Neurocognitive status in long-term survivors of childhood CNS malignancies: a report from the Childhood Cancer Survivor Study.
To assess neurocognitive functioning in adult survivors of childhood Central Nervous System (CNS) malignancy, a large group of CNS malignancy survivors were compared to survivors of non-CNS malignancy and siblings without cancer on a self-report instrument (CCSS-NCQ) assessing four factors, Task Efficiency, Emotional Regulation, Organization and Memory. Additional multiple linear regressions were used to assess the contribution of demographic, illness, and treatment variables to reported neurocognitive functioning in CNS malignancy survivors and the relationship of reported neurocognitive functioning to socioeconomic indicators. Survivors of CNS malignancy reported significantly greater neurocognitive impairment on all CCSS-NCQ factors than non-CNS cancer survivors or siblings (p < .01). Within the CNS malignancy group, medical complications (hearing deficits, paralysis and cerebrovascular incidents) resulted in a greater likelihood of reported deficits on all CCSS-NCQ factors. Total or partial brain irradiation and ventriculoperitoneal (VP) shunt placement was associated with greater impairment on Task Efficiency and Memory. Female gender was associated with a greater likelihood of impaired scores on Task Efficiency and Emotional Regulation, while diagnosis before age 2 years resulted in less likelihood of reported impairment on the Memory factor. CNS malignancy survivors with more impaired CCSS-NCQ scores demonstrated significantly lower educational attainment (p < .01), less household income (p < .001), less full time employment (p < .001), and fewer marriages (p < .001). Survivors of childhood CNS malignancy were found to be at significant risk for neurocognitive impairment that continues to adulthood and is correlated with lower socioeconomic achievement.
Ellenberg
Leah
L
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, USA. lellenberg@charter.net
Liu
Qi
Q
Gioia
Gerard
G
Yasui
Yutaka
Y
Packer
Roger J
RJ
Mertens
Ann
A
Donaldson
Sarah S
SS
Stovall
Marilyn
M
Kadan-Lottick
Nina
N
Armstrong
Gregory
G
Robison
Leslie L
LL
Zeltzer
Lonnie K
LK
D000293:Adolescent; D000328:Adult; D016543:Central Nervous System Neoplasms / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D002648:Child; D003072:Cognition Disorders / Q000209:etiology*; D015331:Cohort Studies; D004522:Educational Status; D004644:Emotions / Q000502:physiology; D004651:Employment; D056344:Executive Function / Q000502:physiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D011159:Population Surveillance; D011832:Radiation Injuries; D012649:Self Concept; D012737:Sex Factors; D035781:Siblings / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D055815:Young Adult