Examination of risk factors for intellectual and academic outcomes following treatment for pediatric medulloblastoma.
BACKGROUND
The aim of this study was to prospectively examine the effects of hearing loss and posterior fossa syndrome (PFS), in addition to age at diagnosis and disease risk status, on change in intellectual and academic outcomes following diagnosis and treatment in a large sample of medulloblastoma patients.


METHODS
Data from at least 2 cognitive and academic assessments were available from 165 patients (ages 3-21 years) treated with surgery, risk-adapted craniospinal irradiation, and 4 courses of chemotherapy with stem cell support. Patients underwent serial evaluation of cognitive and academic functioning from baseline up to 5 years post diagnosis.


RESULTS
Serious hearing loss, PFS, younger age at diagnosis, and high-risk status were all significant risk factors for decline in intellectual and academic skills. Serious hearing loss and PFS independently predicted below-average estimated mean intellectual ability at 5 years post diagnosis. Patients with high-risk medulloblastoma and young age at diagnosis (<7 years) exhibited the largest drop in mean scores for intellectual and academic outcomes.


CONCLUSIONS
Despite a significant decline over time, intellectual and academic outcomes remained within the average range at 5 years post diagnosis for the majority of patients. Future studies should determine if scores remain within the average range at time points further out from treatment. Patients at heightened risk should be closely monitored and provided with recommendations for appropriate interventions.
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Jane E
JE
Schreiber
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
James G
JG
Gurney
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Shawna L
SL
Palmer
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Johnnie K
JK
Bass
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Mingjuan
M
Wang
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Si
S
Chen
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Hui
H
Zhang
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Michelle
M
Swain
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Mary L
ML
Chapieski
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Melanie J
MJ
Bonner
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Donald J
DJ
Mabbott
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Sarah J
SJ
Knight
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Carol L
CL
Armstrong
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Robyn
R
Boyle
Department of Psychology St. Jude Children's Research Hospital, Memphis, Tennessee (J.E.S., S.L.P.); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee (J.G.G.); School of Public Health, University of Memphis, Memphis, Tennessee (J.G.G.); Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee (J.K.B); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (M.W., S.C., H.Z.); Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (A.G.); Royal Children's Hospital Brisbane, Herston, Australia (M.S.); Department of Pediatric Medicine, Texas Children's Hospital, Houston, Texas (M.L.C.); Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (M.J.B.); Department of Psychology, The Hospital for Sick Children, Toronto, Canada (D.J.M.); Department of Psychology, The Royal Children's Hospital Melbourne, Victoria Australia (S.J.K.); Neuro-Oncology Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.L.A); Psychology Service, Sydney Children's Hospital, Randwick, Australia (R.B.).
Amar
A
Gajjar
D000293:Adolescent; D000818:Animals; D002528:Cerebellar Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology*; D003131:Combined Modality Therapy / Q000379:methods; D061888:Craniospinal Irradiation / Q000379:methods; D005260:Female; D034381:Hearing Loss / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008527:Medulloblastoma / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
academic; cognitive; hearing; medulloblastoma; posterior fossa syndrome