Impact of vision loss among survivors of childhood central nervous system astroglial tumors

Abstract

Background The impact of impaired vision on cognitive and psychosocial outcomes among long-term survivors of childhood low-grade gliomas has not been investigated previously, but could inform therapeutic decision-making. Methods Data from the Childhood Cancer Survivor Study was used to investigate psychological (measures of cognitive/emotional function) and socioeconomic (education, income, employment, marital status, independent living) outcomes among astroglial tumors survivors grouped by: (a) vision without impairment, (b) vision with impairment including unilateral blindness, visual field deficits or amblyopia, or (c) bilateral blindness. The effect of vision status on outcomes was examined using multivariable logistic regression, adjusting for age, gender, cranial radiation therapy and medical comorbidities. Results Among 1,233 survivors of childhood astroglial tumor ≥ 5 years post-diagnosis, 277 (22.5%) had visual impairment. In multivariable analysis, survivors with bilateral blindness were more likely to be unmarried (adjusted odds ratio [95% confidence interval]: 4.7 [1.5, 15.0]), live with a caregiver (3.1 [1.3, 7.5]), and be unemployed (2.2 [1.1, 4.5]) compared to those without visual impairment. Bilateral blindness had no measureable effect on cognitive or emotional outcomes, and vision with impairment was not significantly associated with any psychological or socio-economic outcomes. Conclusions Adult survivors of childhood astroglial tumors with bilateral blindness are more likely to live unmarried and dependently and be unemployed. Survivors with visual impairment but some remaining vision did not differ significantly with regard to psychological function and socioeconomic status from those without visual impairment.

Surviving childhood cancer: a systematic review of studies on risk and determinants of adverse socioeconomic outcomes

“…Survivors diagnosed below 6 years of age achieved a lower educational level. 99 de Blank, 2016 North America Astroglial tumours (n = 587)…”

“They've got a lot of needs and I don't think they're being met fully”: A qualitative study of the multi‐professional team approach to the management of children with optic pathway gliomas

“…Optic pathway gliomas (OPGs) are astrocytic tumours of glial origin that are located along the visual pathway and account for 3–8% of all paediatric brain tumours . Patients with an OPG, between 50 and 70%, have a concurrent diagnosis of neurofibromatosis type 1 (NF1), a genetic disorder that results in DNA repair defects and hence an increased incidence of tumours . These children, especially those with NF1, require complex management that can only be achieved with multi‐professional team (MPT) input.…”

“…As OPGs are usually benign tumours, overall survival from OPG ranges from 90% to 100% and so treatment aims to maintain patient and family quality of life, including preservation of vision . This is crucial as reduced vision may negatively impact on other aspects of development .…”

Looking back to inform the future: Lesson learned from survivors of childhood cancer

“…In the study by de Blank et al, a total of 1233 survivors of astroglial tumors with and without visual impairment were selected from the Childhood Cancer Survivor Study. The Childhood Cancer Survivor Study is a multiinstitutional retrospective cohort study of 5‐year survivors of childhood cancer who completed comprehensive questionnaires regarding a wide range of health‐related outcomes.…”

“…The Childhood Cancer Survivor Study is a multiinstitutional retrospective cohort study of 5‐year survivors of childhood cancer who completed comprehensive questionnaires regarding a wide range of health‐related outcomes. The primary outcomes included in the study by de Blank et al were psychological and socioeconomic. Among survivors of astroglial tumors, 277 (22.5%) had vision impairment (eg, no vision in 1 eye, amblyopia) and 47 survivors (3.8%) were legally blind.…”