Neurocognitive and Psychosocial Outcomes in Pediatric Brain Tumor Survivors

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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Pediatric Brain Tumors: Imaging of Late Effects in Pediatric Brain Tumor Survivors

Imaging of Complications and Toxicity following Tumor Therapy - Medical Radiology ◽

10.1007/174_2015_1084 ◽

2015 ◽

pp. 171-192

Author(s):

G. Tallen ◽

M. Warmuth-Metz ◽

P. Hernáiz Driever ◽

Stefan M. Pfister

Keyword(s):

Brain Tumor ◽

Brain Tumors ◽

Late Effects ◽

Pediatric Brain Tumor ◽

Pediatric Brain Tumors ◽

Pediatric Brain

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Feasibility and efficacy of an extended trial of home-based working memory training for pediatric brain tumor survivors: a pilot study

Neuro-Oncology Practice ◽

10.1093/nop/npw015 ◽

2016 ◽

Vol 4 (2) ◽

pp. 111-120 ◽

Cited By ~ 3

Author(s):

Bonnie Carlson-Green ◽

Jennifer Puig ◽

Anne Bendel

Keyword(s):

Working Memory ◽

Brain Tumor ◽

Executive Functioning ◽

Late Effects ◽

Pediatric Brain Tumor ◽

Working Memory Training ◽

Memory Training ◽

Neurocognitive Late Effects ◽

Pediatric Brain

Abstract Background. Impaired working memory appears to play a key role in some of the neurocognitive late effects of pediatric brain tumor treatments, including declines in intellectual and executive functioning. Recent studies of pediatric cancer survivors suggest Cogmed® Working Memory Training is effective at improving working memory, although pediatric brain tumor survivors may demonstrate a less robust response than children with other cancers. The current study sought to determine if an extended course of Cogmed (35 sessions) was both feasible and efficacious for brain tumor survivors and if improvements were observable in near-transfer and far-transfer working memory measures as well as parent rating scores at 6 months post-treatment. Methods. Twenty pediatric brain tumor survivors ages 8 to 18 years with working memory deficits completed 35 sessions of Cogmed. Assessments of working memory and academic skills were completed at baseline, completion of training, and 6-month follow-up and parents completed questionnaires at baseline and 6-month follow-up. Results. Participants showed significant improvements in working memory at training completion and 6-month follow-up and math achievement at 6-month follow-up. Parents reported executive functioning improvements at follow-up as compared with baseline. Participants’ program-based working memory skills did not change significantly between sessions 25 and 35, suggesting that extended training did not provide additional benefit. Conclusions. This study replicates and extends previous research by: (1) demonstrating that brain tumor survivors at high risk for neurocognitive late effects can complete and benefit from working memory training, (2) identifying a point of diminished returns on training time investment, and (3) demonstrating benefits 6 months post-intervention.

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Executive Function and Psychosocial Adjustment in Adolescent Survivors of Pediatric Brain Tumor

Developmental Neuropsychology ◽

10.1080/87565641.2021.1900191 ◽

2021 ◽

pp. 1-20

Author(s):

A. Puhr ◽

E. Ruud ◽

V. Anderson ◽

B.J. Due-Tønnessen ◽

A.B. Skarbø ◽

...

Keyword(s):

Brain Tumor ◽

Executive Function ◽

Psychosocial Adjustment ◽

Pediatric Brain Tumor ◽

Pediatric Brain

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Predictors of adaptive functioning and psychosocial adjustment in children with pediatric brain tumor: A report from the brain radiation investigative study consortium

Pediatric Blood & Cancer ◽

10.1002/pbc.25323 ◽

2014 ◽

Vol 62 (3) ◽

pp. 509-516 ◽

Cited By ~ 13

Author(s):

Kristen E. Robinson ◽

Kelly R. Wolfe ◽

Keith O. Yeates ◽

E. Mark Mahone ◽

Kim M. Cecil ◽

...

Keyword(s):

Brain Tumor ◽

Psychosocial Adjustment ◽

Adaptive Functioning ◽

Pediatric Brain Tumor ◽

Brain Radiation ◽

Pediatric Brain ◽

The Brain

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Late Effects of Therapy for Pediatric Brain Tumor Survivors

Journal of Child Neurology ◽

10.1177/0883073809341709 ◽

2009 ◽

Vol 24 (11) ◽

pp. 1455-1463 ◽

Cited By ~ 99

Author(s):

Christopher D. Turner ◽

Celiane Rey-Casserly ◽

Cori C. Liptak ◽

Christine Chordas

Keyword(s):

Brain Tumor ◽

Late Effects ◽

Pediatric Brain Tumor ◽

Pediatric Brain

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QOL-11. COMPARISON OF TREATMENT BURDEN RATING SCALES ON NEUROCOGNITIVE OUTCOMES IN A MIXED SAMPLE OF PEDIATRIC BRAIN TUMOR SURVIVORS

Neuro-Oncology ◽

10.1093/neuonc/noaa222.674 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii432-iii433

Author(s):

Muhammad Baig ◽

Ineke Olsthoorn ◽

Grace Yang ◽

Wafik Zaky ◽

Peter Stavinoha

Keyword(s):

Working Memory ◽

Brain Tumor ◽

Processing Speed ◽

Pediatric Brain Tumor ◽

Psychosocial Outcomes ◽

Treatment Intensity ◽

Treatment Burden ◽

Younger Age ◽

Neurocognitive Outcomes ◽

Pediatric Brain

Abstract BACKGROUND Predicting neurocognitive outcomes in pediatric brain tumor (PBT) patients is challenging. Rarity of PBT makes inclusion of detailed risk factors (e.g., treatment modality, intensity, individual complications) difficult when sample sizes are small. The Neurological Predictor Scale (NPS) summarizes complications and treatment factors associated with neurocognitive risks and has modest validation. Recently, the Pediatric Neuro-Oncology Rating of Treatment Intensity (PNORTI) was developed to evaluate the impact of treatment intensity on psychosocial outcomes but has not been compared to neurocognitive outcomes. This study compared the NPS and PNORTI in terms of relationship to neurocognitive outcomes known to be at risk in PBT survivors. METHODS 88 PBT survivors’ neuropsychological outcomes were retrospectively analyzed in relation to the NPS and PNORTI. Variables of interest included IQ, working memory, and processing speed. RESULTS NPS associated with lower IQ (rs=-.476, p=.001), lower working memory (rs=-.323, p=.010), and lower processing speed (rs=-.389, p=.007) in patients diagnosed at a younger age, but only processing speed for children diagnosed after age 7 years (rs=-.262, p=.036). PNORTI was not correlated with neurocognitive variables for either group. CONCLUSION NPS has value in predicting neurocognitive outcomes, though much more in a younger age at diagnosis group compared to older patients. The PNORTI did not demonstrate predictive value for these neurocognitive domains in our sample. Given the potential clinical and research value of a summary rating of treatment burden relating to long-term outcome, future research should include relationship to psychosocial outcomes and quality of life.

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