Association Between Executive Functioning and Functional Impairment Among Pediatric Cancer Survivors and Controls

Abstract

Objective To examine the impact of cancer treatment upon neurocognitive and functional impairment; and to explore the relationship between these constructs in pediatric cancer survivors compared to controls. Method A cross-sectional cohort of survivors (n = 26) and controls (n = 53) was included. Survivors were off treatment an average of 6.35 years (SD = 5.38; range 1–15 years) and demonstrated an average “medium” Central Nervous System (CNS) treatment intensity score. Participants completed measures of neurocognitive functions including intellectual assessment (RIST) and executive functions (NIH Examiner), while parents reported on children’s functional impairment (BIS). Results Survivors were similar to controls in neurocognitive ability, including intellectual and executive functions, and functional impairment. Regardless of group membership, NIH Examiner performance and functional impairment increased with age. Increased impairment was associated with different neurocognitive variables for survivors versus controls. Conclusions Research regarding functional impairment of cancer survivors and the association between neurocognitive deficits and functional impairment has been limited. Our results demonstrate that, while low treatment intensity may confer relative sparing of neurocognitive and executive functioning among survivors, functional impairment continues to be a potential risk. In conclusion, pediatric cancer survivors should be screened for functional difficulties, particularly in the areas of interpersonal relations and self-care.

Self-reported and parent proxy reported functional impairment among pediatric cancer survivors and controls

“…Significant BIS-C subscale group differences were observed between 5-7 years and both 8-10 years and 15-18 years on the self-care/self-fulfillment subscale, with 5-7 years reporting greater self-care/self-fulfillment FI (p = .01, p = .032, respectively). These findings are contrary to our previous trend-level findings that as child age increases, parents report greater amounts of functional impairment [33] (Fig. 1b).…”

“…We found that neurocognitive functioning was modestly related to FI, with four of seven Examiner scales correlating with FI in the predicted directions. This finding aligns with our previous parent-reported FI finding that several neurocognitive measures were related to both total and subscale BIS scores for both cancer survivors and controls [33]. There clearly is a link between parent-report of psychosocial adaptation and survivor EF, particularly among children with Central Nervous System (CNS) tumors [36].…”

“…This was not the case, as we found that the two groups were similar on self-reported FI. Our results align with The BIS is a parent-report measure of impairment in children that assesses areas of interpersonal functioning, school functioning, and self-care or fulfillment The BIS-C is a self-report measure of impairment in children that assesses areas of interpersonal functioning, school functioning, and self-care or fulfillment * p < .05; ** p < .01; *** p < .001 Caseness defined by BIS and BIS-C scores greater than or equal to 11.5 or 14 The BIS-C is a self-report measure of impairment in children that assesses areas of interpersonal functioning, school functioning, and self-care or fulfillment The BIS is a parent-report measure of impairment in children that assesses areas of interpersonal functioning, school functioning, and self-care or fulfillment *p < 0.05 **p < 0.01 ***p < 0.001 our previous finding that parent-reported FI did not distinguish between the two groups [33], which may be the product of a variety of methodological issues: low survivor participation rate, lack of treatment intensity heterogeneity, and small sample size. Further, group differences may be more difficult to detect in small samples because such group differences may be based on the relatively small subset of survivors who exhibit impairment, thereby being evident only in large samples [35].…”

“…In the first model, age and SES were entered first, with parent-completed BIS total scores entered second. Age was included because although we found no significant (parent proxy) BIS total difference by age, the older the child, the greater the tendency towards greater BIS (FI) [33]. SES was included because life stressors, closely associated with SES, represent a significant predictor of functional impairment in children [34].…”