title: Intensity of CNS treatment for pediatric cancer: prediction of social outcomes in survivors.
abstract: OBJECTIVE
  To evaluate the association of central nervous system (CNS) treatment intensity and the social functioning of children who have completed treatment for leukemia, lymphoma, and solid tumors outside the CNS. Furthermore, we expected that these associations would be moderated by child age at diagnosis and gender.
  
  
  METHODS
  Peer, teacher, and self-report data were obtained for 82 cancer survivors (age 9-17 years) using classroom rating and nomination procedures that are widely used in research on social development. Information regarding cranial radiation therapy (CRT), intrathecal chemotherapy (ITC), and systemic methotrexate were obtained from medical records and used to create a composite index of CNS treatment intensity.
  
  
  RESULTS
  Higher scores on the index of CNS treatment intensity were associated with poorer peer acceptance, fewer friendships, greater social sensitivity-isolation, and diminished leadership-popularity based on peer-report. These associations were stronger for boys and children who were younger (<10 years old) at diagnosis. In contrast, CNS treatment intensity was only predictive of teacher-perceptions of aggressive-disruptive behavior and it was unrelated to social self-perceptions.
  
  
  CONCLUSIONS
  These results suggest that children who receive CRT and ITC are at risk for problematic peer relations, particularly if they are male or younger at diagnosis. Given the stability of poor peer relationships and documented linkages between peer problems and subsequent academic and psychiatric difficulties, clinical services should address these issues. Research is needed to identify mechanisms that account for these outcomes and provide direction for prevention and treatment efforts.
authors.affiliation: Center for Biobehavioral Health, Columbus Children's Research Institute, and The Ohio State University, Columbus, Ohio, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Vannatta
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Gerhardt
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wells
authors.forename: Robert B
authors.initials: RB
authors.lastname: Noll
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002490:Central Nervous System / Q000187:drug effects* / Q000528:radiation effects*; D002648:Child; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects / Q000523:psychology*; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects / Q000523:psychology; D007398:Interpersonal Relations; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D012737:Sex Factors; D012917:Social Adjustment; D012919:Social Behavior; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents; D008727:Methotrexate