title: Family Functioning Mediates the Association Between Neurocognitive Functioning and Health-Related Quality of Life in Young Adult Survivors of Childhood Brain Tumors.
abstract: OBJECTIVE
  Childhood brain tumor (BT) survivors experience significant neurocognitive sequelae that affect health-related quality of life (HRQOL). A model of neurodevelopmental late effects and family functioning in childhood cancer survivors suggests associations between survivor neurocognitive functioning, family functioning, and survivor HRQOL. This study examines the concurrent associations between survivor neurocognitive functioning, family functioning, and survivor emotional HRQOL, and the indirect effects of neurocognitive functioning on survivor emotional HRQOL through family functioning.
  
  
  METHODS
  Participants included young adult-aged childhood BT survivors (18-30 years old; N=34) who were on average 16 years post-diagnosis, and their mothers. A brief neuropsychological battery assessed working and verbal memory, processing speed, and executive functioning. Survivors and mothers completed measures of family functioning, and mothers completed a proxy-report measure of survivor HRQOL.
  
  
  RESULTS
  Spearman bivariate correlations examined the associations between indices of survivor neurocognitive functioning and concurrent family functioning and survivor emotional HRQOL. Poorer survivor processing speed, working memory, verbal memory, and executive function were significantly associated with worse survivor- and mother-reported family functioning (r's range: 0.36-0.58). Additionally, worse survivor processing speed and executive function were significantly associated with poorer survivor emotional HRQOL (r's range: 0.44-0.48). Bootstrapping analyses provided evidence for the indirect effects of neurocognitive functioning on survivor emotional HRQOL through family functioning.
  
  
  CONCLUSIONS
  These findings suggest that family functioning is an important variable that might mitigate the negative influence of neurocognitive late effects on survivors and is a potential target in future interventions.
authors: Division of Oncology, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
authors: Matthew C
authors: MC
authors: Hocking
authors: Division of Oncology, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania.
authors: Wendy L
authors: WL
authors: Hobbie
authors: School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania.
authors: Janet A
authors: JA
authors: Deatrick
authors: School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania.
authors: Thomas L
authors: TL
authors: Hardie
authors: Division of Oncology, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
authors: Lamia P
authors: LP
authors: Barakat
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D005195:Family Relations / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009035:Mothers / Q000523:psychology; D009483:Neuropsychological Tests; D011788:Quality of Life / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D055815:Young Adult
keywords: brain tumor; families; neurocognitive late effects; quality of life