Assessing neuropsychological phenotypes of pediatric brain tumor survivors

Abstract

Introduction Pediatric brain tumor survivors (PBTS) are at risk for both neurocognitive impairments and psychological difficulties, yet these two domains have historically been discretely examined, with assessment of psychosocial outcomes rarely included in studies of cognitive outcomes. Taking a person‐centered approach, the current study aimed to more comprehensively evaluate PBTS late effect profiles, including both neurocognitive and psychological sequelae, and predictors of these profiles. Method PBTS (N = 89) were assessed in a pediatric neuropsychological clinic between May 2009 and May 2018, diagnosed at least 1 year prior, and off‐treatment for at least 3 months (Mage = 6.57 years, SD = 4.53; 46.1% female). Parent‐ and teacher‐report of psychological symptoms, and performance‐based measures of neurocognitive functioning were examined using latent profile analysis. The R3STEP procedure identified predictors of class membership. Results The optimal model identified four classes characterized by: (1) average functioning across all measures (“Average,” n = 47), (2) average psychosocial functioning and impaired neurocognitive functioning (“Cognitive Deficit,” n = 25), (3) elevated social problems and significant neurocognitive impairments (“Social/Cognitive Deficit,” n = 9), and (4) impaired visual planning and problem‐solving and elevated parent‐reported psychosocial problems, but average processing speed, working memory, and teacher‐reported psychosocial outcomes (“Discrepant,” n = 8). Ethnicity, race, radiation treatment, and diagnoses of neurofibromatosis 1, hydrocephalus, and cerebellar mutism syndrome were significant predictors of class membership (ps < 0.05). Conclusion The present study identified distinct phenotypes with unique patterns of relations among neurocognitive and psychological domains. These findings are a vital first step toward identifying those at highest risk for poor outcomes and informing interventions that effectively address interrelated treatment targets for specific groups.

The Influence of Socioeconomic Status (SES) and Processing Speed on the Psychological Adjustment and Wellbeing of Pediatric Brain Tumor Survivors

“…Notably, several studies have reported that internalizing problems are more frequent in PBTSs than externalizing behaviors [10,87,99]. Accordingly, we observed that the per-centage of patients with clinically relevant internalizing symptoms was higher than the percentage of those displaying externalizing problems (see Results; Figure 1a).…”

“…Among the main complications, PBTSs experience internalizing problems, related to withdrawal, anxiety, depression [9,10], somatization [4], difficulties in social functioning and acceptance, especially by peers [11][12][13]. Moreover, pediatric cancer survivors may also develop in a low percentage of cases post-traumatic stress disorder symptoms (4.7%-21%) [14,15] and suicidal ideation (6-8%) [16].…”

Survivors of infant atypical teratoid/rhabdoid tumors present with severely impaired cognitive functions especially for fluid intelligence and visual processing: data from the German brain tumor studies

“…The ATRT‐Neuropsychology Tool has been implemented in the randomized trial SIOPE ATRT01 (EudraCT 2018‐003335‐29). Analyses should also comprise molecular subgrouping, 53 biomarkers, 54 socioeconomic status, 55 family functioning, 32 neurocognitive profiles, 56 and participation in everyday‐life after treatment 57 …”

Neurobehavioral Impairment in Pediatric Brain Tumor Survivors: A Meta-Analysis

“…There was a significant level of heterogen ity across the different studies (I 2 = 54%, p < 0.01) and no significant publication bias w identified t (15) = 0.36, p = 0.72, Figure S5a. 2021) [83] reported more than o independent cohort in their study [24,30,36,37,39,40,42,43,[45][46][47]49,[55][56][57][58]60,61,[63][64][65][66][70][71][72][73][74][75]77,83]. (a) Abso-lute risk-attention problems; (b) Absolute risk-emotional; (c) Absolute risk psychosocial problems…”