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Fitzpatrick S, Jacola LM, Harman JL, Willard VW. Developmental and adaptive functioning of very young children with solid tumors and brain tumors. Pediatr Blood Cancer 2024; 71:e31046. [PMID: 38679847 DOI: 10.1002/pbc.31046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Infancy/toddlerhood is a period of rapid development. All infants/toddlers (0-36 months-of-age) undergoing cancer-directed treatment at one hospital are offered developmental assessments and related services. Yet, literature comparing development of infants/toddlers with brain tumors to those with non-CNS solid tumors is sparse. DESIGN AND METHODS Developmental assessment data were abstracted from electronic health records of infants/toddlers undergoing treatment for a brain tumor (n = 36; mean age = 21.83 ± 9.96 months) or a solid tumor (n = 40; mean age = 17.35 ± 8.50). Z-scores compared obtained data with age expectations. Chi-square analyses assessed whether a greater proportion of participants scored within the clinical range than normative expectations. Multivariate analysis of variance and chi-square analyses compared developmental outcomes between groups. RESULTS Compared with age expectations, the overall group demonstrated significantly less well-developed skills. Infants/toddlers with solid tumors demonstrated clinical deficits at rates higher than expected for most domains; the rate of impairment for the solid tumor group did not differ significantly from that of the brain tumor group across most subtests. CONCLUSIONS Like young patients with brain tumors, the developmental functioning of infants/toddlers with solid tumors should be studied across time to determine the trajectory of functioning for these young patients and to inform future developmental intervention studies. PRACTICE IMPLICATIONS Infants/toddlers with a malignant solid tumor may be at increased risk for delayed development. These very young patients would likely benefit from developmental assessment, early intervention services during and after treatment, and ongoing monitoring of development across time.
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Affiliation(s)
- Sequoya Fitzpatrick
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Lisa M Jacola
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer L Harman
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Victoria W Willard
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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Drabek-Maunder ER, Mankad K, Aquilina K, Dean JA, Nisbet A, Clark CA. Using diffusion MRI to understand white matter damage and the link between brain microstructure and cognitive deficits in paediatric medulloblastoma patients. Eur J Radiol 2024; 177:111562. [PMID: 38901074 DOI: 10.1016/j.ejrad.2024.111562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/09/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Survivors of medulloblastoma face a range of challenges after treatment, involving behavioural, cognitive, language and motor skills. Post-treatment outcomes are associated with structural changes within the brain resulting from both the tumour and the treatment. Diffusion magnetic resonance imaging (MRI) has been used to investigate the microstructure of the brain. In this review, we aim to summarise the literature on diffusion MRI in patients treated for medulloblastoma and discuss future directions on how diffusion imaging can be used to improve patient quality. METHOD This review summarises the current literature on medulloblastoma in children, focusing on the impact of both the tumour and its treatment on brain microstructure. We review studies where diffusion MRI has been correlated with either treatment characteristics or cognitive outcomes. We discuss the role diffusion MRI has taken in understanding the relationship between microstructural damage and cognitive and behavioural deficits. RESULTS We identified 35 studies that analysed diffusion MRI changes in patients treated for medulloblastoma. The majority of these studies found significant group differences in measures of brain microstructure between patients and controls, and some of these studies showed associations between microstructure and neurocognitive outcomes, which could be influenced by patient characteristics (e.g. age), treatment, radiation dose and treatment type. CONCLUSIONS In future, studies would benefit from being able to separate microstructural white matter damage caused by the tumour, tumour-related complications and treatment. Additionally, advanced diffusion modelling methods can be explored to understand and describe microstructural changes to white matter.
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Affiliation(s)
- Emily R Drabek-Maunder
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK; UCL Dept of Medical Physics and Biomedical Engineering, Malet Place, Gower St, London WC1E 6BT, UK; Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK.
| | - Kshitij Mankad
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - Kristian Aquilina
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - Jamie A Dean
- UCL Dept of Medical Physics and Biomedical Engineering, Malet Place, Gower St, London WC1E 6BT, UK
| | - Andrew Nisbet
- UCL Dept of Medical Physics and Biomedical Engineering, Malet Place, Gower St, London WC1E 6BT, UK
| | - Chris A Clark
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
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Thomas T, Grieco JA, Pulsifer M. Long term neuropsychological outcomes of a pediatric ETANTR brain tumor: A case study. APPLIED NEUROPSYCHOLOGY. CHILD 2024; 13:180-189. [PMID: 38447131 DOI: 10.1080/21622965.2024.2322735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Survivors of pediatric brain tumors are at high risk for long-term neuropsychological difficulties. In the current case study, we present longitudinal neuropsychological data spanning 10 years (from age 9 to 19 years) of a patient with a rare, very large, bifrontal, embryonal tumor with abundant neuropil and true rosettes (ETANTR), which is typically associated with poor survivorship and significant neurological impact. Results demonstrated that the patient had largely intact cognitive functioning with specific difficulties in executive functioning, fine motor skills, and adaptive functioning at her most recent neuropsychology 10-year follow-up. These results highlight outcomes for a patient with remarkable resiliency in the context of numerous risk factors (a very large tumor size, multi-modal treatment, and seizure history). Patient protective factors (a high level of cognitive reserve, family support, and appropriate comprehensive educational services) likely contributed to the patient's favorable neuropsychological outcome. The patient's age at brain tumor diagnosis (9 years) and associated treatment was at a critical period of development for emerging higher order cognitive functions which likely impacted acquisition of executive functioning skills and secondarily adaptive skill outcomes. Consequently, pediatric brain tumor survivors with ETANTR or other frontal tumors require targeted screening of executive functions and proactive interventions.
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Affiliation(s)
- Tina Thomas
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie A Grieco
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Margaret Pulsifer
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Egset KS, Røkke ME, Reinfjell T, Stubberud JE, Weider S. Cognitive and behavioural rehabilitation interventions for survivors of childhood cancer with neurocognitive sequelae: A systematic review. Neuropsychol Rehabil 2024:1-28. [PMID: 38390834 DOI: 10.1080/09602011.2024.2314880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/22/2023] [Indexed: 02/24/2024]
Abstract
There is considerable interest in cognitive and behavioural interventions to manage and improve neurocognitive (dys)functions in childhood cancer survivors and the literature is rapidly growing. This systematic review aimed to examine the literature of such interventions and their impact on executive functions (EFs) and attention. A search of relevant manuscripts was performed in PubMed, PsycINFO, and Web of Science in March 2023 in accordance with the PRISMA statement. After screening 3737 records, 17 unique studies published between 2002 and 2022 were charted and summarized. Participants (N = 718) were mostly children (M = 12.2 years), who were long-term survivors (M = 5.0 years post treatment) of brain or CNS tumours (48%). Identified interventions included computerized cognitive training, physical activity, and cognitive interventions with compensatory strategy training. The highest quality RCT studies included computerized training (i.e., Cogmed), neurofeedback, and exergaming. Evidence suggests that Cogmed may improve the performance of certain working memory tasks (near transfer) and possibly improve visual attention tasks for individuals with working memory impairments. However, the evidence did not support far transfer of effects to real life. No significant effects (near or far-transfer) were found following neurofeedback and exergaming interventions. Finally, a knowledge gap was identified for interventions directed at long-term survivors in adulthood.
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Affiliation(s)
- Kaja Solland Egset
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Magnhild Eitrem Røkke
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trude Reinfjell
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Egil Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Siri Weider
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Tonning Olsson I, Lundgren J, Hjorth L, Munck Af Rosenschöld P, Hammar Å, Perrin S. Neurocognitive development after pediatric brain tumor - a longitudinal, retrospective cohort study. Child Neuropsychol 2024; 30:22-44. [PMID: 36744788 DOI: 10.1080/09297049.2023.2172149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 01/18/2023] [Indexed: 02/07/2023]
Abstract
Survivors of Pediatric Brain Tumors (PBTs) treated with cranial radiation therapy (CRT) often experience a decline in neurocognitive test scores. Less is known about the neurocognitive development of non-irradiated survivors of PBTs. The aim of this study was to statistically model neurocognitive development after PBT in both irradiated and non-irradiated survivors and to find clinical variables associated with the rate of decline in neurocognitive scores. A total of 151 survivors were included in the study. Inclusion criteria: Diagnosis of PBT between 2001 and 2013 or earlier diagnosis of PBT and turning 18 years of age between 2006 and 2013. Exclusion criteria: Death within a year from diagnosis, neurocutaneous syndromes, severe intellectual disability. Clinical neurocognitive data were collected retrospectively from medical records. Multilevel linear modeling was used to evaluate the rate of decline in neurocognitive measures and factors associated with the same. A decline was found in most measures for both irradiated and non-irradiated survivors. Ventriculo-peritoneal (VP) shunting and treatment with whole-brain radiation therapy (WBRT) were associated with a faster decline in neurocognitive scores. Male sex and supratentorial lateral tumor were associated with lower scores. Verbal learning measures were either stable or improving. Survivors of PBTs show a pattern of decline in neurocognitive scores irrespective of treatment received, which suggests the need for routine screening for neurocognitive rehabilitation. However, survivors treated with WBRT and/or a VP shunt declined at a faster rate and appear to be at the highest risk of negative neurocognitive outcomes and to have the greatest need for neurocognitive rehabilitation.
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Affiliation(s)
- Ingrid Tonning Olsson
- Department of Psychology, Lund University, Lund, Sweden
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
| | - Johan Lundgren
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
| | - Lars Hjorth
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
| | - Per Munck Af Rosenschöld
- Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Dept of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Åsa Hammar
- Department of Psychology, Lund University, Lund, Sweden
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
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Svaldi C, Ntemou E, Jonkers R, Kohnen S, de Aguiar V. Language outcomes in children who underwent surgery for the removal of a posterior fossa tumor: A systematic review. Eur J Paediatr Neurol 2024; 48:129-141. [PMID: 38377646 DOI: 10.1016/j.ejpn.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Children who underwent posterior fossa tumor removal may have spoken or written language impairments. The present systematic review synthesized the literature regarding the language outcomes in this population. Benefits of this work were the identification of shortcomings in the literature and a starting point toward formulating guidelines for postoperative language assessment. METHODS A systematic literature search was conducted, identifying studies with patients who had posterior fossa surgery before 18 years of age. Included studies were narratively synthesized to understand language outcomes by language function (e.g., phonology, morphosyntax) at a group and individual level. Furthermore, the influence of several mediators (e.g., postoperative cerebellar mutism syndrome (pCMS), tumor type) was investigated. A critical evaluation of the language assessment tools was conducted. RESULTS The narrative synthesis of 66 studies showed that a broad spectrum of language impairments has been described, characterized by a large interindividual heterogeneity. Patients younger at diagnosis, receiving treatment for a high-grade tumor and/or radiotherapy and diagnosed with pCMS seemed more prone to impairment. Several gaps in language assessment remain, such as a baseline preoperative assessment and the assessment of pragmatics and morphosyntax. Further, there were important methodological differences in existing studies which complicated our ability to accurately guide clinical practice. CONCLUSION Children who had posterior fossa surgery seem to be at risk for postoperative language impairment. These results stress the need for language follow-up in posterior fossa tumor survivors.
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Affiliation(s)
- Cheyenne Svaldi
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands; School of Psychological Sciences, Macquarie University, University Avenue, NSW, 2109, Australia; International Doctorate for Experimental Approaches to Language and Brain (IDEALAB); Newcastle University, Newcastle upon Tyne, United Kingdom; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, Groningen, the Netherlands.
| | - Effy Ntemou
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands; International Doctorate for Experimental Approaches to Language and Brain (IDEALAB); Newcastle University, Newcastle upon Tyne, United Kingdom; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, Groningen, the Netherlands; Linguistics Department, University of Potsdam, Haus 14, Karl-Liebknecht-Strasse 24-25, 14476, Potsdam, Germany.
| | - Roel Jonkers
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
| | - Saskia Kohnen
- School of Psychological Sciences, Macquarie University, University Avenue, NSW, 2109, Australia.
| | - Vânia de Aguiar
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Sarubbo S, Marras CE. Structural networking of the developing brain: from maturation to neurosurgical implications. Front Neuroanat 2023; 17:1242757. [PMID: 38099209 PMCID: PMC10719860 DOI: 10.3389/fnana.2023.1242757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
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Affiliation(s)
| | | | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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Corti C, Oldrati V, Papini M, Strazzer S, Poggi G, Romaniello R, Borgatti R, Urgesi C, Bardoni A. Randomized clinical trial on the effects of a computerized cognitive training for pediatric patients with acquired brain injury or congenital malformation. Sci Rep 2023; 13:14559. [PMID: 37666983 PMCID: PMC10477344 DOI: 10.1038/s41598-023-41810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
Both acquired injuries and congenital malformations often cause lifelong disabilities in children, with a significant impact on cognitive abilities. Remote computerized cognitive training (CCT) may be delivered in ecological settings to favour rehabilitation continuity. This randomized clinical trial (RCT) evaluated the efficacy of an 8-week multi-domain, home-based CCT in a sample of patients aged 11-16 years with non-progressive acquired brain injury (ABI), brain tumor (BT) and congenital brain malformation (CBM). Following a stepped-wedge research design, patients were randomized into two groups: Training-first group, which started the CCT immediately after baseline assessment and Waiting-first group, which started the CCT after a period of time comparable to that required by the training (8 weeks). Post-training and long-term (6 months) changes were assessed. Both groups improved on visual-spatial working memory after the CCT, with benefits maintained after 6 months, while no other changes in cognitive or psychological measures were found. These findings suggest that a multi-domain CCT can generate benefits in visual-spatial working memory, in accordance with data from extant literature reporting that computer games heavily engage visuo-spatial abilities. We speculate that is tapping on the same cognitive ability with a prolonged training that may generate the greatest change after a CCT.
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Affiliation(s)
- Claudia Corti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Viola Oldrati
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy.
| | - Marta Papini
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Sandra Strazzer
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Geraldina Poggi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | - Renato Borgatti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
- Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
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Fraley CE, Neiman JS, Feddersen CR, James C, Jones TG, Mikkelsen M, Nuss R, Schlenz AM, Winters AC, Green AL, Compas BE. Identifying patterns of neurocognitive dysfunction through direct comparison of children with leukemia, central nervous system tumors, and sickle cell disease. Pediatr Blood Cancer 2023; 70:e30299. [PMID: 37036272 PMCID: PMC10546486 DOI: 10.1002/pbc.30299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/06/2023] [Accepted: 02/23/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE To quantify and compare the magnitude and type of neurocognitive dysfunction in at-risk children with central nervous system (CNS) tumors, acute lymphoblastic leukemia (ALL), and sickle cell disease (SCD) using a common instrument and metric to directly compare these groups with each other. METHODS Fifty-three participants between the ages of 7 and 12 years (n = 27 ALL, n = 11 CNS tumor, n = 15 SCD) were enrolled and assessed using the NIH Toolbox Cognition Battery (NIHTCB). Participants with ALL or CNS tumor were 0-18 months posttherapy, while participants with SCD possessed the SS or Sβ0 genotype, took hydroxyurea, and had no known history of stroke. RESULTS Independent sample t-tests showed that participants with ALL and CNS tumor experienced greatest deficits in processing speed (ALL d = -0.96; CNS tumor d = -1.2) and inhibitory control and attention (ALL d = -0.53; CNS tumor d = -0.97) when compared with NIHTCB normative data. Participants with SCD experienced deficits in cognitive flexibility only (d = -0.53). Episodic memory was relatively spared in all groups (d = -0.03 to -0.32). There were no significant differences in function when groups were compared directly with each other by analysis of variance. CONCLUSIONS Use of a common metric to quantify the magnitude and type of neurocognitive dysfunction across at-risk groups of participants by disease shows that participants perform below age-expected norms in multiple domains and experience dysfunction differently than one another. This approach highlights patterns of dysfunction that can inform disease- and domain-specific interventions.
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Affiliation(s)
- Claire E Fraley
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jamie S Neiman
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charlotte R Feddersen
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Claire James
- Department of Biology, Carleton College, Northfield, Minnesota, USA
| | - Taylor G Jones
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Margit Mikkelsen
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachelle Nuss
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alyssa M Schlenz
- Developmental Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amanda C Winters
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Adam L Green
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
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Mash LE, Kahalley LS, Raghubar KP, Goodrich-Hunsaker NJ, Abildskov TJ, De Leon LA, MacLeod M, Stancel H, Parsons K, Biekman B, Desai NK, Grosshans DR, Paulino AC, Chu ZD, Whitehead WE, Okcu MF, Chintagumpala M, Wilde EA. Cognitive Sparing in Proton versus Photon Radiotherapy for Pediatric Brain Tumor Is Associated with White Matter Integrity: An Exploratory Study. Cancers (Basel) 2023; 15:cancers15061844. [PMID: 36980730 PMCID: PMC10047305 DOI: 10.3390/cancers15061844] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Radiotherapy for pediatric brain tumors is associated with reduced white matter structural integrity and neurocognitive decline. Superior cognitive outcomes have been reported following proton radiotherapy (PRT) compared to photon radiotherapy (XRT), presumably due to improved sparing of normal brain tissue. This exploratory study examined the relationship between white matter change and late cognitive effects in pediatric brain tumor survivors treated with XRT versus PRT. Pediatric brain tumor survivors treated with XRT (n = 10) or PRT (n = 12) underwent neuropsychological testing and diffusion weighted imaging >7 years post-radiotherapy. A healthy comparison group (n = 23) was also recruited. Participants completed age-appropriate measures of intellectual functioning, visual-motor integration, and motor coordination. Tractography was conducted using automated fiber quantification (AFQ). Fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) were extracted from 12 tracts of interest. Overall, both white matter integrity (FA) and neuropsychological performance were lower in XRT patients while PRT patients were similar to healthy control participants with respect to both FA and cognitive functioning. These findings support improved long-term outcomes in PRT versus XRT. This exploratory study is the first to directly support for white matter integrity as a mechanism of cognitive sparing in PRT.
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Affiliation(s)
- Lisa E Mash
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Lisa S Kahalley
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX 77030, USA
| | - Kimberly P Raghubar
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | | | - Tracy J Abildskov
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Luz A De Leon
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Marianne MacLeod
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Heather Stancel
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Kelley Parsons
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Brian Biekman
- Department of Psychology, University of Houston, Houston, TX 77204, USA
| | - Nilesh K Desai
- Department of Radiology, Division of Neuroradiology, Texas Children's Hospital, Houston, TX 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - David R Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Arnold C Paulino
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zili D Chu
- Department of Radiology, Division of Neuroradiology, Texas Children's Hospital, Houston, TX 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - William E Whitehead
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mehmet Fatih Okcu
- Department of Pediatrics, Division of Hematology Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Murali Chintagumpala
- Department of Pediatrics, Division of Hematology Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Department of Pediatrics, Division of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
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Kautiainen R, Aleksonis H, King TZ. A Systematic Review of Host Genomic Variation and Neuropsychological Outcomes for Pediatric Cancer Survivors. Neuropsychol Rev 2023; 33:278-306. [PMID: 35305234 DOI: 10.1007/s11065-022-09539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/25/2022] [Indexed: 10/18/2022]
Abstract
Pediatric survivors of brain tumors and acute lymphoblastic leukemia (ALL) are at risk for long-term deficits in their neuropsychological functioning. Researchers have begun examining associations between germline single nucleotide polymorphisms (SNPs), which interact with cancer treatment, and neuropsychological outcomes. This review synthesizes the impact of treatment-related toxicity from germline SNPs by neuropsychological domain (i.e., working memory, processing speed, psychological functioning) in pediatric survivors. By focusing on specific neuropsychological domains, this review will examine outcome measurement and critique methodology. Fourteen studies were identified and included in this review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All studies were published in peer-reviewed journals in English by November 24th, 2021. Reviewed studies were not of sufficient quality for a meta-analysis due to varying measurement strategies, gaps in reported descriptive variables, and low power. All neuropsychological domains evaluated in this review had associations with SNPs, except fine motor and visual integration abilities. Only five SNPs had consistent neuropsychological findings in more than one study or cohort. Future research and replication studies should use validated measures of discrete skills that are central to empirically validated models of survivors' long-term outcomes (i.e., attention, working memory, processing speed). Researchers should examine SNPs across pathophysiological pathways to investigate additive genetic risk in pediatric cancer survivors. Two SNPs were identified that confer resiliency in neuropsychological functioning, and future work should investigate resiliency genotypes and their underlying biological mechanisms.
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Affiliation(s)
- Rella Kautiainen
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Holly Aleksonis
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Tricia Z King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, Georgia.
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12
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Das AK, Mani SK, Singh SK, Kumar S. Management and outcome of unusual pediatric brain tumors: challenges experienced at a tertiary care center of a developing country. Childs Nerv Syst 2023; 39:169-183. [PMID: 36198891 DOI: 10.1007/s00381-022-05694-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Primary brain tumors are the most frequent solid pediatric tumors, accounting for 40-50% of all cancers in children. Eighty to ninety percent of the 250,000 new cases of pediatric cancer each year are discovered in low and middle-income nations, where nearly 88 percent of the world's children reside. This article aims to emphasize the unusual presentation, management, and surgical outcome of complex pediatric brain tumors. METHODS We performed a retrospective study of patients who were admitted to the neurosurgery department with unusual pediatric brain tumors between March 1, 2019, and March 1, 2022. The study included pediatric patients up to age 18 years. We included those pediatric brain tumors whose (i) location was uncommon, or (ii) presented with unusual clinical presentation, or (iii) histopathology suggested to be a rare tumor, or (iv) radiological features were atypical. RESULTS We included 9 cases of rare unusual pediatric brain tumors. Three out of 9 cases required preoperative embolization due to its hypervascular nature on digital subtraction angiography (DSA). All patients underwent surgical excision within 24-48 h of tumor devascularization. One out of 9 cases died in follow-up period due to pleural effusion and distant metastasis to lungs. CONCLUSION Treatment considerations for unusual pediatric brain tumors include a comprehensive multidisciplinary approach, including community-based screening and proper referral system for early treatment, a variety of treatment modalities, and sophisticated follow-up strategy. Government shall work in coherence with tertiary centers to spread social awareness and provide various financial scheme to prevent treatment dropouts.
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Affiliation(s)
- Anand Kumar Das
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India
| | - Suraj Kant Mani
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India
| | - Saraj Kumar Singh
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India.
| | - Subhash Kumar
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India
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13
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Józefacka NM, Machnikowska-Sokołowska MD, Kołek MF, Gruszczyńska KJ, Musioł K. Cognitive performance of medulloblastoma tumour survivors related to the area of cerebellum damage. Rep Pract Oncol Radiother 2022; 27:1037-1044. [PMID: 36632295 PMCID: PMC9826648 DOI: 10.5603/rpor.a2022.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022] Open
Abstract
Background The aim of the study was to determine the relationship between a damaged cerebellum area and the cognitive performance of medulloblastoma tumour survivors. Also, age-based differences in cognitive performance were tested. Materials and methods Magnetic resonance imaging (MRI) technique was used to obtain brain images of survivors. The cognitive performance was tested using Wechsler Intelligence Scale for Children Revised (WISC-R) and Wechsler Adult Intelligence Scale (WAIS). Statistical analysis was performed with highly robust permutation tests. Results There were two anatomical features strongly influencing the cognitive performance of survivors. The extension of the foramen of Luschka had a negative impact on the overall verbal IQ score and some non-verbal scales while the excision of the middle part of the vermis influenced scores in such scales as arithmetic and picture completing. Conclusions Children with postoperative damages in the area of the middle part of the vermis are more likely to suffer from cognitive dysfunctions after the end of the treatment.
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Affiliation(s)
| | - Magdalena Dagmara Machnikowska-Sokołowska
- Division of Diagnostic Imaging Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia Katowice, Katowice, Poland
| | | | - Katarzyna Jadwiga Gruszczyńska
- Division of Diagnostic Imaging Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia Katowice, Katowice, Poland
| | - Katarzyna Musioł
- Department of Paediatric Oncology, Haematology and Chemotherapy, Medical University of Silesia, Katowice, Poland
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14
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Chipeeva N, Deviaterikova A, Glebova E, Romanova E, Karelin A, Kasatkin V. Comparison of Neurocognitive Functioning and Fine Motor Skills in Pediatric Cancer Survivors and Healthy Children. Cancers (Basel) 2022; 14:cancers14235982. [PMID: 36497461 PMCID: PMC9738267 DOI: 10.3390/cancers14235982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/07/2022] Open
Abstract
Background: The late treatment outcomes of pediatric brain tumors and of hematopoietic and lymphoid tissue tumors are an important focus of both rehabilitation and research. Neurocognitive and motor disorders induce further learning problems impeding social-emotional adaptation throughout a whole lifespan. Core deficits in short-term and working memory, visuospatial constructional ability, verbal fluency, and fine motor skills underlie distorted intellectual and academic achievement. This study aimed to assess the individual differences in cognitive ability and fine motor skills of pediatric tumor survivors and the age-matched healthy controls. Methods: A total of 504 tumor survivors after treatment and 646 age-matched healthy controls underwent neurocognitive and fine motor assessments. Findings: The group of tumor survivors scored significantly worse in both neurocognitive and fine motor skill in compared with the healthy control group. The pediatric brain tumor survivors (PBT group) performed worse in cognitive (p < 0.001 for verbal fluency and p < 0.001 for visuospatial constructional ability) and motor tests (p < 0.001) compared to the healthy controls. Hematopoietic and Lymphoid Tissues tumors survivors (THL group) performed worse in verbal fluency (p < 0.01) and visuospatial constructional test (p < 0.001) compared to the control group. Furthermore, the PBT group had worse results in visuospatial constructional ability (p < 0.05) and fine motor (p < 0.001) ability than the THL group. Significant differences between females and males were found in fine motor test performance in the PBT group (p < 0.05), as well as in verbal fluency (p < 0.01) and visuospatial constructional ability (p < 0.01) in the control group. Neurocognitive and fine motor skill characteristics in the THL group did not correlate with age.
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Affiliation(s)
- Nadezda Chipeeva
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Correspondence: ; Tel.: +7-950-737-08-43
| | - Alena Deviaterikova
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
| | - Elena Glebova
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
| | - Elizaveta Romanova
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
| | - Alexander Karelin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
| | - Vladimir Kasatkin
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
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15
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Beuriat PA, Cristofori I, Gordon B, Grafman J. The shifting role of the cerebellum in executive, emotional and social processing across the lifespan. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2022; 18:6. [PMID: 35484543 PMCID: PMC9047369 DOI: 10.1186/s12993-022-00193-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022]
Abstract
The cerebellum's anatomical and functional organization and network interactions between the cerebellum and the cerebral cortex and subcortical structures are dynamic across the lifespan. Executive, emotional and social (EES) functions have likewise evolved during human development from contributing to primitive behaviors during infancy and childhood to being able to modulate complex actions in adults. In this review, we address how the importance of the cerebellum in the processing of EES functions might change across development. This evolution is driven by the macroscopic and microscopic modifications of the cerebellum that are occurring during development including its increasing connectivity with distant supra-tentorial cortical and sub-cortical regions. As a result of anatomical and functional changes, neuroimaging and clinical data indicate that the importance of the role of the cerebellum in human EES-related networks shifts from being crucial in newborns and young children to being only supportive later in life. In early life, given the immaturity of cortically mediated EES functions, EES functions and motor control and perception are more closely interrelated. At that time, the cerebellum due to its important role in motor control and sequencing makes EES functions more reliant on these computational properties that compute spatial distance, motor intent, and assist in the execution of sequences of behavior related to their developing EES expression. As the cortical brain matures, EES functions and decisions become less dependent upon these aspects of motor behavior and more dependent upon high-order cognitive and social conceptual processes. At that time, the cerebellum assumes a supportive role in these EES-related behaviors by computing their motor and sequential features. We suspect that this evolving role of the cerebellum has complicated the interpretation of its contribution to EES computational demands.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA. .,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. .,Rockfeller School of Medicine, Claude Bernard University, Lyon, France.
| | - Irene Cristofori
- Institute of Cognitive, Neuroscience Marc Jeannerod, CNRS/UMR 5229, 69500, Bron, France.,Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Barry Gordon
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA.,Departments of Neurology, Psychiatry and Cognitive Neurology & Alzheimer's Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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16
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Cacciotti C, Chordas C, Valentino K, Allen R, Lenzen A, Burns K, Nagarajan R, Manley P, Pillay-Smiley N. Cardiac Dysfunction in Medulloblastoma Survivors Treated with Photon Irradiation. Neurooncol Pract 2022; 9:338-343. [PMID: 35859541 PMCID: PMC9290868 DOI: 10.1093/nop/npac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Medulloblastoma is an aggressive central nervous system (CNS) tumor that occurs mostly in the pediatric population. Treatment often includes a combination of surgical resection, craniospinal irradiation (CSI) and chemotherapy. Children who receive standard photon CSI are at risk for cardiac toxicities including coronary artery disease, left ventricular scarring and dysfunction, valvular damage, and atherosclerosis. Current survivorship guidelines recommend routine echocardiogram (ECHO) surveillance. In this multi-institution study, we describe markers of cardiac dysfunction in medulloblastoma survivors.
Methods
A retrospective chart review of medulloblastoma patients who had photon beam CSI followed by ECHO between 1980 and 2010 at Lurie Children’s Hospital and Dana-Farber/Boston Children’s Hospital.
Results
During the 30-year study period, 168 medulloblastoma patient records were identified. Included in this study were the 75 patients who received CSI or spinal radiation and ECHO follow up. The mean age at CSI was 8.6 years (range, 2.9-20), and the mean number of years between radiation (RT) completion and first ECHO was 7.4 (range, 2-16). Mean ejection fraction (EF) was 60.0% and shortening fraction (SF) was 33.8%. Five patients (7%) had abnormal ECHO results: three with EF <50% and two with SF <28%.
Conclusion
Majority of medulloblastoma patients who received CSI have relatively normal ECHOs post treatment, however 7% of patients had abnormal ECHOs. The implication of our study for medulloblastoma survivors is that further investigations are needed in this populations with a more systematic, longitudinal assessment to determine predictors and screenings.
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Affiliation(s)
- Chantel Cacciotti
- Dana Farber / Boston Children’s Cancer and Blood Disorder Center, Boston MA
- Children’s Hospital London Health Sciences/Western University, London, ON
| | - Christine Chordas
- Dana Farber / Boston Children’s Cancer and Blood Disorder Center, Boston MA
| | - Katie Valentino
- Ann & Robert H. Lurie Children’s Hospital/Northwestern University, Chicago IL
| | - Rudy Allen
- Ann & Robert H. Lurie Children’s Hospital/Northwestern University, Chicago IL
| | - Alicia Lenzen
- Ann & Robert H. Lurie Children’s Hospital/Northwestern University, Chicago IL
| | - Karen Burns
- Cincinnati Children’s Hospital Medical Center/University of Cincinnati, Cincinnati OH
| | - Rajaram Nagarajan
- Cincinnati Children’s Hospital Medical Center/University of Cincinnati, Cincinnati OH
| | - Peter Manley
- Dana Farber / Boston Children’s Cancer and Blood Disorder Center, Boston MA
| | - Natasha Pillay-Smiley
- Ann & Robert H. Lurie Children’s Hospital/Northwestern University, Chicago IL
- Cincinnati Children’s Hospital Medical Center/University of Cincinnati, Cincinnati OH
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17
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Levitch CF, Holland AA, Bledsoe J, Kim SY, Barnett M, Ramjan S, Sands SA. Comparison of neuropsychological functioning in pediatric posterior fossa tumor survivors: Medulloblastoma, low-grade astrocytoma, and healthy controls. Pediatr Blood Cancer 2022; 69:e29491. [PMID: 34842359 PMCID: PMC10409501 DOI: 10.1002/pbc.29491] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neuropsychological comparison of medulloblastoma (MB) and cerebellar low-grade astrocytoma (LGA) survivors to controls can clarify treatment-related neurocognitive late effects. While both brain tumor groups undergo surgery to the posterior fossa, children with MB additionally receive craniospinal irradiation with boost and chemotherapy. This study provides an updated comparison of neuropsychological functioning in these two groups and examines effects of demographic risk factors upon outcomes. PROCEDURE Forty-two children (16 MB, nine LGA, and 17 controls) completed measures of intellectual functioning, verbal learning/memory, visual-motor integration, and fine-motor functioning. The effects of age at diagnosis, time since diagnosis, gender, fatigue, and social status on neuropsychological functioning were examined. RESULTS MB survivors demonstrated the worst neurocognitive late effects, but they were less severe and extensive than in prior studies. LGA survivors' mean scores were below normative expectations in working memory, processing speed, and fine-motor functioning. In this overall sample, processing speed difficulties were independent of fine-motor functioning and fatigue. Higher parental education was associated with better intellectual functioning, working memory, delayed recall, and visual-motor integration. Neuropsychological function was not associated with gender, age at diagnosis, or time since diagnosis. CONCLUSION The results support that contemporary treatment approaches with craniospinal irradiation plus boost and chemotherapy confer the greatest risk for late effects, while surgical resection is associated with subtle but important neurocognitive difficulties. Ultimately, this study furthers our understanding of factors impacting neuropsychological function in pediatric MB and LGA survivors and contributes to empirical support for close monitoring and targeted interventions into survivorship.
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Affiliation(s)
- Cara F. Levitch
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alice Ann Holland
- University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, Texas
- Children’s Medical Center Dallas, Department of Psychiatry, Dallas, Texas
| | - Jesse Bledsoe
- Seattle Children’s Hospital, Department of Psychiatry and Behavioral Sciences, Seattle, Washington
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Medicine, Seattle, Washington
| | - Soo Young Kim
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marie Barnett
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sameera Ramjan
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen A. Sands
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
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18
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Kasatkin V, Deviaterikova A, Shurupova M, Karelin A. The feasibility and efficacy of short-term visual-motor training in pediatric posterior fossa tumor survivors. Eur J Phys Rehabil Med 2022; 58:51-59. [PMID: 34247471 PMCID: PMC9980593 DOI: 10.23736/s1973-9087.21.06854-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pediatric posterior fossa tumor (PFT) survivors experience a range of cognitive and motor impairments that require timely rehabilitation of these functions. In Russia, rehabilitation services are only just beginning to be formed; therefore, it is necessary to test rehabilitation protocols for children surviving cancer. AIM To evaluate the efficacy of short-term cognitive and motor training (CMT) aimed on visual-motor integration in PFT survivors using training devices. DESIGN "Single center" quasi randomized controlled experiment. SETTING Outpatients of the Russkoe Pole Rehabilitation Center. POPULATION The 63 children cancer survivors between the ages of 6 and 17 years. METHODS The baseline level of cognitive and motor functions was assessed in all participants. Then the sample of patients split into two subgroups of equal sex, age, and diagnosis. The intervention subgroup received six sessions of CMT for two weeks, and the other subgroup underwent 'empty' two weeks with no intervention. Reassessment of motor and cognitive functions was conducted in all participants. Then the subgroups changed: the first subgroup underwent 'empty' two weeks, and the second subgroup completed the CMT, and further reassessment was provided. RESULTS The primary results demonstrate an increase in gross and fine motor skills, motor coordination, visual-motor integration, and visual processing after CMT. Secondary results show that the age at onset is an important factor in the subsequent decline in cognitive, motor functions, and eye movements. Children with medulloblastoma perform worse on motor tests than children with astrocytoma. A tumor in the IV ventricle is the most harmful, and a tumor in the cerebellar hemispheres is the least harmful to a child's cognitive and motor development. CONCLUSIONS This study shows the effectiveness of a short-term CMT program for children who survived PFT. The study also found that cognitive, motor, and visual-motor functions are affected by the tumor's localization, malignancy, and the child's age at onset. CLINICAL REHABILITATION IMPACT Short-term rehabilitation methods can be useful in pediatric oncological practice. Reconstruction of cognitive functions can occur during the training of more "simple" functions, such as hand-eye integration. The study makes a significant contribution to the methods of short-term rehabilitation in children who survived cancer.
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Affiliation(s)
- Vladimir Kasatkin
- Department of Neurocognitive, Psychophysiological Research and Physical Rehabilitation, Russian Field Rehabilitation Center, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Alena Deviaterikova
- Department of Neurocognitive, Psychophysiological Research and Physical Rehabilitation, Russian Field Rehabilitation Center, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia - .,Department of Visual Perception, Russian Academy of Education, Moscow, Russia
| | - Marina Shurupova
- Department of Neurocognitive, Psychophysiological Research and Physical Rehabilitation, Russian Field Rehabilitation Center, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia.,Department of Medical Rehabilitation, Federal Center of Brain and Neurotechnologies, Moscow, Russia.,Department of High Nervous Activity, Lomonosov Moscow State University, Moscow, Russia
| | - Alexander Karelin
- Department of Neurocognitive, Psychophysiological Research and Physical Rehabilitation, Russian Field Rehabilitation Center, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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19
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Sands SA. Patients With Pediatric Brain Tumor: When Do Their Delays Begin? J Clin Oncol 2021; 39:2324-2326. [PMID: 34129387 DOI: 10.1200/jco.21.01076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stephen A Sands
- Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
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20
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Ayoub R, Lau K, Yuen N, Fernandes D, Elder M, Yeung J, Wong SC, Nieman BJ. Spatiotemporal Mapping of Early Volume Loss in the Mouse Brain after Cranial Irradiation. Radiat Res 2021; 196:394-403. [PMID: 34270782 DOI: 10.1667/rade-21-00013.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/05/2021] [Indexed: 11/03/2022]
Abstract
Sequelae after pediatric cranial radiotherapy (CRT) result in long-term changes in brain structure. While past evidence indicates regional differences in brain volume change, it remains unclear how these manifest in the time course of change after CRT. In this study, we spatiotemporally characterized volume losses induced by cranial irradiation in a mouse model, with a dense sampling of measurements over the first week postirradiation. Wild-type mice received whole-brain irradiation (7 Gy) or sham irradiation (0 Gy) at 16 days of age. In vivo magnetic resonance imaging was performed at one time point before, and 2-4 time points postirradiation in each mouse, with a particular focus on sampling during the first week after cranial irradiation. Volume changes across the brain were measured, and the degree and timing of volume loss were quantified across structures from a predefined atlas. Volume measurements across the brain after cranial irradiation revealed a ∼2-day delay in which volume is not significantly altered, after which time volume change proceeds over the course of four days. Volume losses were 3% larger and emerged 40% slower in white matter than in gray matter. Large volume loss was also observed in the ventricles. Differences in the timing and magnitude of volume change between gray and white matter after cranial irradiation were observed. These results suggest differences in the mechanism and/or kinetics underlying the associated radio-response, which may have implications in development.
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Affiliation(s)
- Ramy Ayoub
- Departments of Medical Biophysics, University of Toronto, Ontario, Canada.,Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kaylie Lau
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nili Yuen
- Departments of Medical Biophysics, University of Toronto, Ontario, Canada.,Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Darren Fernandes
- Departments of Medical Biophysics, University of Toronto, Ontario, Canada.,Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Madeline Elder
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonas Yeung
- Departments of Medical Biophysics, University of Toronto, Ontario, Canada.,Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shun C Wong
- Departments of Medical Biophysics, University of Toronto, Ontario, Canada.,Radiation Oncology, University of Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Ontario, Canada.,The Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian J Nieman
- Departments of Medical Biophysics, University of Toronto, Ontario, Canada.,Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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21
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"I'm With my People!": Perceived Benefits of Participation in a Group Social Skills Intervention for Children and Adolescent Survivors of Brain Tumors. Cancer Nurs 2021; 44:197-204. [PMID: 32000176 DOI: 10.1097/ncc.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children and adolescent survivors of brain tumors may experience impairments in social competence. OBJECTIVE This qualitative randomized controlled substudy aimed to investigate the outcomes of a social skills intervention group by interviewing these children and adolescents and their caregivers following group participation. INTERVENTIONS/METHODS Children and adolescents were randomized to the Social Skills Intervention Program or the attention control group. Using purposive sampling, 12 patients (average age, 11.42 years) and 12 caregivers were interviewed following group participation. The Social Skills Intervention Program consists of eight 2-hour manualized sessions delivered weekly; each session was structured around a social skill (eg, making friends, bullying) through arts and crafts and cognitive-behavioral strategies. The sessions in the control group were structured around daily themes (eg, summer activities) doing arts and crafts. Interviews were analyzed using content analysis. RESULTS Themes unique to the intervention program included improved self-control and self-acceptance, reduced feelings of sadness, and improved problem solving. Themes common to both groups included group bonding over similar experiences, increased social confidence with peers and family, and reduced acting out. CONCLUSIONS This study uncovered additional unique intervention effects not captured by quantitative measures: improved self-control and problem solving and benefits of the group experience in general. IMPLICATIONS FOR PRACTICE Findings support the need for group socialization opportunities for children with brain tumors. Nurses can promote socializing opportunities for children and adolescent survivors of brain tumors during and after medical treatment ends to prevent social competence deterioration.
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22
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Jacola LM, Partanen M, Lemiere J, Hudson MM, Thomas S. Assessment and Monitoring of Neurocognitive Function in Pediatric Cancer. J Clin Oncol 2021; 39:1696-1704. [PMID: 33886364 DOI: 10.1200/jco.20.02444] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Marita Partanen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | - Sophie Thomas
- Nottingham Children's Hospital, Nottingham, United Kingdom
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23
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Oyefiade A, Paltin I, De Luca CR, Hardy KK, Grosshans DR, Chintagumpala M, Mabbott DJ, Kahalley LS. Cognitive Risk in Survivors of Pediatric Brain Tumors. J Clin Oncol 2021; 39:1718-1726. [PMID: 33886348 DOI: 10.1200/jco.20.02338] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ade Oyefiade
- Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, The University of Toronto, Toronto, ON, Canada
| | - Iris Paltin
- The Children's Hospital of Philadelphia, Philadelphia, PA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Cinzia R De Luca
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kristina K Hardy
- Neuropsychology Division, Children's National Hospital, Washington, DC.,Departments of Psychiatry and Behavioral Sciences and Pediatrics, The George Washington University School of Medicine, Washington, DC
| | - David R Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Murali Chintagumpala
- Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX
| | - Donald J Mabbott
- Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, The University of Toronto, Toronto, ON, Canada
| | - Lisa S Kahalley
- Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX.,Psychology Service, Texas Children's Hospital, Houston, TX
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24
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Partanen M, Anghelescu DL, Hall L, Schreiber JE, Rossi M, Gajjar A, Jacola LM. Longitudinal associations between exposure to anesthesia and neurocognitive functioning in pediatric medulloblastoma. Eur J Cancer 2021; 148:103-111. [PMID: 33743477 DOI: 10.1016/j.ejca.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/04/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
AIM To examine whether anesthesia exposure is associated with neurocognitive decline in pediatric medulloblastoma. METHODS Patients were treated at St. Jude Children's Research Hospital and completed ≥2 protocol-directed neurocognitive assessments (n = 107) as part of a multisite clinical trial for pediatric medulloblastoma (NCT00085202). Patients received risk-adapted craniospinal photon irradiation, followed by four cycles of high-dose chemotherapy and stem cell rescue. Neurocognitive testing was completed at study baseline (after surgery and <2 weeks of starting radiation therapy) and annually for 5 years. Data on anesthesia exposure during treatment was abstracted from medical records. RESULTS Patients were 10.2 years at diagnosis on average (SD = 4.5; 37% female, 73% average-risk). Mean cumulative anesthesia duration was 20.4 h (SD = 15.2; range 0.7-55.6 h). In the overall group, longer anesthesia duration was associated with greater declines in IQ (Estimate = -0.08, P < 0.001), attention (Estimate = -0.10, P < .001) and processing speed (Estimate = -0.13, P < 0.001). Similar results were shown in subgroups of patients who were <7 years at diagnosis (IQ = -0.14, P = 0.027; Attention = -0.25: P = 0.011), ≥7 years at diagnosis (Attention = -0.07, P = 0.039; Processing Speed = -0.08, P = 0.022), treated for high-risk disease (IQ = -0.09, P = 0.024; Attention = -0.11, P = 0.034; Processing Speed = -0.13, P = 0.001), or treated for average-risk disease (IQ = -0.05, P = .022; Attention = -0.08, P = 0.011; Processing Speed = -0.10, P < 0.001). CONCLUSION Greater anesthesia exposure is a risk factor for clinically significant neurocognitive decline, in addition to factors of age at diagnosis and treatment risk arm. This result is notable as there are evidence-based strategies that can limit the need for anesthesia. Limiting anesthesia exposure, as feasible, may mitigate neurocognitive late effects, and thus, improve quality of life for survivors.
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Affiliation(s)
- M Partanen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - L Hall
- St. Jude Children's Research Hospital, Memphis, USA
| | - J E Schreiber
- The Children's Hospital of Philadelphia, Philadelphia, USA
| | - M Rossi
- St. Jude Children's Research Hospital, Memphis, USA
| | - A Gajjar
- St. Jude Children's Research Hospital, Memphis, USA
| | - L M Jacola
- St. Jude Children's Research Hospital, Memphis, USA.
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25
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Siciliano RE, Thigpen JC, Desjardins L, Cook JL, Steele EH, Gruhn MA, Ichinose M, Park S, Esbenshade AJ, Pastakia D, Wellons JC, Compas BE. Working memory training in pediatric brain tumor survivors after recent diagnosis: Challenges and initial effects. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:412-421. [PMID: 33501845 DOI: 10.1080/21622965.2021.1875226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Research shows promise for cognitive interventions for children diagnosed with brain tumors. Interventions have been delivered approximately 5 years postdiagnosis on average, yet recent evidence shows cognitive deficits may appear near diagnosis. The present study assessed the feasibility and initial effects of working memory training in children with brain tumors delivered soon after diagnosis and followed 2 years postdiagnosis. Children completed baseline assessments 10 months postdiagnosis and were randomized to complete adaptive or nonadaptive (i.e., control) Cogmed Working Memory Training. Children were administered the WISC-IV Working Memory Index (WMI) and NIH Toolbox Cognitive Battery (NTCB), and parents completed attentional and executive function measures at four time points. On average, participants completed half of prescribed Cogmed sessions. Retention for the three follow-up assessments proved difficult. For both Cogmed groups, WMI and NTCB scores significantly improved immediately postintervention compared to baseline scores. Significant differences were not maintained at the remaining follow-ups. There was preliminary evidence for improved executive function at the final follow-up on parent-reported measures. Working memory training closer to diagnosis proved difficult, though results suggest evidence of cognitive improvement. Future studies should continue to examine potentially efficacious interventions for children with brain tumors and optimal delivery windows to maximize impact.
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Affiliation(s)
- Rachel E Siciliano
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Jennifer C Thigpen
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Leandra Desjardins
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Ellen H Steele
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Meredith A Gruhn
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Megan Ichinose
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Adam J Esbenshade
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Devang Pastakia
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John C Wellons
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
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26
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The Neurological Predictor Scale Predicts Adaptive Functioning via Executive Dysfunction in Young Adult Survivors of Childhood Brain Tumor. J Int Neuropsychol Soc 2021; 27:1-11. [PMID: 32641194 DOI: 10.1017/s1355617720000624] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Survivors of childhood brain tumors experience neurological sequelae that disrupt everyday adaptive functioning (AF) skills. The Neurological Predictor Scale (NPS), a cumulative measure of tumor treatments and sequelae, predicts cognitive outcomes, but findings on its relation to informant-reported executive dysfunction (ED) and AF are mixed. Given known effects of frontal-subcortical system disruptions on AF, this study assessed the NPS' relationship with AF as mediated by frontal systems dysfunction, measured by the Frontal Systems Behavior Scale (FrSBe). METHODS 75 participants (Mage = 23.5, SDage = 4.5) were young adult survivors of childhood brain tumors at least 5 years past diagnosis. FrSBe and Scales of Independent Behavior-Revised (SIB-R), a measure of AF, were administered to informants. Parallel multiple mediator models included Apathy and ED as mediators, and age at diagnosis and time between diagnosis and assessment as covariates. RESULTS More complex treatment and sequelae were correlated with poorer functioning. Mediation models were significant for all subscales: Motor Skills (MS), p = .0001; Social Communication (SC), p = .002; Personal Living (PL), p = .004; Community Living (CL), p = .007. The indirect effect of ED on SC and CL was significant; the indirect effect of Apathy was not significant for any subscales. CONCLUSIONS More complex tumor treatment and sequelae were associated with poorer long-term AF via increased ED. Cognitive rehabilitation programs may focus on the role of executive function and initiation that contribute to AF, particularly SC and CL skills, to help survivors achieve comparable levels of independence in everyday function as their peers.
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27
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Predictors of cognitive function in pediatric brain tumor patients: Pre-surgery through 24-month follow-up. APPLIED NEUROPSYCHOLOGY. CHILD 2021; 10:340-347. [PMID: 31887256 PMCID: PMC7326643 DOI: 10.1080/21622965.2019.1706179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to examine the feasibility of cognitive assessment from pre-surgery through 2-year follow-up in a sample of pediatric brain tumor (BT) patients. We sought to investigate cognitive function over the course of diagnosis and treatment, and as a function of presenting problems, tumor location, treatment type, and tumor severity. Using a prospective, longitudinal design, standardized IQ measures were administered to pediatric BT patients (ages 6-16) prior to surgery (n = 25), 6 months post-diagnosis (n = 24), and 24 months post-diagnosis (n = 23). Group differences emerged based on tumor severity and treatment type at multiple time points, including prior to surgical intervention; children with high grade tumors performed more poorly than children with low grade tumors, and children receiving surgery plus adjuvant therapy performed more poorly than children who received surgery only. When considered together, an analysis of covariance demonstrated that tumor grade significantly accounted for variability in cognitive functioning, while treatment type did not. Although there is overlap clinically between tumor severity and treatment received, results suggest that tumor severity is an important factor contributing to variability in cognitive functioning and should also be considered when monitoring risk for cognitive deficits in children diagnosed with BT.
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28
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Beuriat PA, Cohen-Zimerman S, Smith GNL, Krueger F, Gordon B, Grafman J. A New Insight on the Role of the Cerebellum for Executive Functions and Emotion Processing in Adults. Front Neurol 2020; 11:593490. [PMID: 33424746 PMCID: PMC7786249 DOI: 10.3389/fneur.2020.593490] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: We investigated whether the cerebellum plays a critical or supportive role in in executive and emotion processes in adults. Many investigators now espouse the hypothesis that participants with cerebellar lesions experience executive functions and emotions (EE) disorders. But we hypothesized that these disorders would be milder if the damage is relatively limited to the cerebellum compared to damage involving the cerebellum plus additional cortical areas. Methods: We studied veterans with penetrating Traumatic Brain Injury (pTBI) participating in the Vietnam Head Injury Study (VHIS). We selected veterans with a cerebellar lesion (n = 24), a prefrontal cortex lesion (n = 20), along with healthy controls (HC) (n = 55). Tests of executive functions and emotions were analyzed as well as caregiver burden. We performed between-group null hypothesis significance testing, Bayesian hypothesis tests and correlational analyses. Results: Performance of participants with cerebellar lesions which extended to the cerebral cortex was similar to the HC on the Executive Function tests but they were significantly impaired on the Working Memory Index. No differences were found on the emotional processing tasks with one exception-the Facial Expression of Emotion-Test (FEEST). We then examined a sub-group of participants with large cerebellar lesions (>15%) but minimal lesions in the cerebral cortex (<15%). This sub-group of participants performed similarly to the HC on the Working Memory Index and on the FEEST. Conclusions: We suggest that the cerebellar cortex may not be critical for executive functions or processing emotional stimuli in adults as suggested. Instead, we find that the cerebellum has a supportive role characterized by its computing of the motor requirements when EE processing is required.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan Ability Lab, Chicago, IL, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
- Rockfeller School of Medicine, Claude Bernard University, Lyon, France
| | - Shira Cohen-Zimerman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan Ability Lab, Chicago, IL, United States
| | - Gretchen N. L. Smith
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan Ability Lab, Chicago, IL, United States
| | - Frank Krueger
- School of Systems Biology, George Mason University, Fairfax, VA, United States
- Department of Psychology, University of Mannheim, Mannheim, Germany
| | - Barry Gordon
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan Ability Lab, Chicago, IL, United States
- Departments of Neurology, Psychiatry, and Cognitive Neurology and Alzheimer's Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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29
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Liguoro I, Passone E, Zilli T, Maieron M, De Colle MC, Skrap M, Dolcemascolo V, Sommariva G, Cogo P, Tomasino B. Possible association between the integrity of cerebellar pathways and neurocognitive performance in children with posterior fossa tumors. Pediatr Blood Cancer 2020; 67:e28538. [PMID: 32652734 DOI: 10.1002/pbc.28538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cerebellar tumor survivors often exhibit neuropsychological deficits that could be related to alterations in cerebro-cerebellar networks. This is a pilot study designed to understand if diffusion tensor imaging (DTI)-based tractography is able to identify possible correlations between cerebellar white matter structure and cognitive outcome in children on long-term follow-up for posterior fossa (PF) tumors who were thoroughly assessed for neuropsychological functioning. METHODS DTI-based tractography was performed in pediatric patients with PF tumors. Fractional anisotropy (FA) and volumetric measurements of spinocerebellar, dentorubrothalamocortical and corticopontocerebellar tracts were analyzed. Cognitive and neuropsychological functioning was assessed by the Wechsler Intelligence Scale for Children-IV Edition (WISC-IV) and the Developmental Neuropsychological Assessment (NEPSY II). The associations between Full-Scale Intelligence Quotient (FSIQ), NEPSY-II scores, and fiber tracts were tested by the Spearman rank correlation coefficient. RESULTS Seven patients (median age at diagnosis five years, range, 3-13) treated for medulloblastoma (2/7; 29%) and pilocytic astrocytoma (5/7; 71%) were retrospectively evaluated. All children had complete surgery. The median FSIQ was 84 (range, 67-93). Patients presented with several deficits on many NEPSY-II tasks; in particular, memory was impaired in nearly half of them. FSIQ and neurocognitive tasks significantly correlated with specific corticopontocerebellar tracts. CONCLUSION Children on follow-up for PF tumor showed scattered cognitive impairments, including deficits in long-term and immediate memory. Tractography allowed us to describe a possible association between the integrity of cerebellar pathways and neurocognitive performance, suggesting that the myelinization of these fibers may represent an indicator for the development of long-term cognitive sequelae.
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Affiliation(s)
- Ilaria Liguoro
- Division of Pediatrics, Department of Medicine-DAME, University of Udine, Udine, Italy
| | - Eva Passone
- Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Tiziana Zilli
- San Vito al Tagliamento, Pordenone, Scientific Institute Eugenio Medea, Italy
| | - Marta Maieron
- Department of Medical Physics, University Hospital of Udine, Udine, Italy
| | | | - Miran Skrap
- Department of Neurosurgery, University Hospital of Udine, Udine, Italy
| | | | - Giulia Sommariva
- Division of Pediatrics, Department of Medicine-DAME, University of Udine, Udine, Italy.,Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Paola Cogo
- Division of Pediatrics, Department of Medicine-DAME, University of Udine, Udine, Italy.,Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Barbara Tomasino
- San Vito al Tagliamento, Pordenone, Scientific Institute Eugenio Medea, Italy
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30
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Bledsoe JC, Breiger D, Breiger M, Shonka S, Ermoian RP, Ojemann JG, Werny DM, Leary SES, Geyer JR. Differential trajectories of neurocognitive functioning in females versus males following treatment for pediatric brain tumors. Neuro Oncol 2020; 21:1310-1318. [PMID: 31123753 DOI: 10.1093/neuonc/noz092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Female and male trajectories of cerebellar and lobar brain structures are sexually dimorphic, making sex a potential candidate moderator of neurocognitive late effects from radiation treatment. We sought to evaluate longitudinal neurocognitive functioning in male versus female children treated for posterior fossa brain tumors. METHODS Fifty-one female and 63 male survivors of posterior fossa tumors completed neuropsychological testing at 2 timepoints. We included patients treated with surgical resection, chemotherapy, and radiation therapy. Multilevel mixed modeling was used to predict IQ score as a function of patient sex following treatment (~2 or ~4 years post treatment). Effect sizes were used as a measure of clinical significance. RESULTS Multilevel models resulted in a significant sex by time interaction (F = 6.69, P = 0.011). Females' cognitive scores were considerably higher compared with males at 4 years posttreatment. Females demonstrated an average improvement of 7.61 standard score IQ points compared with a decline of 2.97 points for males at 4 years follow-up. Effect sizes for female IQ compared with male IQ at 4 years posttreatment were between 0.8 and 0.9. CONCLUSION Trajectories of neurocognitive functioning following posterior fossa tumor treatment differed between female and male children. Sexual dimorphism in radiation late effects may alter treatment decisions in children. Research into sex-specific neuroprotective mechanisms underlying neurocognitive development following pediatric brain tumor treatments is warranted.
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Affiliation(s)
- Jesse C Bledsoe
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - David Breiger
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Micah Breiger
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Sophia Shonka
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Ralph P Ermoian
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, Seattle Children's Hospital and Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - David M Werny
- Department of Endocrinology, Seattle Children's Hospital and Department of Pediatrics, University of Washington, Seattle, Washington
| | - Sarah E S Leary
- Department of Hematology/Oncology, Seattle Children's Hospital and Department of Pediatrics, University of Washington, Seattle, Washington
| | - J Russell Geyer
- Department of Hematology/Oncology, Seattle Children's Hospital and Department of Pediatrics, University of Washington, Seattle, Washington
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31
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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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32
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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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33
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Beuriat PA, Cristofori I, Richard N, Bardi L, Loriette C, Szathmari A, Di Rocco F, Leblond P, Frappaz D, Faure-Conter C, Claude L, Mottolese C, Desmurget M. Cerebellar lesions at a young age predict poorer long-term functional recovery. Brain Commun 2020; 2:fcaa027. [PMID: 32954287 PMCID: PMC7425375 DOI: 10.1093/braincomms/fcaa027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 12/12/2022] Open
Abstract
Early studies on long-term functional recovery after motor and premotor lesions showed better outcomes in younger monkeys than in older monkeys. This finding led to the widespread belief that brain injuries cause less impairment in children than adults. However, this view has limitations and a large body of evidence now indicates that cerebral damages can be more harmful when inflicted at young age, during critical periods of neural development. To date, this issue has been mainly investigated in the context of focal and diffuse cortical lesions. Much less is known about the potential influence of early cerebellar damages. Several studies exist in survivor of posterior fossa tumours. However, in these studies, critical confounders were not always considered and contradictory conclusions were provided. We studied the impact or early cerebellar damage on long-term functional recovery in three groups of 15 posterior fossa survivors, comparable with respect to their tumour characteristics (type, size and location) but operated at different ages: young (≤7 years), middle (>7 and ≤13 years) and older (>13 years). Daily (health-related quality of life scale, performance status scale), motor (International Cooperative Ataxia Rating Scale, Pegboard Purdue Test) and cognitive (full-scale intelligence quotient) functioning were assessed. A general linear model controlling for age at surgery, radiotherapy, preservation of deep cerebellar nuclei, tumour volume and delay between surgery and assessment was used to investigate significant variations in outcome measures. Early age at surgery, lesion of deep cerebellar nuclei and postoperative radiotherapy had a significant, independent negative influence on long-term recovery. Tumour volume and delay between surgery and assessment had no statistically detectable impact. The negative influence of early age at surgery was significant in all domains: daily functioning (health-related quality of life scale, performance status scale), motor functioning (International Cooperative Ataxia Rating Scale, Pegboard Purdue Test) and cognitive functioning (full-scale intelligence quotient). These results support the existence of an early critical period of development during which the cerebellar ‘learning machine’ is of critical importance. Although the extent to which the early deficits here observed can be reversed needs now to be established, our data plead for the implementation of prompt and intense rehabilitation interventions in children operated before 7 years of age.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Irene Cristofori
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Nathalie Richard
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Lara Bardi
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Celia Loriette
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Alexandru Szathmari
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Federico Di Rocco
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Pierre Leblond
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008 Lyon, France
| | - Didier Frappaz
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008 Lyon, France
| | - Cécile Faure-Conter
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008 Lyon, France
| | - Line Claude
- Department of Radiotherapy, Centre Léon Bérard, 69008 Lyon, France
| | - Carmine Mottolese
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Michel Desmurget
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
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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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35
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Medulloblastoma in childhood: What effects on neurocognitive functions? Cancer Radiother 2019; 23:370-377. [DOI: 10.1016/j.canrad.2018.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022]
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Aleksonis HA, Wier R, Pearson MM, Cannistraci CJ, Anderson AW, Kuttesch JF, Compas BE, Hoskinson KR. Associations among diffusion tensor imaging and neurocognitive function in survivors of pediatric brain tumor: A pilot study. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:111-122. [PMID: 31146596 DOI: 10.1080/21622965.2019.1613993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to determine associations among neurocognitive outcomes and white matter integrity in the inferior fronto-occipital fasciculus (IFOF), uncinate fasciculus (UF), and genu of the corpus callosum (gCC) in survivors of pediatric brain tumor and healthy controls (HCs). Eleven survivors (ages 8-16; >2 years post-treatment) and 14 HCs underwent MRI; diffusion tensor imaging tractography (DSI Studio) was used to assess white matter integrity. Participants completed neuropsychological assessment of overall cognitive ability, executive function, processing speed, divided attention, and memory. As previously reported, survivors performed significantly worse than HCs on measures of overall IQ, working memory, processing speed, and executive function (ps < .01), but not on measures of long-delay memory. Mean fractional anisotropy was significantly lower in survivors than HC in the right IFOF, left UF, and gCC (ps < .05). Correlations with the total sample revealed a number of significant positive associations among white matter tracts and scores on neurocognitive measures. Survivors show deficits on measures of cognitive function and decreased white matter integrity compared to HCs. Results revealed a more general pattern of associations among white matter pathways and neurocognitive outcomes than initially hypothesized. It is possible that survivors with diffuse pathology from treatment effects (i.e., hydrocephalus or posterior fossa syndrome) show more general decreases in cognitive functioning and white matter integrity. Additional research with a larger and more diverse group of survivors is needed to better understand white matter integrity and neurocognitive outcome associations in this population.
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Affiliation(s)
- Holly A Aleksonis
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ryan Wier
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Matthew M Pearson
- Institute for Neurology and Neurosurgery, Sacred Heart Medical Group, Pensacola, Florida, USA
| | - Christopher J Cannistraci
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam W Anderson
- Vanderbilt University Institute of Imaging Science, Nashville, Tennessee, USA
| | - John F Kuttesch
- Pediatric Hematology and Oncology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Bruce E Compas
- Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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37
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Desjardins L, Barrera M, Schulte F, Chung J, Cataudella D, Janzen L, Bartels U, Downie A. Predicting social withdrawal, anxiety and depression symptoms in pediatric brain tumor survivors. J Psychosoc Oncol 2019; 37:22-36. [DOI: 10.1080/07347332.2018.1535531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Leandra Desjardins
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Fiona Schulte
- Department of Psychology, Division of Hematology/Oncology, Alberta Children’s Hospital, Calgary, Canada
| | - Joanna Chung
- Department of Psychology, Division of Hematology/Oncology, BC Children’s Hospital, Vancouver, Canada
| | - Danielle Cataudella
- Department of Psychology, Division of Hematology/Oncology, London Health Sciences Centre, London, Canada
| | - Laura Janzen
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Andrea Downie
- Department of Psychology, Division of Hematology/Oncology, London Health Sciences Centre, London, Canada
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38
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Willard VW. Social skills interventions for survivors of pediatric brain tumors: A review and reformulation. Pediatr Blood Cancer 2018; 65:e27434. [PMID: 30160028 DOI: 10.1002/pbc.27434] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/18/2018] [Accepted: 08/03/2018] [Indexed: 11/10/2022]
Abstract
Youth with brain tumors are at risk for late effects. Families report that survivors' difficulties with peer relationships are among the most distressing and impactful on quality of life. As such, interventions have been designed to improve social functioning. The objective was to review the nine published social skills intervention studies for survivors of brain tumors with regard to study design, participation rates, skills targeted, assessment measures, and outcomes. Results of this review were used to discuss future directions, with a focus on alternative approaches to inclusion criteria (including developmental considerations and screening for weaknesses), intervention timing and modality.
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Desjardins L, Solomon A, Janzen L, Bartels U, Schulte F, Chung J, Cataudella D, Downie A, Barrera M. Executive functions and social skills in pediatric brain tumor survivors. APPLIED NEUROPSYCHOLOGY-CHILD 2018; 9:83-91. [PMID: 30501139 DOI: 10.1080/21622965.2018.1522589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pediatric brain tumor survivors (PBTSs) may experience impairment in executive functions and social competence, but their interrelation is not well understood. This study aimed to address the specificity of this relationship. PBTSs (n = 91) were on average 11.21 years old, 5 years from diagnosis, and 48.4% female. One parent and PBTS completed the Social Skills Rating System (subscales: Cooperation, Assertiveness, Empathy, Self-Control, and Total), and parents also completed the Behavior Rating Inventory of Executive Function (General Executive Composite [GEC], Metacognition [MI], and Behavioral Regulation [BRI] indices) and the (Withdrawal scale). Based on proxy reports, more PBTSs had deficits in Cooperation, Assertiveness and Responsibility skills relative to normative data. MI was more consistently associated with parent reported social skills deficits than BRI. PBTSs reported fewer deficits in social skills relative to normative data across all scales; none of the correlations between PBTSs reported social skills and executive functions were significant. Time since diagnosis and proxy reported lower total social skills predicted greater withdrawal. These findings highlight the importance of assessing differential perspectives of PBTSs social competence, and that metacognitive strategies may bear particular importance for the social skills of PBTSs.
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Affiliation(s)
- Leandra Desjardins
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Aden Solomon
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Laura Janzen
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Ute Bartels
- Department of Neuro-Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Fiona Schulte
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Andrea Downie
- Department of Psychology, London Health Sciences Centre, London, Canada
| | - Maru Barrera
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
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40
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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: 67] [Impact Index Per Article: 11.2] [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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41
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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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Krull KR, Hardy KK, Kahalley LS, Schuitema I, Kesler SR. Neurocognitive Outcomes and Interventions in Long-Term Survivors of Childhood Cancer. J Clin Oncol 2018; 36:2181-2189. [PMID: 29874137 DOI: 10.1200/jco.2017.76.4696] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recent research has demonstrated that survivors of childhood cancer are at risk for a myriad of late effects that affect physical and mental quality of life. We discuss the patterns and prevalence of neurocognitive problems commonly experienced by survivors of CNS tumors and acute lymphoblastic leukemia, the two most commonly researched cancer diagnoses. Research documenting the direct effects of tumor location and treatment type and intensity is presented, and patient characteristics that moderate outcomes (eg, age at diagnosis and sex) are discussed. Potential biologic mechanisms of neurotoxic treatment exposures, such as cranial irradiation and intrathecal and high-dose antimetabolite chemotherapy, are reviewed. Genetic, brain imaging, and neurochemical biomarkers of neurocognitive impairment are discussed. Long-term survivors of childhood cancer are also at risk for physical morbidity (eg, cardiac, pulmonary, endocrine) and problems with health behaviors (eg, sleep); research is reviewed that demonstrates these health problems contribute to neurocognitive impairment in survivors with or without exposure to neurotoxic therapies. We conclude this review with a discussion of literature supporting specific interventions that may be beneficial in the treatment of survivors who already experience neurocognitive impairment, as well as in the prevention of impairment manifestation.
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Affiliation(s)
- Kevin R Krull
- Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Lisa S. Kahalley, Baylor College of Medicine; Shelli R. Kesler, University of Texas MD Anderson Cancer Center, Houston, TX; and Ilse Schuitema, Leiden University, Leiden, the Netherlands
| | - Kristina K Hardy
- Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Lisa S. Kahalley, Baylor College of Medicine; Shelli R. Kesler, University of Texas MD Anderson Cancer Center, Houston, TX; and Ilse Schuitema, Leiden University, Leiden, the Netherlands
| | - Lisa S Kahalley
- Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Lisa S. Kahalley, Baylor College of Medicine; Shelli R. Kesler, University of Texas MD Anderson Cancer Center, Houston, TX; and Ilse Schuitema, Leiden University, Leiden, the Netherlands
| | - Ilse Schuitema
- Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Lisa S. Kahalley, Baylor College of Medicine; Shelli R. Kesler, University of Texas MD Anderson Cancer Center, Houston, TX; and Ilse Schuitema, Leiden University, Leiden, the Netherlands
| | - Shelli R Kesler
- Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Lisa S. Kahalley, Baylor College of Medicine; Shelli R. Kesler, University of Texas MD Anderson Cancer Center, Houston, TX; and Ilse Schuitema, Leiden University, Leiden, the Netherlands
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Marusak HA, Iadipaolo AS, Harper FW, Elrahal F, Taub JW, Goldberg E, Rabinak CA. Neurodevelopmental consequences of pediatric cancer and its treatment: applying an early adversity framework to understanding cognitive, behavioral, and emotional outcomes. Neuropsychol Rev 2018; 28:123-175. [PMID: 29270773 PMCID: PMC6639713 DOI: 10.1007/s11065-017-9365-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/08/2017] [Indexed: 01/29/2023]
Abstract
Today, children are surviving pediatric cancer at unprecedented rates, making it one of modern medicine's true success stories. However, we are increasingly becoming aware of several deleterious effects of cancer and the subsequent "cure" that extend beyond physical sequelae. Indeed, survivors of childhood cancer commonly report cognitive, emotional, and psychological difficulties, including attentional difficulties, anxiety, and posttraumatic stress symptoms (PTSS). Cognitive late- and long-term effects have been largely attributed to neurotoxic effects of cancer treatments (e.g., chemotherapy, cranial irradiation, surgery) on brain development. The role of childhood adversity in pediatric cancer - namely, the presence of a life-threatening disease and endurance of invasive medical procedures - has been largely ignored in the existing neuroscientific literature, despite compelling research by our group and others showing that exposure to more commonly studied adverse childhood experiences (i.e., domestic and community violence, physical, sexual, and emotional abuse) strongly imprints on neural development. While these adverse childhood experiences are different in many ways from the experience of childhood cancer (e.g., context, nature, source), they do share a common element of exposure to threat (i.e., threat to life or physical integrity). Therefore, we argue that the double hit of early threat and cancer treatments likely alters neural development, and ultimately, cognitive, behavioral, and emotional outcomes. In this paper, we (1) review the existing neuroimaging research on child, adolescent, and adult survivors of childhood cancer, (2) summarize gaps in our current understanding, (3) propose a novel neurobiological framework that characterizes childhood cancer as a type of childhood adversity, particularly a form of early threat, focusing on development of the hippocampus and the salience and emotion network (SEN), and (4) outline future directions for research.
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Affiliation(s)
- Hilary A Marusak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA.
| | - Allesandra S Iadipaolo
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
| | - Felicity W Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Farrah Elrahal
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
| | - Jeffrey W Taub
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Elimelech Goldberg
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Kids Kicking Cancer, Southfield, MI, USA
| | - Christine A Rabinak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA
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44
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Alias H, Lau SCD, Schuitema I, de Sonneville LMJ. Neuropsychological Consequences for Survivors of Childhood Brain Tumor in Malaysia. Front Psychol 2018; 9:703. [PMID: 29896137 PMCID: PMC5986920 DOI: 10.3389/fpsyg.2018.00703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/23/2018] [Indexed: 01/06/2023] Open
Abstract
Objective: This study aimed to evaluate neuropsychological consequences in survivors of childhood brain tumor. Method: A case-control study was conducted over a period of 4 months in a tertiary referral center in Kuala Lumpur, Malaysia. Fourteen survivors of childhood brain tumor aged 7–18 years, who were off-treatment for at least 1 year and were in remission, and 31 unrelated healthy controls were recruited. The median age at diagnosis was 8.20 years (range: 0.92–12.96 years). The diagnoses of brain tumors were medulloblastoma, germ cell tumor, pineocytoma, pilocystic astrocytoma, suprasellar germinoma, and ependymoma. Eleven survivors received central nervous system irradiation. Seven tasks were selected from the Amsterdam Neuropsychological Tasks program to evaluate alertness (processing speed), and major aspects of executive functioning, such as working memory capacity, inhibition, cognitive flexibility, and sustained attention. Speed, stability and accuracy of responses were the main outcome measures. Results: Survivors of childhood brain tumor showed statistically significant poorer performance on all tasks compared to healthy controls. Both processing speed and accuracy were impaired in the survivors, in particular under more complex task conditions. The survivors demonstrated deficits in alertness, sustained attention, working memory capacity, executive visuomotor control, and cognitive flexibility. Longer duration off treatment appeared to be correlated with poorer alertness, memory capacity, and inhibition. Conclusion: Survivors of childhood brain tumor in our center showed impaired neuropsychological functioning. Development of less toxic treatment protocols is important to prevent late effects of cognitive deficits in survivors of childhood brain tumor.
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Affiliation(s)
- Hamidah Alias
- Department of Pediatrics, UKM Medical Center, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Sie Chong D Lau
- Department of Pediatrics, UKM Medical Center, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Ilse Schuitema
- Department of Clinical Child and Adolescent Studies, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
| | - Leo M J de Sonneville
- Department of Clinical Child and Adolescent Studies, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
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45
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Harman JL, Wise J, Willard VW. Early intervention for infants and toddlers: Applications for pediatric oncology. Pediatr Blood Cancer 2018; 65:e26921. [PMID: 29271555 DOI: 10.1002/pbc.26921] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/01/2017] [Accepted: 11/16/2017] [Indexed: 01/23/2023]
Abstract
Young children (<3 years) with cancer are at risk for delays in development due to their disease and its required treatments and restrictions. In the United States, Part C of the Individuals with Disabilities Education Act describes a system of early intervention (EI) services for young children with delays or the potential for delays in development. Children with cancer may be eligible for EI but are rarely referred. Our objectives are to describe the critical impact of early childhood development on long-term outcomes, review current considerations for EI, and advocate for the referral to EI for young children with cancer.
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Affiliation(s)
- Jennifer L Harman
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jillian Wise
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Victoria W Willard
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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46
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Jacobson LA, Mahone EM, Yeates KO, Ris MD. Processing speed in children treated for brain tumors: effects of radiation therapy and age. Child Neuropsychol 2018; 25:217-231. [PMID: 29621934 DOI: 10.1080/09297049.2018.1456517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The current study examined processing speed in children two years post-treatment for brain tumors (BT) with radiation therapy (RT) compared to those treated with without RT. Participants included 59 children (4-17 years) with BT assessed as part of the Brain Radiation Investigative Study Consortium (BRISC). Processing speed was assessed at two time points: Time1 (3-9 months post-surgery) for 26 children who received whole brain or focal RT (RT group) and 33 treated without RT (no-RT group), and again two years later (Time2) for 42 participants (17 RT, 25 no-RT). Linear mixed effects (LME) regression analyses examined differences in cognitive and motor speed between groups and across visits, with age at Time1 (age1) treated as a moderating variable, and sex and primary tumor size as covariates. No effects for treatment group or visit were found for motor speed (Pegboard) or mean reaction time (Attention Network Task). On the Wechsler Processing Speed Index (PSI), the no-RT group performed better than the RT group, with a group-by-age interaction such that across visits, the difference between the no-RT and RT groups was larger among children who were older at initial treatment (≥10 years) than among those who were younger (<10 years). Cumulative brain injury earlier in life (tumor, surgery, plus RT) may result in greater impact on more complex tasks of cognitive efficiency. Children receiving RT showed reduced processing speed over time, with a larger group difference among those who were over 10 years at treatment.
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Affiliation(s)
- Lisa A Jacobson
- a Department of Neuropsychology , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Neuropsychology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - E Mark Mahone
- a Department of Neuropsychology , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Neuropsychology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Keith O Yeates
- c Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute , University of Calgary , Calgary , Canada
| | - M Douglas Ris
- d Department of Pediatrics, Section of Psychology , Texas Children's Hospital , Houston , TX , USA.,e Department of Pediatrics, Section of Psychology , Baylor College of Medicine , Houston , TX , USA
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47
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Pfeiffer SM, Hutchinson AD. The efficacy of cognitive interventions for improving cognitive performance and academic achievement in children after cancer treatment: A systematic review. J Psychosoc Oncol 2018; 36:238-258. [PMID: 29336728 DOI: 10.1080/07347332.2017.1399954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Academic decline has been reported in children after cancer treatment, believed to be as a result of cognitive impairment. Cognitive interventions may improve both the present and future outcomes for children after cancer treatment by improving cognitive and/or academic performance. This review aimed to examine the efficacy of cognitive interventions in children who had received cancer treatment. A systematic search of the PsycInfo and PubMed databases was conducted in May 2015 to identify studies in which cognitive interventions were conducted with children who had undergone cancer treatment and were under the age of 21. Cognitive or academic outcomes needed to be reported pre- and post-intervention to meet the inclusion criteria. Eleven studies were included in this review. Computerized and home-based cognitive interventions were found to be most successful at improving cognitive skills. However, few cognitive interventions assessed academic achievement specifically. Future cognitive intervention research studies should include measures of academic achievement outcomes, because academic achievement and cognitive outcomes may differ. Future research regarding the effectiveness of early, home-based and computerized intervention is warranted.
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Affiliation(s)
- Susan M Pfeiffer
- a School of Psychology, Social Work & Social Policy , University of South Australia , Adelaide , SA , Australia
| | - Amanda D Hutchinson
- a School of Psychology, Social Work & Social Policy , University of South Australia , Adelaide , SA , Australia
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48
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Desjardins L, Thigpen JC, Kobritz M, Bettis AH, Gruhn MA, Ichinose M, Hoskinson K, Fraley C, Vreeland A, McNally C, Compas BE. Parent reports of children's working memory, coping, and emotional/behavioral adjustment in pediatric brain tumor patients: A pilot study. Child Neuropsychol 2017; 24:959-974. [PMID: 28969482 DOI: 10.1080/09297049.2017.1365828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neurocognitive problems in childhood survivors of brain tumors are well documented. Further, research has shown that problems in cognitive functioning may be associated with impairment in the use of complex strategies needed to cope with stress, including secondary control coping strategies (e.g., acceptance and cognitive reappraisal) which have been associated with fewer adjustment problems. The present study measured cognitive function, coping strategies, and adjustment in children ages 6-16 years at the time of brain tumor diagnosis and at two follow-up time-points up to 1 year post-diagnosis. In a prospective design, working memory was assessed in a total of 29 pediatric brain tumor patients prior to undergoing surgery, child self-reported coping was assessed at 6 months post-diagnosis, and parent-reported child adjustment was assessed at 12 months post-diagnosis. Significant correlations were found between working memory difficulties and secondary control coping. Secondary control coping was also negatively correlated with child attention and total problems. Regression analyses did not support secondary control coping mediating the association between working memory difficulties and child attention or total problems. These findings represent the first longitudinal assessment of the association between working memory, coping, and adjustment across the first year of a child's brain tumor diagnosis and suggest a possible role for early interventions addressing both working memory difficulties and coping in children with brain tumors.
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Affiliation(s)
- Leandra Desjardins
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Jennifer C Thigpen
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Molly Kobritz
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Alexandra H Bettis
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Meredith A Gruhn
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Megan Ichinose
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Kristen Hoskinson
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Claire Fraley
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Allison Vreeland
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Colleen McNally
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Bruce E Compas
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
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49
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King TZ, Ailion AS, Fox ME, Hufstetler SM. Neurodevelopmental model of long-term outcomes of adult survivors of childhood brain tumors. Child Neuropsychol 2017; 25:1-21. [DOI: 10.1080/09297049.2017.1380178] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tricia Z. King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Alyssa S. Ailion
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Michelle E. Fox
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Schell M. Hufstetler
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
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50
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Quast LF, Turner EM, McCurdy MD, Hocking MC. Health-related quality of life in parents of pediatric brain tumor survivors at the end of tumor-directed therapy. J Psychosoc Oncol 2017; 34:274-90. [PMID: 27070180 DOI: 10.1080/07347332.2016.1175535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study examines theoretical covariates of health-related quality of life (HRQL) in parents of pediatric brain tumor survivors (PBTS) following completion of tumor-directed therapy. METHODS Fifty PBTS (ages 6-16) completed measures of neurocognitive functioning and their parents completed measures of family, survivor, and parent functioning. RESULTS Caregiving demand, caregiver competence, and coping/supportive factors were associated with parental physical and psychosocial HRQL, when controlling for significant background and child characteristics. CONCLUSION Study findings can inform interventions to strengthen caregiver competence and family functioning following the completion of treatment, which may improve both parent and survivor outcomes.
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Affiliation(s)
- Lauren F Quast
- a Division of Oncology, The Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Elise M Turner
- b Department of Psychology , Drexel University , Philadelphia , PA , USA
| | - Mark D McCurdy
- b Department of Psychology , Drexel University , Philadelphia , PA , USA
| | - Matthew C Hocking
- a Division of Oncology, The Children's Hospital of Philadelphia , Philadelphia , PA , USA.,c Division of Psychiatry, Perelman School of Medicine at the University of Pennsylvania , Philadelphia , PA , USA
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