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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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Ghimire P, Hasegawa H, Kalyal N, Hurwitz V, Ashkan K. Patient-Reported Outcome Measures in Neurosurgery: A Review of the Current Literature. Neurosurgery 2018; 83:622-630. [PMID: 29165605 DOI: 10.1093/neuros/nyx547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 10/02/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) play an important role in the evaluation of health outcomes, quality of life, and satisfaction, and have been successfully utilized in many areas of clinical medicine and surgical practice. The prevalence of PROMs in neurosurgery is not known. OBJECTIVE To review the PROMs that have been utilized in the published neurosurgery literature to date. METHODS Articles were searched in MEDLINE, EMBASE, HMIC Health Management Information Consortium, PsycARTICLES, and PsycINFO using search terms related to neurosurgery and PROMs, published from 1806 to August 2016. A total of 268 articles were identified that were stratified by the inclusion and exclusion criteria leading to a total of 137 articles. Twenty-six PROMs, involving both adult and pediatric populations, were identified. RESULTS A large number of generic and disease-specific PROMs are used in the neurosurgical literature. Generic PROMs are usually nonspecific measures of health status. Disease-specific PROMs may not address issues relevant to neurosurgical procedures. There are very few neurosurgery-specific PROMs that take into account the impact of a neurosurgical procedure on a specific condition. CONCLUSION PROMs that currently feature in the neurosurgical literature may not address the specific outcomes relevant to neurosurgical practice. There is an emergent need for generic and disease-specific PROMs to be validated in neurosurgical patients and neurosurgery-specific PROMs developed to address unmet needs of patients undergoing neurosurgical procedures.
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Affiliation(s)
- Prajwal Ghimire
- Department of Neurosurgery, King's Coll-ege Hospital, London, United Kingdom
| | - Harutomo Hasegawa
- Department of Neurosurgery, King's Coll-ege Hospital, London, United Kingdom
| | - Nida Kalyal
- Department of Neurosurgery, King's Coll-ege Hospital, London, United Kingdom
| | - Victoria Hurwitz
- Department of Neurosurgery, King's Coll-ege Hospital, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's Coll-ege Hospital, London, United Kingdom
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Schulte F, Russell KB, Cullen P, Embry L, Fay-McClymont T, Johnston D, Rosenberg AR, Sung L. Systematic review and meta-analysis of health-related quality of life in pediatric CNS tumor survivors. Pediatr Blood Cancer 2017; 64. [PMID: 28266804 DOI: 10.1002/pbc.26442] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pediatric central nervous system (CNS) tumor survivors are at high risk for numerous late effects including decreased health-related quality of life (HRQOL). Our objective was to summarize studies describing HRQOL in pediatric CNS tumor survivors and compare HRQOL outcomes in studies that included a comparison group. PROCEDURE EMBASE, MEDLINE, and PsychINFO were used to identify relevant articles published until August, 2016. Eligible studies reported outcomes for pediatric CNS tumor survivors diagnosed before age 21, at least 5 years from diagnosis and/or 2 years off therapy and used a standardized measure of HRQOL. All data were abstracted by two reviewers. Random-effects meta-analyses were performed using Review Manager 5.0. RESULTS Of 1,912 unique articles identified, 74 were included in this review. Papers described 29 different HRQOL tools. Meta-analyses compared pediatric CNS tumor survivors to healthy comparisons and other pediatric cancer survivors separately. HRQOL was significantly lower for CNS (n = 797) than healthy comparisons (n = 1,397) (mean difference = -0.54, 95% confidence interval [CI] = -0.72 to -0.35, P < 0.001, I2 = 35%). HRQOL was also significantly lower for CNS (n = 244) than non-CNS survivors (n = 414) (mean difference = -0.56, 95% CI = -0.73 to -0.38, P < 0.00001, I2 = 0%). CONCLUSIONS Pediatric CNS tumor survivors experience worse HRQOL than healthy comparisons and non-CNS cancer survivors. Future HRQOL work should be longitudinal, and/or multisite studies that examine HRQOL by diagnosis and treatment modalities.
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Affiliation(s)
- Fiona Schulte
- Departments of Oncology and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Haematology, Oncology and Transplant Program, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - K Brooke Russell
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Departments of Oncology and Psychology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patricia Cullen
- Loretto Heights School of Nursing, Regis University, Denver, Colorado
| | - Leanne Embry
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Taryn Fay-McClymont
- Departments of Oncology and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna Johnston
- Department of Haematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Abby R Rosenberg
- Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Lillian Sung
- Department of Haematology/Oncology, SickKids Hospital, Toronto, Ontario, Canada
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Thabet AA, Tawahina AA, Henley D, Pelling H, Vostanis P, Qamar KA. Mental Health and Quality of Life of Disable Palestinian Children in the Gaza Strip. Health (London) 2015. [DOI: 10.4236/health.2015.78117] [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]
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Abstract
OBJECTIVE To assess self-perceptions of social behavior among children treated for a brain tumor and comparison children. To investigate group differences in the accuracy of children's self-perceptions as measured by discrepancies between self and peer reports of social behavior and to understand if these phenomena differ by gender. METHOD Self and peer reports of social behavior were obtained in the classrooms of 116 children who were treated for an intracranial tumor. Social behaviors were assessed using the Revised Class Play, which generates indices for 5 behavioral subscales: Leadership-popularity, Prosocial, Aggressive-disruptive, Sensitive-isolated, and Victimization. A child matched for gender, race, and age was selected from each survivor's classroom to serve as a comparison. Abbreviated IQ scores were obtained in participants' homes. RESULTS Relative to comparison children, those who had undergone treatment for a brain tumor overestimated their level of Leadership-popularity and underestimated levels of Sensitive-isolated behaviors and Victimization by peers. Female survivors were more likely than male survivors to underestimate Sensitive-isolated behaviors and Victimization. CONCLUSION Following treatment for a brain tumor, children (particularly girls) may be more likely than healthy children to underestimate peer relationship difficulties. These discrepancies should be considered when obtaining self-report from survivors and developing interventions to improve social functioning.
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Barakat LP, Li Y, Hobbie WL, Ogle SK, Hardie T, Volpe EM, Szabo MM, Reilly M, Deatrick JA. Health-related quality of life of adolescent and young adult survivors of childhood brain tumors. Psychooncology 2014; 24:804-11. [PMID: 25111013 DOI: 10.1002/pon.3649] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/13/2014] [Accepted: 07/18/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Our aim was to expand research on predictors of health-related quality of life (HRQOL) for adolescent and young adult survivors of childhood brain tumors who are not living independently by evaluating the mediating role of family functioning in the association of disease severity/treatment late effects with survivor self-report and caregiver-proxy report of physical and emotional HRQOL. METHODS Mothers (N = 186) and their survivors living at home (N = 126) completed self-report and caregiver-proxy report of physical and emotional HRQOL. Mothers completed family functioning measures of general family functioning, caregiving demands, and caregiver distress. Medical file review and caregiver report were used to evaluate disease severity/treatment late effects. RESULTS Using structural equation models, family functioning was adjusted for sociodemographic factors. Disease severity/treatment late effects had significant direct effects on self-report and caregiver-proxy report of physical and emotional HRQOL. Family functioning had a significant direct effect on caregiver-proxy report of physical and emotional HRQOL, but these findings were not confirmed for self-report HRQOL. Model-fit indices suggested good fit of the models, but the mediation effect of family functioning was not supported. CONCLUSIONS Disease severity/treatment late effects explained self-report and caregiver-proxy report of physical and emotional HRQOL for these adolescent and young adult survivors of childhood brain tumors. Family functioning was implicated as an important factor for caregiver-proxy report only. To enhance physical and emotional HRQOL, findings underscore the importance of coordinated, multidisciplinary follow-up care for the survivors who are not living independently and their families to address treatment late effects and support family management.
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Affiliation(s)
- Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yimei Li
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wendy L Hobbie
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Sue K Ogle
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Maureen Reilly
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Janet A Deatrick
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Gudrunardottir T, Lannering B, Remke M, Taylor MD, Wells EM, Keating RF, Packer RJ. Treatment developments and the unfolding of the quality of life discussion in childhood medulloblastoma: a review. Childs Nerv Syst 2014; 30:979-90. [PMID: 24569911 DOI: 10.1007/s00381-014-2388-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 02/11/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE To describe how the quality of life (QOL) discussion in childhood medulloblastoma (MB) relates to treatment developments, survival and sequelae from 1920 to 2014. METHODS Articles containing "childhood medulloblastoma" and "quality of life" were identified in PubMed. Those containing phrases pertaining to psychological, emotional, behavioral or social adjustment in the title, abstract or keywords were selected. Inclusion of relevant older publications was assured by cross-checking references. RESULTS 1920-1930s: suction, electro-surgery, kilovolt (KV) irradiation. Survival = months. Focus on operative mortality, symptoms and survival. 1940s: radiotherapy improved. 1950s: chemotherapy and intubation. Survival = years. Opinions oscillated between optimism/awareness of physical sequelae of radiotherapy. 1960s: magnified vision, ventriculo-peritoneal (VP) shunts, megavolt (MV) irradiation. Long-term survival shifted the attention towards neurological problems, disability and carcinogenesis of radiotherapy. 1970s: CT, microscope, bipolar coagulation, shunt filters, neuroanesthesia, chemotherapy trials and staging studies. Operative mortality decreased and many patients (re)entered school; emphasis on neuropsychological sequelae, IQ and academic performance. 1980s: magnetic resonance imaging (MRI), Cavitron ultrasonic aspiration (CUSA), laser surgery, hyper-fractionated radiotherapy (HFRT). Cerebellar mutism, psychological and social issues. 1990s: pediatric neurosurgery, proton beams, stem cell rescue. Reflections on QOL as such. 21st century: molecular genetics. Premature aging, patterns of decline, risk- and resilience factors. DISCUSSION QOL is a critical outcome measure. Focus depends on survival and sequelae, determined after years of follow-up. Detailed measurements are limited by time, money and human resources, and self-reporting questionnaires represent a crude measure limited by subjectivity. Therapeutic improvements raise the question of QOL versus cure. QOL is a potential primary research endpoint; multicenter international studies are needed, as are web-based tools that work across cultures.
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Affiliation(s)
- Thora Gudrunardottir
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC, USA,
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Yoo HJ, Kim DS, Lai JS, Cella D, Shin HY, Ra YS. Validation of Pediatric Functional Assessment of Cancer Therapy Questionnaire (Version 2.0) in Brain Tumor Survivor Aged 13 Years and Older (Parent Form)(PedsFACT-BrS Parent of Adolescent). J Korean Neurosurg Soc 2011; 49:147-52. [PMID: 21556233 DOI: 10.3340/jkns.2011.49.3.147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 02/08/2011] [Accepted: 03/03/2011] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the reliability and validity of the Pediatric Functional Assessment of Cancer Therapy Questionnaire Brain Tumor Survivor (version 2.0) Aged 13 years and older (Parent Form) (pedsFACT-BrS parent of adolescent). METHODS The pedsFACT-BrS parent of adolescent was translated and cross-culturally adapted into Korean, following standard Functional Assessment of Chronic Illness Therapy (FACIT) methodology. The psychometric properties of the pedsFACT-BrS parent of adolescent were evaluated in 170 brain tumor patient's mothers (mean age=43.38 years). Pretesting was performed in 30 mothers, and the results indicated good symptom coverage and overall comprehensibility. The participants also completed the Child Health Questionnaire Parent Form 50 (CHQ-PF-50), Neuroticism in Eysenck Personality Questionnaire, and Karnofsky score. RESULTS In validating the pedsFACT-BrS parent of adolescent, we found high internal consistency, with Cronbach's α coefficients ranging from 0.76 to 0.94. The assessment of test-retest reliability using intraclass correlation coefficient revealed satisfactory values with ICCs ranging from 0.84 to 0.93. The pedsFACT-BrS for parent of adolescent also demonstrated good convergent and divergent validities when correlated with the Child Health Questionnaire Parent Form 50 (CHQ-PF-50) and the Neuroticism in Eysenck Personality Questionnaire. The pedsFACT-BrS parent of adolescent showed good clinical validity, and effectively differentiated between clinically distinct patient groups according to the type of treatment, tumor location, shunt, and Karnofsky score of parent proxy report. CONCLUSION We confirmed that this reliable and valid instrument can be used to properly evaluate the quality of life of Korean adolescent brain tumor patients by their parents' proxy report.
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Affiliation(s)
- Hee-Jung Yoo
- Department of Neurosurgery, Asan Medical Center, Ulsan University of Medicine, Seoul, Korea
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Castellino SM, Tooze JA, Flowers L, Parsons SK. The peabody picture vocabulary test as a pre-screening tool for global cognitive functioning in childhood brain tumor survivors. J Neurooncol 2011; 104:559-63. [PMID: 21225316 DOI: 10.1007/s11060-010-0521-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 12/21/2010] [Indexed: 11/28/2022]
Abstract
Minimal acceptable global intelligence is often a determinant for entry into studies utilizing children's self-reported health-related quality of life (HRQL) or symptoms' appraisal. However, most measures of cognitive functioning are lengthy and require a trained psychologist for administration. We used the Peabody Picture Vocabulary Test (third edition; PPVT-III) to assess adequacy of verbal comprehension and language flexibility before entry into a pilot pharmacologic intervention trial in pediatric BT survivors who were >1 year from treatment, and received >23.4 gray as part of therapy. Participation included the ability to complete self-reported measures of HRQL. Among thirteen BT survivors who were screened, twelve proceeded to the full intervention trial and then underwent a detailed baseline neurocognitive assessment including the Wechsler Abbreviated Scale of Intelligence (WASI), administered by a neuropsychologist. Correlation of PPVT-III with WASI was 0.90 for full scale IQ (P < 0.0001), 0.89 for verbal IQ (P = 0.0001) and 0.75 for performance IQ (P = 0.0004) The PPVT-III is easy to administer by trained clinical staff and is a reliable clinic-based screening tool for research studies. While it is not designed to replace in depth neuropsychological evaluation of potential areas of cognitive dysfunction, it provides an estimation of minimal global cognitive functioning for entry into studies that rely on self-report in childhood BT survivors and other cancer survivors who have received central nervous system-directed therapy.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC, USA.
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Yoo H, Ra YS, Park HJ, Lai JS, Cella D, Shin HY, Kim DS, Kim WC, Shin YS. Validation of pediatric Functional Assessment of Cancer Therapy: patient version 2 of "brain tumor survivor" for grade school patients aged 7-12 years. Qual Life Res 2010; 20:529-35. [PMID: 21127998 DOI: 10.1007/s11136-010-9786-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND We evaluated the reliability and validity of the Pediatric Functional Assessment of Cancer Therapy-Childhood Brain Tumor Survivor version 2.0 (pedsFACT-BrS; patient version for grade school children aged 7-12 years). METHODS After translating and cross-culturally adapting it into Korean, the psychometric properties of the pedsFACT-BrS were evaluated in 148 childhood brain tumor survivors (mean age, 9.67 years). Pre-testing was performed in 25 patients. RESULTS The pedsFACT-BrS showed good symptom coverage and overall user comprehension. Internal consistency was acceptable, with Cronbach's α coefficients ranging from 0.70 to 0.92. The pedsFACT-BrS also demonstrated good convergent and divergent validities when correlated with the Revised Children's Manifest Anxiety Scale and Kovacs' Children's Depression Scale. The pedsFACT-BrS showed good known-group validity and effectively differentiated between clinically distinct patient groups (patient vs. control groups, and among patients having different Karnofsky scores), but offered only partial discrimination of physical well-being (PWB) scores when patients were grouped by treatment type. CONCLUSIONS Our results indicate that this instrument is reliable and valid and can be used to evaluate the quality of life of Korean childhood brain tumor survivors.
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Affiliation(s)
- Heejung Yoo
- Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yoo H, Kim DS, Shin HY, Lai JS, Cella D, Park HJ, Ra YS, Kim WC, Shin YS. Validation of the Pediatric Functional Assessment of Cancer Therapy Questionnaire (Version 2.0) in brain tumor survivors aged 13 years and older. J Pain Symptom Manage 2010; 40:559-65. [PMID: 20615660 DOI: 10.1016/j.jpainsymman.2010.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 01/25/2010] [Accepted: 01/27/2010] [Indexed: 11/24/2022]
Abstract
We evaluated the reliability and validity of the Pediatric Functional Assessment of Cancer Therapy-Childhood Brain Tumor Survivor Questionnaire (pedsFACT-BrS, Version 2). This was specifically directed to patients aged 13 years and older (adolescents). The pedsFACT-BrS was translated and cross-culturally adapted into Korean, following standard Functional Assessment of Chronic Illness Therapy methodology. The psychometric properties of the pedsFACT-BrS in adolescents were evaluated in 161 brain tumor (BT) patients (mean age=15.53 years). Pretesting was performed in 30 patients, and the results indicated good symptom coverage and overall comprehensibility. In validating the pedsFACT-BrS for adolescents, we found high internal consistency, with Cronbach's α coefficients ranging from 0.76 to 0.91. The pedsFACT-BrS for adolescents also demonstrated good convergent and divergent validities when correlated with the Revised Children's Manifest Anxiety Scale and the Kovacs' Children's Depression Inventory. The pedsFACT-BrS for adolescents showed good clinical validity and effectively differentiated between clinically distinct patient groups according to Karnofsky score, type of treatment, and treatment on/off status. This reliable and valid instrument can now be used to properly evaluate the quality of life of Korean adolescent BT patients.
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Affiliation(s)
- Heejung Yoo
- Department of Neurosurgery, Ulsan University College of Medicine, Seoul, Republic of Korea
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Mehrotra N, Shamji MF, Vassilyadi M, Ventureyra ECG. Intracranial tumors in first year of life: the CHEO experience. Childs Nerv Syst 2009; 25:1563-9. [PMID: 19551387 DOI: 10.1007/s00381-009-0936-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Revised: 05/17/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION One seventh of pediatric brain tumors are diagnosed in the first year of life. With more widespread and accessible neuroimaging, these lesions are being diagnosed earlier, but there remains scant literature about their natural history. METHODS A retrospective review was performed of brain tumor patients presenting to the Children's Hospital of Eastern Ontario (CHEO) through the last 34 years. Patients presenting in the first year of life, including symptoms, management features, and functional outcome, were analyzed using ANOVA and chi (2) statistics. RESULTS Eighteen cases of brain tumors in the first year of life were identified: 12 suptratentorial, eight with benign histology, and six infratentorial all with malignant histology. Median age of presentation differed by lesion location (p = 0.05) and glial tumors were most common. Raised intracranial pressure was more than twice as prevalent with posterior fossa lesions (p < 0.01) with equivalent likelihood of increasing head circumference (p = 0.74), whereas seizures were more frequent with supratentorial tumors (p = 0.04). Gross total resection was achieved in 47% of patients, cerebrospinal fluid diversion was more frequently necessary among infratentorial lesions (p = 0.02), and adjuvant therapy was more utilized for infratentorial lesions (p < 0.01). Among eight surviving infants, seven had supratentorial tumors, five survived to adulthood, and six are functionally independent. CONCLUSIONS Brain tumors in the first year of life represent 4.8% of patients treated at CHEO. Mode of presentation, utilization of adjuvant therapy, and survival depend on tumor location and histology, with worse prognosis for infratentorial lesions. One third of patients had acceptable functional outcome requiring no special assistance.
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Affiliation(s)
- Naveen Mehrotra
- Division of Neurosurgery, Children's Hospital of Eastern Ontario, 401, Smyth Road, Ottawa, Canada
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