Increased Risk of Severe Neurocognitive Impairment in Adult Survivors of Pediatric CNS Tumors
As reported in the Journal of Clinical Oncology by Brinkman et al, a study in the St. Jude Lifetime Cohort showed that adult survivors of pediatric central nervous system (CNS) tumors are at increased risk of severe neurocognitive impairment.
Study Details
The study involved 224 survivors of CNS tumors treated at St. Jude Children’s Research Hospital who had completed neurocognitive testing, had a current median age of 26 years (range = 19–53 years), and were a median of 18 years (range = 11–42 years) from diagnosis. Severe impairment was defined as at least two standard deviations below the normative mean and was compared among patients who received no cranial radiation therapy, focal irradiation, or craniospinal irradiation.
Prevalence of Deficits
Overall, the prevalence of severe neurocognitive impairment ranged from 8% on direct assessment of working memory to 57% on a test of fine motor dexterity. Overall, compared with an estimated overall rate of 2% in the general population, 20% to 30% of survivors had severe impairment on performance-based measures of intellect, short- and long-term memory, mathematics, and cognitive fluency. On self-reported measures, a significant adverse impact on daily function was reported by < 10% of survivors, except for working memory (21%).
Prevalence of severe impairment in cognitive domains and specific abilities varied by radiation exposure. In multivariate analysis, craniospinal irradiation was associated with the greatest risk, with a 1.5- to 3-fold increased risk of severe impairment compared with no cranial radiation therapy (eg, risk ratios [RRs] = 2.70, 95% confidence interval [CI] = 1.37–5.34, for intelligence; 2.93, 95% CI = 1.69–5.08, for memory; and 1.74, 95% CI = 1.24–2.45, for executive function).
Seizures were associated with poorer academic performance (RR = 1.48, 95% CI = 1.02–2.14), attention (RR = 1.54, 95% CI = 1.12–2.13), and memory (RR = 1.44, 95% CI = 1.04–1.99). Hydrocephalus with shunt placement was associated with impaired intelligence (RR = 1.78, 95% CI = 1.12–2.82) and memory (RR = 1.42, 95% CI = 1.03–1.95).
Effects on Function
Neurocognitive impairment was significantly associated with lower educational attainment, unemployment, and nonindependent living. For example, survivors with impaired intellect, academics, or executive function were at 40% increased risk of not completing college; those with impaired attention, memory, or executive function were at twofold greater risk of unemployment; and those with impairment in intelligence, academics, memory, or executive function had a 50% increased risk of nonindependent living.
The investigators concluded: “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 cranial radiation therapy, and is associated with disrupted attainment of adult social milestones.”
The study was supported by the National Cancer Institute and the American Lebanese-Syrian Associated Charities.
Tara M. Brinkman, PhD, of St. Jude Children’s Research Hospital, is the corresponding author of the Journal of Clinical Oncology article.
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