title: Restricted access to the environment and quality of life in adult survivors of childhood brain tumors.
abstract: Survivors of pediatric brain tumors (BTs) are at-risk for late effects which may affect mobility within and access to the physical environment. This study examined the prevalence of and risk factors for restricted environmental access in survivors of childhood BTs and investigated the associations between reduced environmental access, health-related quality of life (HRQOL), and survivors' social functioning. In-home evaluations were completed for 78 BT survivors and 78 population-based controls matched on age, sex, and zip-code. Chi-square tests and multivariable logistic regression models were used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) for poor environmental access and reduced HRQOL. The median age of survivors was 22 years at the time of study. Compared to controls, survivors were more likely to report avoiding most dimensions of their physical environment, including a single flight of stairs (p < 0.001), uneven surfaces (p < 0.001), traveling alone (p = 0.01), and traveling to unfamiliar places (p = 0.001). Overall, survivors were 4.8 times more likely to report poor environmental access (95 % CI 2.0-11.5, p < 0.001). In survivors, poor environmental access was associated with reduced physical function (OR = 3.6, 95 % CI 1.0-12.8, p = 0.04), general health (OR = 6.0, 95 % CI 1.8-20.6, p = 0.002), and social functioning (OR = 4.3, 95 % CI 1.1-17.3, p = 0.03). Adult survivors of pediatric BTs were more likely to avoid their physical environment than matched controls. Restricted environmental access was associated with reduced HRQOL and diminished social functioning. Interventions directed at improving physical mobility may have significant impact on survivor quality of life.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA. tara.brinkman@stjude.org
authors.forename: Tara M
authors.initials: TM
authors.lastname: Brinkman
authors.forename: Zhenghong
authors.initials: Z
authors.lastname: Li
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Neglia
authors.forename: Amar
authors.initials: A
authors.lastname: Gajjar
authors.forename: James L
authors.initials: JL
authors.lastname: Klosky
authors.forename: Rachel
authors.initials: R
authors.lastname: Allgood
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001932:Brain Neoplasms / Q000150:complications / Q000401:mortality / Q000523:psychology*; D003071:Cognition / Q000502:physiology; D004777:Environment; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011788:Quality of Life; D012189:Retrospective Studies; D012917:Social Adjustment; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D055815:Young Adult