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Long-Term Neurocognitive Functioning and Social Attainment in Adult Survivors of Pediatric CNS Tumors: Results From the St Jude Lifetime Cohort Study.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2016 Apr 20; Vol. 34 (12), pp. 1358-67. Date of Electronic Publication: 2016 Feb 01. - Publication Year :
- 2016
-
Abstract
- Purpose: To assess the prevalence and severity of neurocognitive impairment in adult survivors of pediatric CNS tumors and to examine associated treatment exposures.<br />Patients and Methods: Participants included 224 survivors of CNS tumors who were treated at St Jude Children's Research Hospital (current median age [range], 26 years [19 to 53 years]; time from diagnosis, 18 years [11 to 42 years]) and completed neurocognitive testing. Information on cranial radiation therapy (CRT) doses and parameters of delivery were abstracted from medical records. The prevalence of severe impairment (ie, at least two standard deviations below normative mean) was compared across radiation treatment groups (no CRT, focal irradiation, craniospinal irradiation) using the χ(2) test. Log-binomial models were used to estimate risk ratios (RRs) and corresponding 95% CIs for severe impairment.<br />Results: In multivariable models, craniospinal irradiation was associated with a 1.5- to threefold increased risk of severe impairment compared with no CRT (eg, intelligence: RR = 2.70; 95% CI, 1.37 to 5.34; memory: RR = 2.93; 95% CI, 1.69 to 5.08; executive function: RR = 1.74; 95% CI, 1.24 to 2.45). Seizures were associated with impaired academic performance (RR = 1.48; 95% CI, 1.02 to 2.14), attention (RR = 1.54; 95% CI, 1.12 to 2.13), and memory (RR = 1.44; 95% CI, 1.04 to 1.99). Hydrocephalus with shunt placement was associated with impaired intelligence (RR = 1.78; 95% CI, 1.12 to 2.82) and memory (RR = 1.42; 95% CI, 1.03 to 1.95). Differential follow-up time contributed to variability in prevalence estimates between survivors treated with older nonconformal and those treated with more contemporary conformal radiation therapy methods. Neurocognitive impairment was significantly associated with lower educational attainment, unemployment, and nonindependent living.<br />Conclusion: Survivors of pediatric CNS tumors are at risk of severe neurocognitive impairment in adulthood. The prevalence of severe impairment is greater than expected in the general population, even in the absence of CRT, and is associated with disrupted attainment of adult social milestones.<br /> (© 2016 by American Society of Clinical Oncology.)
- Subjects :
- Adult
Central Nervous System Diseases diagnosis
Central Nervous System Neoplasms diagnosis
Central Nervous System Neoplasms epidemiology
Central Nervous System Neoplasms psychology
Chi-Square Distribution
Cognition Disorders diagnosis
Cranial Irradiation adverse effects
Educational Status
Female
Humans
Independent Living psychology
Longitudinal Studies
Male
Middle Aged
Multivariate Analysis
Neuropsychological Tests
Odds Ratio
Prevalence
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Unemployment psychology
United States epidemiology
Young Adult
Central Nervous System Diseases epidemiology
Central Nervous System Diseases psychology
Central Nervous System Neoplasms therapy
Cognition
Cognition Disorders epidemiology
Cognition Disorders psychology
Social Behavior
Survivors psychology
Subjects
Details
- Language :
- English
- ISSN :
- 1527-7755
- Volume :
- 34
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 26834063
- Full Text :
- https://doi.org/10.1200/JCO.2015.62.2589