducted using PRISMA guidelines. Nine articles were identified for inclusion in the final review. These articles were reviewed using a quality rating. RESULTS Participants included patients 19 years of age or younger, parents and RTs. All were single-site studies. Five studies had a control group, 3 studies had no control group, and 1 study was qualitative. Quality was not high. Six studies reported significant effects. Only one study reported group differences in children's reported anxiety. CONCLUSION Cognitive behavioural approaches appear to be worth exploring further, as are approaches grounded in child development. Therapeutic play, particularly procedural preparation via play, also seems to be a useful starting point.
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Affiliation(s)
- Moira O'Connor
- School of Psychology, Faculty of Health Sciences, Curtin University, Australia.
| | - Georgia Kb Halkett
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Australia
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80
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Kristiansen I, Strinnholm M, Strömberg B, Frisk P. Clinical characteristics, long-term complications and health-related quality of life (HRQoL) in children and young adults treated for low-grade astrocytoma in the posterior fossa in childhood. J Neurooncol 2019; 142:203-210. [PMID: 30623287 PMCID: PMC6399181 DOI: 10.1007/s11060-018-03085-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/24/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pilocytic astrocytoma is the most common brain tumour in childhood but knowledge concerning its long-term outcome is sparse. The aim of the study was to investigate if children treated for low-grade pilocytic astrocytoma in the posterior fossa had complications affecting physical and psychological health, cognitive functions, learning difficulties and HRQoL. METHODS A descriptive single-centre study, where 22 children and young adults out of 27 eligible patients (81%) treated for pilocytic astrocytoma, with a mean follow-up time of 12.4 years (5-19 years) participated (14 adults, two by telephone interviews and eight children). The study included a review of medical records, an interview, neurological investigation, screening tools for psychiatric symptoms (Beck Depression and Anxiety Inventories and Beck Youth Inventory Scales) and HRQoL measures (RAND-36). RESULTS Motor complications were most common, reported in 12 patients and mainly affecting fine-motor skills. Seven patients reported cognitive difficulties affecting performance in school. Educational support was given in the period immediately after treatment but not after primary school. None had elevated levels of psychiatric symptoms and the level of HRQoL as well as their psychosocial and educational situation was in correspondence with Swedish norms. The HRQoL score for vitality (VT) almost reached statistical significance. CONCLUSIONS The long-term functional outcome for children treated for low-grade astrocytoma is favourable. However, some patients report neurological complications and learning difficulties, which are unmet in school. Therefore, there is a need to identify those who need more thorough medical and cognitive follow-up programmes including interventions in school.
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Affiliation(s)
- Ingela Kristiansen
- Department of Women's and Children's Health, Uppsala University and Uppsala University Childrens' Hospital, 75185, Uppsala, Sweden.
| | - Margareta Strinnholm
- Department of Women's and Children's Health, Uppsala University and Uppsala University Childrens' Hospital, 75185, Uppsala, Sweden
| | - Bo Strömberg
- Department of Women's and Children's Health, Uppsala University and Uppsala University Childrens' Hospital, 75185, Uppsala, Sweden
| | - Per Frisk
- Department of Women's and Children's Health, Uppsala University and Uppsala University Childrens' Hospital, 75185, Uppsala, Sweden
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81
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Stavinoha PL, Askins MA, Powell SK, Pillay Smiley N, Robert RS. Neurocognitive and Psychosocial Outcomes in Pediatric Brain Tumor Survivors. Bioengineering (Basel) 2018; 5:E73. [PMID: 30208602 PMCID: PMC6164803 DOI: 10.3390/bioengineering5030073] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 01/15/2023] Open
Abstract
The late neurocognitive and psychosocial effects of treatment for pediatric brain tumor (PBT) represent important areas of clinical focus and ongoing research. Neurocognitive sequelae and associated problems with learning and socioemotional development negatively impact PBT survivors' overall health-related quality of life, educational attainment and employment rates. Multiple factors including tumor features and associated complications, treatment methods, individual protective and vulnerability factors and accessibility of environmental supports contribute to the neurocognitive and psychosocial outcomes in PBT survivors. Declines in overall measured intelligence are common and may persist years after treatment. Core deficits in attention, processing speed and working memory are postulated to underlie problems with overall intellectual development, academic achievement and career attainment. Additionally, psychological problems after PBT can include depression, anxiety and psychosocial adjustment issues. Several intervention paradigms are briefly described, though to date research on innovative, specific and effective interventions for neurocognitive late effects is still in its early stages. This article reviews the existing research for understanding PBT late effects and highlights the need for innovative research to enhance neurocognitive and psychosocial outcomes in PBT survivors.
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Affiliation(s)
- Peter L Stavinoha
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Martha A Askins
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Stephanie K Powell
- Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Natasha Pillay Smiley
- Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Rhonda S Robert
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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82
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Peterson RK, Katzenstein JM. Working memory and processing speed among pediatric brain tumor patients treated with photon or proton beam radiation therapy. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1510330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rachel K. Peterson
- Psychology Department, The Hospital for Sick Children, Toronto, ON, Canada
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83
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Schreiber JE, Palmer SL, Conklin HM, Mabbott DJ, Swain MA, Bonner MJ, Chapieski ML, Huang L, Zhang H, Gajjar A. Posterior fossa syndrome and long-term neuropsychological outcomes among children treated for medulloblastoma on a multi-institutional, prospective study. Neuro Oncol 2018; 19:1673-1682. [PMID: 29016818 DOI: 10.1093/neuonc/nox135] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Patients treated for medulloblastoma who experience posterior fossa syndrome (PFS) demonstrate increased risk for neurocognitive impairment at one year post diagnosis. The aim of the study was to examine longitudinal trajectories of neuropsychological outcomes in patients who experienced PFS compared with patients who did not. Methods Participants were 36 patients (22 males) who experienced PFS and 36 comparison patients (21 males) who were matched on age at diagnosis and treatment exposure but did not experience PFS. All patients underwent serial evaluation of neurocognitive functioning spanning 1 to 5 years post diagnosis. Results The PFS group demonstrated lower estimated mean scores at 1, 3, and 5 years post diagnosis on measures of general intellectual ability, processing speed, broad attention, working memory, and spatial relations compared with the non-PFS group. The PFS group exhibited estimated mean scores that were at least one standard deviation below the mean for intellectual ability, processing speed, and broad attention across all time points and for working memory by 5 years post diagnosis. Processing speed was stable over time. Attention and working memory declined over time. Despite some change over time, caregiver ratings of executive function and behavior problem symptoms remained within the average range. Conclusion Compared with patients who do not experience PFS, patients who experience PFS exhibit greater neurocognitive impairment, show little recovery over time, and decline further in some domains. Findings highlight the particularly high risk for long-term neurocognitive problems in patients who experience PFS and the need for close follow-up and intervention.
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Affiliation(s)
- Jane E Schreiber
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Shawna L Palmer
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Heather M Conklin
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Donald J Mabbott
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Michelle A Swain
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Melanie J Bonner
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Mary L Chapieski
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Lu Huang
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Hui Zhang
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Amar Gajjar
- Department of Psychology, Department of Biostatistics, and Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA; Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas, USA
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84
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White matter network topology relates to cognitive flexibility and cumulative neurological risk in adult survivors of pediatric brain tumors. NEUROIMAGE-CLINICAL 2018; 20:485-497. [PMID: 30148064 PMCID: PMC6105768 DOI: 10.1016/j.nicl.2018.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/13/2018] [Accepted: 08/09/2018] [Indexed: 01/08/2023]
Abstract
Adult survivors of pediatric brain tumors exhibit deficits in executive functioning. Given that brain tumors and medical treatments for brain tumors result in disruptions to white matter, a network analysis was used to explore the topological properties of white matter networks. This study used diffusion tensor imaging and deterministic tractography in 38 adult survivors of pediatric brain tumors (mean age in years = 23.11 (SD = 4.96), 54% female, mean years post diagnosis = 14.09 (SD = 6.19)) and 38 healthy peers matched by age, gender, handedness, and socioeconomic status. Nodes were defined using the Automated Anatomical Labeling (AAL) parcellation scheme, and edges were defined as the mean fractional anisotropy of streamlines that connected each node pair. Global efficiency and average clustering coefficient were reduced in survivors compared to healthy peers with preferential impact to hub regions. Global efficiency mediated differences in cognitive flexibility between survivors and healthy peers, as well as the relationship between cumulative neurological risk and cognitive flexibility. These results suggest that adult survivors of pediatric brain tumors, on average one and a half decades post brain tumor diagnosis and treatment, exhibit altered white matter topology in the form of suboptimal integration and segregation of large scale networks, and that disrupted topology may underlie executive functioning impairments. Network based studies provided important topographic insights on network organization in long-term survivors of pediatric brain tumor. Long term brain tumor survivorship is associated with altered white matter networks. Hub regions were preferentially impacted in survivors. Network properties explain cognitive flexibility differences between survivors and peers.
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85
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Pulsifer MB, Duncanson H, Grieco J, Evans C, Tseretopoulos ID, MacDonald S, Tarbell NJ, Yock TI. Cognitive and Adaptive Outcomes After Proton Radiation for Pediatric Patients With Brain Tumors. Int J Radiat Oncol Biol Phys 2018; 102:391-398. [PMID: 30108004 DOI: 10.1016/j.ijrobp.2018.05.069] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Radiation therapy is integral in treatment of pediatric brain tumors, but it is associated with negative long-term sequelae. Proton beam radiation therapy (PRT), which enables better focusing of radiation on tumors, may entail fewer sequelae. This prospective study examined cognitive and adaptive functioning in children and young adults treated with PRT. METHODS AND MATERIALS A total of 155 patients were assessed using age-appropriate measures for cognitive and adaptive functioning at start of or during PRT (baseline) and at follow-up. Mean age at baseline was 8.9 years; mean follow-up interval was 3.6 years. Diagnoses included medulloblastoma, craniopharyngioma, ependymoma, glial tumors, germ cell tumors, and others. The sample was divided by age at baseline (<6 years [N = 57, or 37%] and ≥6 years [N = 98, or 63%]) and by PRT field (craniospinal irradiation [CSI; 39%] and focal irradiation [61%]). RESULTS Scores for mean intelligence quotient (IQ) and adaptive functioning skills were in the average range at baseline and follow-up. Overall, mean IQ scores declined from 105.4 to 102.5 (P = .005); however, only the younger CSI group showed significant decline. Patients receiving CSI, regardless of age, appeared particularly vulnerable in IQ, processing speed, and working memory. Adaptive skills were stable across the 4 age-by-treatment field groups. CONCLUSIONS At a mean of 3.6 years after PRT, IQ declined slightly for the group, largely because of significant IQ decline in younger patients treated with CSI. No significant change was seen in patients <6 years treated with focal PRT or in older patients. Adaptive skills remained stable across age and treatment type.
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Affiliation(s)
- Margaret B Pulsifer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts.
| | - Haley Duncanson
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Julie Grieco
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Casey Evans
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Shannon MacDonald
- Harvard Medical School, Harvard University, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nancy J Tarbell
- Harvard Medical School, Harvard University, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Torunn I Yock
- Harvard Medical School, Harvard University, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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86
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Raj SP, Narad ME, Salloum R, Platt A, Thompson A, Baum KT, Wade SL. Development of a Web-Based Psychosocial Intervention for Adolescent and Young Adult Survivors of Pediatric Brain Tumor. J Adolesc Young Adult Oncol 2018; 7:187-195. [DOI: 10.1089/jayao.2017.0084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Stacey P. Raj
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- School of Psychology, Xavier University, Cincinnati, Ohio
| | - Megan E. Narad
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ralph Salloum
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Amber Platt
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aimee Thompson
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Shari L. Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
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87
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Irestorm E, Perrin S, Tonning Olsson I. Pretreatment Cognition in Patients Diagnosed With Pediatric Brain Tumors. Pediatr Neurol 2018; 79:28-33. [PMID: 29249552 DOI: 10.1016/j.pediatrneurol.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/30/2017] [Accepted: 11/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a large body of literature identifying risk factors for the long-term cognitive alterations found in survivors of pediatric brain tumors. Less is known about baseline cognitive functioning in this population, but studies suggest that cognitive dysfunctions are often present at the time of diagnosis. This study aimed to identify potential risk factors for lower cognitive function at the time of pediatric brain tumor diagnosis. METHODS Participants were children and adolescents (n = 101) diagnosed with a pediatric brain tumor between 2006 and 2015, who underwent a pretreatment neuropsychologic assessment. Multivariate regression models were used to estimate the association between gender, age at diagnosis, tumor size and location, increased intracranial pressure, epilepsy, and six different indicators of cognitive functioning. RESULTS Overall, cognitive performance was relatively intact, with results close to norm means, but impairments were found in memory and cognitive processing speed. Male gender, older age, epilepsy, increased intracranial pressure, and larger tumors were all associated with lower cognitive function at the time of brain tumor diagnosis; whereas tumor location was not. CONCLUSIONS Pretreatment neuropsychologic assessments, with some adjustments, can be carried out with children and adolescents with brain tumors. Our study adds to a small but growing body of literature documenting cognitive impairments at the time of diagnosis; these impairments may partly explain the longer-term deficits that commonly occur in pediatric brain tumor survivors. Consistent with previous research, pretreatment impairments were more common among boys, older children, and those with increased intracranial pressure, epilepsy, and larger tumors. The relationship between baseline and longer-term cognitive deficits requires further examination.
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Affiliation(s)
- Elin Irestorm
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden.
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Ingrid Tonning Olsson
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden; Department of Psychology, Lund University, Lund, Sweden
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88
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Vanclooster S, Bilsen J, Peremans L, Van der Werff Ten Bosch J, Laureys G, Willems E, Genin S, Van Bogaert P, Paquier P, Jansen A. Attending school after treatment for a brain tumor: Experiences of children and key figures. J Health Psychol 2017; 24:1436-1447. [DOI: 10.1177/1359105317733534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reintegration into school is a milestone for childhood brain tumor survivors, as well as for their parents, teachers, and healthcare providers. We explored their experiences following the school re-entry by conducting semi-structured interviews. Thematic analysis resulted in four main themes: “school performance,” “psychosocial well-being,” “support and approach,” and “communication and collaboration.” Children were pleased to return to school despite confrontation with adverse outcomes. Parents, teachers, and healthcare providers identified current and future concerns and challenges, as well as opportunities for academic and personal development. Their experiences highlight the importance of coordinated and systematic follow-up in close collaboration with healthcare providers.
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Affiliation(s)
- Stephanie Vanclooster
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Peremans
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | | | - Geneviève Laureys
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Elsie Willems
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Sophie Genin
- Department of Neuropsychology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Van Bogaert
- Department of Pediatric Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Paquier
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Unit of Clinical and Experimental Neurolinguistics, Center for Linguistics, Vrije Universiteit Brussel, Brussels, Belgium
- Unit of Translational Neurosciences, School of Medicine and Health Sciences, Universiteit Antwerpen, Antwerp, Belgium
| | - Anna Jansen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Pediatric Neurology Unit, Department of Pediatrics, UZ Brussel, Brussels, Belgium
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89
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Barrera M, Atenafu EG, Schulte F, Bartels U, Sung L, Janzen L, Chung J, Cataudella D, Hancock K, Saleh A, Strother D, McConnell D, Downie A, Hukin J, Zelcer S. Determinants of quality of life outcomes for survivors of pediatric brain tumors. Pediatr Blood Cancer 2017; 64. [PMID: 28296130 DOI: 10.1002/pbc.26481] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION To describe the quality of life (QOL) of pediatric brain tumor survivors (PBTSs) prospectively and to identify potential medical, personal and family contextual factors associated with QOL. METHODS Ninety-one PBTSs (8-16 years) who were off treatment and attending a regular classroom participated. Self- and caregiver-proxy-reported on QOL at baseline, 2 and 8 months. At baseline, cognitive, executive function, attention and memory, medical and demographics information were attained. RESULTS Significant improvements over time in PBTS's emotional QOL were self- and proxy-reported (P < 0.01) and global QOL proxy-reported (P = 0.04). Receiving cranial irradiation therapy (CIT) and poor behavioral regulation predicted poor global QOL scores reported by both informants (P < 0.017). Poor behavioral regulation also predicted poor self-reported school functioning, and poor proxy-reported emotional and social QOL (P < 0.037). Boys reported better emotional QOL (P = 0.029), and PBTSs over 11 years old were reported to have better emotion and school-related QOL. Finally, being non-White and having low income predicted poor self-reported global and emotional QOL (P = 0.041). CONCLUSIONS Receiving CIT, having poor behavioral regulation, being a female, under 11 years old and coming from low-income, non-White families place PBTSs at risk for poor QOL.
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Affiliation(s)
- Maru Barrera
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Fiona Schulte
- Department of Psychology, Alberta Children's Hospital, Calgary, Alberta, Canada.,Division of Hematology/Oncology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lillian Sung
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura Janzen
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joanna Chung
- Department of Psychology, BC Children's Hospital, Vancouver, British Columbia, Canada.,Division of Hematology/Oncology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Danielle Cataudella
- Department of Psychology, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology/Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Kelly Hancock
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amani Saleh
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Douglas Strother
- Division of Hematology/Oncology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Dina McConnell
- Department of Psychology, BC Children's Hospital, Vancouver, British Columbia, Canada.,Division of Hematology/Oncology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Andrea Downie
- Department of Psychology, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology/Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Juliette Hukin
- Division of Hematology/Oncology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Shayna Zelcer
- Division of Hematology/Oncology, London Health Sciences Centre, London, Ontario, Canada
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90
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Lai JS, Beaumont JL, Nowinski CJ, Cella D, Hartsell WF, Han-Chih Chang J, Manley PE, Goldman S. Computerized Adaptive Testing in Pediatric Brain Tumor Clinics. J Pain Symptom Manage 2017; 54:289-297. [PMID: 28797854 PMCID: PMC5610102 DOI: 10.1016/j.jpainsymman.2017.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/20/2017] [Accepted: 05/25/2017] [Indexed: 12/23/2022]
Abstract
CONTEXT Monitoring of health-related quality of life and symptoms of patients with brain tumors is needed yet not always feasible. This is partially due to lack of brief-yet-precise assessments with minimal administration burden that are easily incorporated into clinics. Dynamic computerized adaptive testing (CAT) or static fixed-length short forms, derived from psychometrically sound item banks, are designed to fill this void. OBJECTIVE This study evaluated the comparability of scores obtained from CATs and short forms. METHODS Patients (ages 7-22 years) were recruited from brain tumor clinics and completed Patient-Reported Outcome Measurement Information System CATs and short forms (Fatigue, Mobility, Upper Extremity, Depressive Symptoms, Anxiety, and Peer Relationships). Pearson correlations, paired t-tests, and Cohen's d were used to evaluate the relationship, significant differences, and the magnitude of the difference between these two scores, respectively. RESULTS Data from 161 patients with brain tumors were analyzed. Patients completed each CAT within 2 minutes. Scores obtained from CATs and short forms were highly correlated (r = 0.95-0.98). Significantly different CAT vs. short-form scores were found on 4 (of 6) domains yet with negligible effect sizes (|d| < 0.09). These relationships varied across patients with different levels of reported symptoms, with the strongest association at the worst or best symptom scores. CONCLUSIONS This study demonstrated the comparability of scores from CATs and short forms. Yet the agreement between these two varied across degrees of symptom severity which was a result of the ceiling effects of static short forms. We recommend CATs to enable individualized assessment for longitudinal monitoring.
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Affiliation(s)
- Jin-Shei Lai
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Jennifer L Beaumont
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cindy J Nowinski
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Cella
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William F Hartsell
- Northwestern Medicine Chicago Proton Center, Warrenville, Illinois, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - John Han-Chih Chang
- Northwestern Medicine Chicago Proton Center, Warrenville, Illinois, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Peter E Manley
- Children's Hospital Boston and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Stewart Goldman
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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91
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Monte Carlo-driven predictions of neurocognitive and hearing impairments following proton and photon radiotherapy for pediatric brain-tumor patients. J Neurooncol 2017; 135:521-528. [DOI: 10.1007/s11060-017-2597-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
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92
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Profiles of Executive Function Across Children with Distinct Brain Disorders: Traumatic Brain Injury, Stroke, and Brain Tumor. J Int Neuropsychol Soc 2017; 23:529-538. [PMID: 28502261 DOI: 10.1017/s1355617717000364] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study examined whether children with distinct brain disorders show different profiles of strengths and weaknesses in executive functions, and differ from children without brain disorder. METHODS Participants were children with traumatic brain injury (N=82; 8-13 years of age), arterial ischemic stroke (N=36; 6-16 years of age), and brain tumor (N=74; 9-18 years of age), each with a corresponding matched comparison group consisting of children with orthopedic injury (N=61), asthma (N=15), and classmates without medical illness (N=68), respectively. Shifting, inhibition, and working memory were assessed, respectively, using three Test of Everyday Attention: Children's Version (TEA-Ch) subtests: Creature Counting, Walk-Don't-Walk, and Code Transmission. Comparison groups did not differ in TEA-Ch performance and were merged into a single control group. Profile analysis was used to examine group differences in TEA-Ch subtest scaled scores after controlling for maternal education and age. RESULTS As a whole, children with brain disorder performed more poorly than controls on measures of executive function. Relative to controls, the three brain injury groups showed significantly different profiles of executive functions. Importantly, post hoc tests revealed that performance on TEA-Ch subtests differed among the brain disorder groups. CONCLUSIONS Results suggest that different childhood brain disorders result in distinct patterns of executive function deficits that differ from children without brain disorder. Implications for clinical practice and future research are discussed. (JINS, 2017, 23, 529-538).
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93
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de Vries M, de Ruiter MA, Oostrom KJ, Schouten-Van Meeteren AYN, Maurice-Stam H, Oosterlaan J, Grootenhuis MA. The association between the behavior rating inventory of executive functioning and cognitive testing in children diagnosed with a brain tumor. Child Neuropsychol 2017; 24:844-858. [PMID: 28693404 DOI: 10.1080/09297049.2017.1350262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pediatric brain tumor survivors (PBTS) suffer from cognitive late effects, such as deteriorating executive functioning (EF). We explored the suitability of the Behavior Rating Inventory of Executive Function (BRIEF) to screen for these late effects. We assessed the relationship between the BRIEF and EF tasks, and between the BRIEF-Parent and BRIEF-Teacher, and we explored the clinical utility. Eighty-two PBTS (8-18 years) were assessed with EF tasks measuring attention, cognitive flexibility, inhibition, visual-, and working memory (WM), and with the BRIEF-Parent and BRIEF-Teacher. Pearson's correlations between the BRIEF and EF tasks, and between the BRIEF-Parent and BRIEF-Teacher were calculated. The BRIEF-Parent related poorly to EF tasks (rs < .26, ps > .01), but of the BRIEF-Teacher the WM-scale, Monitor-scale, Behavioral-Regulation-Index, and Meta-cognition-Index, and Total-score (rs > .31, ps < .01) related significantly to some EF tasks. When controlling for age, only the WM scale and Total score related significantly to the attention task (ps < .01). The inhibit scales of the BRIEF-Parent and BRIEF-Teacher correlated significantly (r = .33, p < .01). Children with clinically elevated scores on BRIEF scales that correlated with EF tasks performed worse on all EF tasks (ds 0.56-1.23, ps < .05). The BRIEF-Teacher Total and Index scores might better screen general EF in PBTS than the BRIEF-Parent. However, the BRIEF-Teacher is also not specific enough to capture separate EFs. Solely relying on the BRIEF as a screening measure of EFs in BPTS is insufficient. Questionnaires and tasks give distinctive, valuable information.
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Affiliation(s)
- M de Vries
- a Research Priority Area Yield , University of Amsterdam, Amsterdam, The Netherlands.,b University of Nottingham - Malaysia Campus, School of Psychology, Semenyih, Selangor, Malaysia.,c Emma Children's Hospital, AMC, Psychosocial Department, Amsterdam, The Netherlands.,d Department of Medical Psychology, VU University Medical Center , Amsterdam, The Netherlands
| | - M A de Ruiter
- c Emma Children's Hospital, AMC, Psychosocial Department, Amsterdam, The Netherlands
| | - K J Oostrom
- c Emma Children's Hospital, AMC, Psychosocial Department, Amsterdam, The Netherlands.,d Department of Medical Psychology, VU University Medical Center , Amsterdam, The Netherlands
| | | | - H Maurice-Stam
- c Emma Children's Hospital, AMC, Psychosocial Department, Amsterdam, The Netherlands
| | - J Oosterlaan
- f Emma Children's Hospital, AMC, Amsterdam , The Netherlands.,g Department of Clinical Neuropsychology, VU University , Amsterdam, The Netherlands
| | - M A Grootenhuis
- c Emma Children's Hospital, AMC, Psychosocial Department, Amsterdam, The Netherlands.,h Princess Maxima Center for pediatric oncology, Utrecht, The Netherlands
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94
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Antonini TN, Ris MD, Grosshans DR, Mahajan A, Okcu MF, Chintagumpala M, Paulino A, Child AE, Orobio J, Stancel HH, Kahalley LS. Attention, processing speed, and executive functioning in pediatric brain tumor survivors treated with proton beam radiation therapy. Radiother Oncol 2017; 124:89-97. [PMID: 28655455 DOI: 10.1016/j.radonc.2017.06.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/31/2017] [Accepted: 06/08/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE This study examines attention, processing speed, and executive functioning in pediatric brain tumor survivors treated with proton beam radiation therapy (PBRT). MATERIAL AND METHODS We examined 39 survivors (age 6-19years) who were 3.61years post-PBRT on average. Craniospinal (CSI; n=21) and focal (n=18) subgroups were analyzed. Attention, processing speed, and executive functioning scores were compared to population norms, and clinical/demographic risk factors were examined. RESULTS As a group, survivors treated with focal PBRT exhibited attention, processing speed, and executive functioning that did not differ from population norms (all p>0.05). Performance in the CSI group across attention scales was normative (all p>0.05), but areas of relative weakness were identified on one executive functioning subtest and several processing speed subtests (all p<0.01). CONCLUSIONS Survivors treated with PBRT may exhibit relative resilience in cognitive domains traditionally associated with radiation late effects. Attention, processing speed, and executive functioning remained intact and within normal limits for survivors treated with focal PBRT. Among survivors treated with CSI, a score pattern emerged that was suggestive of difficulties in underlying component skills (i.e., processing speed) rather than true executive dysfunction. No evidence of profound cognitive impairment was found in either group.
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Affiliation(s)
- Tanya N Antonini
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - M Douglas Ris
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - David R Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Anita Mahajan
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - M Fatih Okcu
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, United States
| | - Murali Chintagumpala
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, United States
| | - Arnold Paulino
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Amanda E Child
- Department of Psychology, University of Houston, Houston, United States
| | - Jessica Orobio
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - Heather H Stancel
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - Lisa S Kahalley
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States.
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95
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Barrera M, Atenafu EG, Schulte F, Bartels U, Sung L, Janzen L, Chung J, Cataudella D, Hancock K, Saleh A, Strother D, McConnell D, Downie A, Hukin J, Zelcer S. Determinants of social competence in pediatric brain tumor survivors who participated in an intervention study. Support Care Cancer 2017; 25:2891-2898. [DOI: 10.1007/s00520-017-3708-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/10/2017] [Indexed: 11/28/2022]
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96
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Goldman RD, Cheng S, Cochrane DD. Improving diagnosis of pediatric central nervous system tumours: aiming for early detection. CMAJ 2017; 189:E459-E463. [PMID: 27895146 DOI: 10.1503/cmaj.160074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ran D Goldman
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics (Goldman), Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics (Cheng), and Division of Pediatric Neurosurgery, Department of Surgery (Cochrane), BC Children's Hospital, Vancouver, BC; Child and Family Research Institute (Goldman, Cheng, Cochrane), University of British Columbia, Vancouver, BC
| | - Sylvia Cheng
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics (Goldman), Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics (Cheng), and Division of Pediatric Neurosurgery, Department of Surgery (Cochrane), BC Children's Hospital, Vancouver, BC; Child and Family Research Institute (Goldman, Cheng, Cochrane), University of British Columbia, Vancouver, BC
| | - D Douglas Cochrane
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics (Goldman), Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics (Cheng), and Division of Pediatric Neurosurgery, Department of Surgery (Cochrane), BC Children's Hospital, Vancouver, BC; Child and Family Research Institute (Goldman, Cheng, Cochrane), University of British Columbia, Vancouver, BC
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97
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Prevention of radiotherapy-induced neurocognitive dysfunction in survivors of paediatric brain tumours: the potential role of modern imaging and radiotherapy techniques. Lancet Oncol 2017; 18:e91-e100. [DOI: 10.1016/s1470-2045(17)30030-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 02/06/2023]
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98
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de Ruiter MA, Schouten-van Meeteren AYN, van Vuurden DG, Maurice-Stam H, Gidding C, Beek LR, Granzen B, Oosterlaan J, Grootenhuis MA. Psychosocial profile of pediatric brain tumor survivors with neurocognitive complaints. Qual Life Res 2016; 25:435-446. [PMID: 26289022 PMCID: PMC4722086 DOI: 10.1007/s11136-015-1091-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 10/25/2022]
Abstract
PURPOSE With more children surviving a brain tumor, neurocognitive consequences of the tumor and its treatment become apparent, which could affect psychosocial functioning. The present study therefore aimed to assess psychosocial functioning of pediatric brain tumor survivors (PBTS) in detail. METHODS Psychosocial functioning of PBTS (8-18 years) with parent-reported neurocognitive complaints was compared to normative data on health-related quality of life (HRQOL), self-esteem, psychosocial adjustment, and executive functioning (one-sample t tests) and to a sibling control group on fatigue (independent-samples t test). Self-, parent-, and teacher-report questionnaires were included, where appropriate, providing complementary information. RESULTS Eighty-two PBTS (mean age 13.4 years, SD 3.2, 49 % males) and 43 healthy siblings (mean age 14.3, SD 2.4, 40 % males) were included. As compared to the normative population, PBTS themselves reported decreased physical, psychological, and generic HRQOL (d = 0.39-0.62, p < 0.008). Compared to siblings, increased fatigue-related concentration problems (d = 0.57, p < 0.01) were reported, although self-reported self-esteem and psychosocial adjustment seemed not to be affected. Parents of PBTS reported more psychosocial (d = 0.81, p < 0.000) and executive problems (d = 0.35-0.43, p < 0.016) in their child than parents of children in the normative population. Teachers indicated more psychosocial adjustment problems for female PBTS aged 8-11 years than for the female normative population (d = 0.69, p < 0.025), but they reported no more executive problems. CONCLUSIONS PBTS with parent-reported neurocognitive complaints showed increased psychosocial problems, as reported by PBTS, parents, and teachers. IMPLICATIONS FOR CANCER SURVIVORS Systematic screening of psychosocial functioning is necessary so that tailored support from professionals can be offered to PBTS with neurocognitive complaints.
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Affiliation(s)
- Marieke Anna de Ruiter
- />Pediatric Psychosocial Department, Emma Children’s Hospital AMC, Meibergdreef 9, Room A3-241, 1105 AZ Amsterdam, The Netherlands
| | | | | | - Heleen Maurice-Stam
- />Pediatric Psychosocial Department, Emma Children’s Hospital AMC, Meibergdreef 9, Room A3-241, 1105 AZ Amsterdam, The Netherlands
| | - Corrie Gidding
- />Department of Pediatric Oncology/Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laura Rachel Beek
- />Department of Medical Psychology, Wilhelmina Children’s Hospital UMC, Utrecht, The Netherlands
| | - Bernd Granzen
- />Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jaap Oosterlaan
- />Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Martha Alexandra Grootenhuis
- />Pediatric Psychosocial Department, Emma Children’s Hospital AMC, Meibergdreef 9, Room A3-241, 1105 AZ Amsterdam, The Netherlands
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99
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Sands SA. Proton Beam Radiation Therapy: The Future May Prove Brighter for Pediatric Patients With Brain Tumors. J Clin Oncol 2016; 34:1024-6. [PMID: 26811526 DOI: 10.1200/jco.2015.65.4350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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100
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Play-based procedural preparation and support intervention for cranial radiation. Support Care Cancer 2015; 24:2421-7. [PMID: 26634562 DOI: 10.1007/s00520-015-3040-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/23/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE The primary objective of this study was to examine the relationship between play-based procedural preparation and support intervention and use of sedation in children with central nervous system (CNS) tumors during radiation therapy. The secondary objective was to analyze the cost-effectiveness of the intervention compared to costs associated with daily sedation. METHODS A retrospective chart review was conducted, and 116 children aged 5-12 years met criteria for inclusion. Outcome measures included the total number of radiation treatments received, the number of treatments received with and without sedation, and the type and duration of interventions, which consisted of developmentally appropriate play, education, preparation, and distraction provided by a certified child life specialist. RESULTS The results of univariate analyses showed that age, tumor location, and total number and duration of interventions were significantly associated with sedation use during radiation therapy. Multivariate analyses showed that, after adjustment for age, tumor location, and craniospinal radiation, a significant relationship was found between the total number and duration of the interventions and sedation use. The implementation of a play-based procedural preparation and support intervention provided by a certified child life specialist significantly reduced health-care costs by decreasing the necessity of daily sedation. CONCLUSIONS Support interventions provided by child life specialists significantly decreased both sedation use and the cost associated with daily sedation during cranial radiation therapy in children with CNS tumors. This study supports the value of the child life professional as a play-based developmental specialist and a crucial component of cost-effective healthcare.
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