Articulating viewpoints to better define and respond to the needs of adolescents and young adult survivors of pediatric brain tumors

Abstract Background Cranial radiotherapy may damage the cerebral vasculature. The aim of this study was to understand the prevalence and risk factors of cerebrovascular disease (CVD) and white matter hyperintensities (WMHs) in childhood brain tumors (CBT) survivors treated with radiotherapy. Methods Seventy CBT survivors who received radiotherapy were enrolled in a cross-sectional study at a median 20 years after radiotherapy cessation. The prevalence of and risk factors for CVD were investigated using MRI, MRA, and laboratory testing. Tumors, their treatment, and stroke-related data were retrieved from patients’ files. Results Forty-four individuals (63%) had CVD at a median age of 27 years (range, 16-43 years). The prevalence rates at 20 years for CVD, small-vessel disease, and large-vessel disease were 52%, 38%, and 16%, respectively. Ischemic infarcts were diagnosed in 6 survivors, and cerebral hemorrhage in 2. Lacunar infarcts were present in 7, periventricular or deep WMHs in 34 (49%), and mineralizing microangiopathy in 21 (30%) survivors. Multiple pathologies were detected in 44% of the participants, and most lesions were located in a high-dose radiation area. Higher blood pressure was associated with CVD and a presence of WMHs. Higher cholesterol levels increased the risk of ischemic infarcts and WMHs, and lower levels of high-density lipoprotein and higher waist circumference increased the risk of lacunar infarcts. Conclusions Treating CBTs with radiotherapy increases the risk of early CVD and WMHs in young adult survivors. These results suggest an urgent need for investigating CVD prevention in CBT patients.

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Neurocognitive and Family Functioning and Quality of Life Among Young Adult Survivors of Childhood Brain Tumors

The Clinical Neuropsychologist ◽

10.1080/13854046.2011.580284 ◽

2011 ◽

Vol 25 (6) ◽

pp. 942-962 ◽

Cited By ~ 25

Author(s):

Matthew C. Hocking ◽

Wendy L. Hobbie ◽

Janet A. Deatrick ◽

Matthew S. Lucas ◽

Margo M. Szabo ◽

...

Keyword(s):

Quality Of Life ◽

Young Adult ◽

Brain Tumors ◽

Family Functioning ◽

Adult Survivors ◽

Childhood Brain Tumors ◽

Young Adult Survivors

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Tumor location and neurocognitive impairment in adult survivors of pediatric brain tumors: A report from the St. Jude Lifetime Cohort (SJLIFE).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9531 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9531-9531

Author(s):

Tara M. Brinkman ◽

Wei Liu ◽

Gregory T. Armstrong ◽

Amar J. Gajjar ◽

Thomas E. Merchant ◽

...

Keyword(s):

Brain Tumors ◽

Processing Speed ◽

Adult Survivors ◽

Pediatric Brain Tumors ◽

Tumor Location ◽

Age At Diagnosis ◽

Neurocognitive Functions ◽

Pediatric Brain

9531 Background: Follow-up guidelines identify supratentorial tumor location as a risk factor for poor neurocognitive outcomes during childhood; yet few studies have systematically compared long-term cognitive outcomes between adult survivors of childhood infratentorial and supratentorial brain tumors. Methods: Neurocognitive functions were evaluated in 130 adult survivors of pediatric brain tumors (58 supratentorial and 72 infratentorial, mean [SD] current age = 27.4 years [5.2], age at diagnosis = 8.6 years [4.6], and time since diagnosis = 18.8 years [4.8]) participating in the SJLIFE long-term follow-up protocol. Age-adjusted standard scores for measures of intelligence, attention, memory, processing speed, and executive functioning were calculated, with clinical impairment defined as scores <10th percentile. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression models to examine associations between neurocognitive functions and tumor location. Results: As a group, survivors performed below average across multiple neurocognitive domains, including full scale IQ (mean=88.1; SD=18.2), with 34% demonstrating impaired IQ. Survivors of infratentorial tumors were more likely to be impaired on measures of focused attention (OR=2.19, 95% CI=1.03-4.65) and fine motor dexterity (OR=2.62, 95% CI=1.21-5.66) compared to survivors of supratentorial tumors. After adjusting for sex, age at diagnosis, shunt placement and cranial radiation (yes/no), infratentorial tumor location was only associated with reduced performance on a task of visual abstract reasoning (OR=3.76, 95% CI=1.40-10.1). Cranial radiation therapy was independently associated with impaired short-term memory (OR=15.6, 95% CI=1.64-147.8) and processing speed (OR=3.86, 95% CI=1.15-13.0). Conclusions: Tumor location was not associated with neurocognitive impairment after adjusting for treatment exposures. To further delineate potential differences associated with tumor location, future studies will examine factors including radiation dose/volume, extent of surgical resection, and medical complications.

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Medical and Psychosocial Correlates of Insomnia Symptoms in Adult Survivors of Pediatric Brain Tumors

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsv071 ◽

2015 ◽

Vol 41 (6) ◽

pp. 623-630 ◽

Cited By ~ 27

Author(s):

Eric S. Zhou ◽

Peter E. Manley ◽

Karen J. Marcus ◽

Christopher J. Recklitis

Keyword(s):

Brain Tumors ◽

Adult Survivors ◽

Pediatric Brain Tumors ◽

Psychosocial Correlates ◽

Pediatric Brain ◽

Insomnia Symptoms

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The Neurological Predictor Scale Predicts Adaptive Functioning via Executive Dysfunction in Young Adult Survivors of Childhood Brain Tumor

Journal of the International Neuropsychological Society ◽

10.1017/s1355617720000624 ◽

2020 ◽

pp. 1-11

Author(s):

Rella J. Kautiainen ◽

Michelle E. Fox ◽

Tricia Z. King

Keyword(s):

Young Adult ◽

Brain Tumors ◽

Indirect Effect ◽

Cognitive Rehabilitation ◽

Adaptive Functioning ◽

Executive Dysfunction ◽

Adult Survivors ◽

Childhood Brain Tumors ◽

Young Adult Survivors ◽

Frontal Systems

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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