Tumor locus moderates anxiety symptoms in a pediatric neuro-oncologic sample

Difficulties encountered by physicians and mental health professionals in evaluating and caring for affective and behavioral problems in pediatric brain tumor survivors

BACKGROUND

Pediatric brain tumor survivors (PBTS) present a high risk for emotional and behavioral disorders. When addressing these difficulties, differences in study designs; variety of and disagreement about diagnoses; and intricate links of emotional, behavioral, and cognitive issues may complicate the interpretation of studies and probably also the work of clinicians. We aimed to survey the difficulties perceived by physicians and mental health professionals in their practice and their interest in developing a new evaluative tool.

METHODOLOGY

We surveyed 29 health professionals involved in the follow-up of this population. They completed questionnaires about their clinical practice (difficulties, needs, activities) and indicated diagnosis hypotheses and treatment plans on a clinical case developed for this study.

RESULTS

Emotional and behavioral disorders were reported as difficult to assess for 93% of participants. The overlap of symptoms (90%) and the lack of an adapted diagnostic framework (90%) were the main reasons mentioned. Respectively 93%, 90%, and 65% of participants would at least "often" make referrals to psychological (93%), neuropsychological (90%), and psychiatric (65%) assessments and care. Family and group therapy were less common as was drug management. All participants were in favor of creating a tool to help with diagnosis and treatment. When responding to a clinical case, the heterogeneity of participants' responses highlighted their issues in diagnosing and managing these patients.

CONCLUSION

This survey exemplifies the difficulties of health professionals related to the evaluation and management of affective and behavioral disorders experienced by PBTS. It underlines the need to help professionals by initiating systematic assessment strategies with this vulnerable population.

Neural substrates for heightened anxiety in children with brain tumors

This study investigated anxiety symptoms' associations with cognitive functioning and tumor locus in pediatric brain tumor patients. Data from 91 patients were collected as part of a neuropsychological assessment. Significant relationships were found between anxiety symptoms and mental set shifting (Wisconsin Card Sorting). Analyses revealed patients with right cortical tumors or left cerebellar tumors had significantly greater anxiety than those with midline/bilateral tumor and those with left cortical or right cerebellar tumors. Results support the specific risk of anxiety with right cortical and left cerebellar tumors. Results highlight the association of anxiety and one important element of executive functioning.