Nav: Home

Late effects of treatment hinder independence of adult survivors of childhood brain tumors

August 09, 2018

In the first study of its kind, St. Jude Children's Research Hospital investigators have found that more than half of pediatric central nervous system tumor survivors do not achieve complete independence as adults.

The findings, published online today in the Journal of Clinical Oncology, show that cognitive impairment and physical performance limitations are strong predictors of non-independence in survivors.

The study also means survivorship is at a level where late effects can be studied.

"Survival rates have improved dramatically over the past several decades," said corresponding author Tara Brinkman, PhD, an assistant member of the St. Jude Department of Epidemiology and Cancer Control and the Department of Psychology. "Unfortunately, we know that survivors are not achieving personal and professional milestones consistent with what we would expect healthy young or middle-aged adults to attain."

Brinkman looked at six aspects of independence in more than 300 survivors, including employment, independent living, marital status, assistance with routine or personal care needs, and the ability to drive.

"We wanted to see how these markers clustered together among survivors to generate different profiles of independence," Brinkman said. "Three groups emerged."

About 40 percent of survivors were classified as independent, which means they've achieved independence consistent with societal expectations. Another third was non-independent and required the most assistance. Brinkman categorized the remaining survivors as moderately independent, indicating they were able to do some things an adult is expected to do, but were not fully independent.

"We then looked at predictors of group membership," Brinkman said, "specifically, treatments that could predict the group of survivors who weren't able to achieve independence."

Aggressive therapies including cranial spinal radiation, younger age at diagnosis, and hydrocephalus with shunt placement were strong predictors of non-independence. Cognitive impairment was the strongest predictor of non-independence.

Conversely, in the moderately independent group, physical performance limitations, including problems with strength, aerobic capacity, and the ability to perform adaptive physical functions were associated with non-independence. Cognitive impairment was not a factor.

"For several decades with this population, we've focused on optimizing survival rates," Brinkman said. "Now that five- and 10-year survival is being realized, we want to maximize that and promote survivors' independence."

Intervening with survivors earlier may help them achieve the highest possible physical and mental levels.

"Screening for cognitive and physical performance deficits earlier in the course of survivorship will help us identify patients who may be on this trajectory toward non-independence," Brinkman said. "Identifying survivors at-risk early on would then allow us to intervene and potentially mitigate the adverse outcomes in adulthood."
-end-
The other St. Jude authors were Kirsten Ness, Zhenghong Li, I-Chan Huang, Kevin Krull, Amar Gajjar, Thomas Merchant, James Klosky, Robyn Partin, Ingrid Tonning Olsson, Frederick Boop, Paul Klimo Jr., Wassim Chemaitilly, Raja Khan, Deokumar Srivastava, Leslie Robison, Melissa Hudson and Gregory Armstrong.

The research was supported by grants (CA195547, CA21765) from the National Cancer Institute, part of the National Institutes of Health; and ALSAC, the fundraising and awareness organization of St. Jude.

St. Jude Children's Research Hospital

Related Cognitive Impairment Articles:

Genomic copy number variants contribute to cognitive impairment in the UK
Genetic alterations of rare deletions or duplications of small DNA segments, called copy number variants (CNVs), have been known to increase risk of neurodevelopmental disorders such as schizophrenia, autism spectrum disorder, and intellectual disability.
Mild cognitive impairment (MCI)
Greek researchers demonstrated the potential of a self-administered virtual supermarket cognitive training game for remotely detecting mild cognitive impairment (MCI), without the need for an examiner, among a sample of older adults.
Link between sleep and cognitive impairment in the elderly
Daytime sleepiness is very common in the elderly with prevalence rates of up to 50 percent.
New guidelines could help improve research into vascular cognitive impairment
New guidelines have been developed that it is hoped will help to progress research into vascular cognitive impairment following a study led by academics at the University of Bristol that brought together the views of over 150 researchers in 27 countries.
Depression prevalence in patients with mild cognitive impairment
Depression commonly occurs in patients with mild cognitive impairment and a new review of the medical literature suggests an overall pooled prevalence of 32 percent, according to an article published online by JAMA Psychiatry.
Research provides insights on the link between kidney damage and cognitive impairment
Kidney damage was linked with worse performance on tests of global cognitive function, executive function, memory, and attention.
Mild cognitive impairment patients take about 3 medications for concomittant diseases
Dr. Vasileios Papaliagkas, the corresponding author of the paper, pointed that the vast majority of MCI patients were taking at least one medication, whereas slightly less than half of the patients (40 percent) took at least four medications.
Post-mortem assessment guidelines for vascular cognitive impairment
New research, led by academics at the University of Bristol, has outlined the first validated set of pathological criteria for assessing the likelihood that cognitive impairment was caused by vascular disease.
Study: Training helps those with mild cognitive impairment
New research from the Center for BrainHealth at the University of Texas at Dallas shows that strategy-based reasoning training can improve the cognitive performance for those with mild cognitive impairment, a preclinical stage of those at risk for Alzheimer's disease.
Why are blacks at higher risk for cognitive impairment?
Social and economic disadvantages play a significant role in why blacks face a much higher risk than whites of developing cognitive impairment later in life, indicates a national study led by a Michigan State University sociologist.

Related Cognitive Impairment Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#513 Dinosaur Tails
This week: dinosaurs! We're discussing dinosaur tails, bipedalism, paleontology public outreach, dinosaur MOOCs, and other neat dinosaur related things with Dr. Scott Persons from the University of Alberta, who is also the author of the book "Dinosaurs of the Alberta Badlands".