title: Neurocognitive functioning in adult survivors of childhood non-central nervous system cancers.
abstract: BACKGROUND We sought to measure self-reported neurocognitive functioning among survivors of non-central nervous system (CNS) childhood cancers, overall and compared with a sibling cohort, and to identify factors associated with worse functioning. METHODS In a retrospective cohort study, 5937 adult survivors of non-CNS cancers and 382 siblings completed a validated neuropsychological instrument with subscales in task efficiency, emotional regulation, organization, and memory. Scores were converted to T scores; scores in the worst 10% of siblings' scores (ie, T score > or =63) were defined as impaired. Non-CNS cancer survivors and siblings were compared with multivariable linear regression and log-binomial regression. Among survivors, log-binomial models assessed the association of patient and treatment factors with neurocognitive dysfunction. All statistical tests were two-sided. RESULTS Non-CNS cancer survivors had similar or slightly worse (<0.5 standard deviation) mean test scores for all four subscales than siblings. However, frequencies of impaired survivors were approximately 50% higher than siblings in task efficiency (13.0% of survivors vs 7.3% of siblings), memory (12.5% vs 7.6%), and emotional regulation (21.2% vs 14.4%). Impaired task efficiency was most often identified in patients with acute lymphoblastic leukemia who received cranial radiation therapy (18.1% with impairment), myeloid leukemia who received cranial radiation therapy (21.2%), and non-Hodgkin lymphoma (13.9%). In adjusted analysis, diagnosis age of younger than 6 years, female sex, cranial radiation therapy, and hearing impairment were associated with impairment. CONCLUSION A statistically and clinically significantly higher percentage of self-reported neurocognitive impairment was found among survivors of non-CNS cancers than among siblings.
authors.affiliation: MSPH, Section of Pediatric Hematology-Oncology, Yale University School of Medicine, 333 Cedar St, LMP 2073, PO Box 208064, New Haven, CT 06525, USA. nina.kadan-lottick@yale.edu
authors.forename: Nina S
authors.initials: NS
authors.lastname: Kadan-Lottick
authors.forename: Lonnie K
authors.initials: LK
authors.lastname: Zeltzer
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Leah
authors.initials: L
authors.lastname: Ellenberg
authors.forename: Gerard
authors.initials: G
authors.lastname: Gioia
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology; D016371:Cranial Irradiation / Q000009:adverse effects; D004522:Educational Status; D004644:Emotions; D005260:Female; D034381:Hearing Loss / Q000150:complications; D006801:Humans; D016014:Linear Models; D008297:Male; D008568:Memory; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013315:Stress, Psychological / Q000453:epidemiology; D017741:Survivors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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