LGG-11. Cognitive, Academic, and Quality of Life Outcomes in Survivors of Pediatric Low-Grade Glioma: Challenging the ‘Benign Tumor’ Perception

Abstract

High survival rates in pediatric low-grade gliomas (pLGG) may overshadow potentially significant long-term toxicities and functional impact. Chemo-radiation sequelae are well documented, in contrast to those who undergo surgical resection or observation alone. We performed a retrospective cohort study from 2000-2015, assessing cognitive, academic, and quality of life (QoL) impact on 45 eligible pLGG survivors aged 0-16 years at diagnosis, at a median 7.4 years post-treatment. A multidisciplinary panel oversaw proxy questionnaires for young children (<7 years), proxy and self-reported for adolescents (8-15 years) and self-reported for young adults (>15 years). Data included demographics; tumor and treatment; early school (young child) progress; academic and occupation achievement (adolescents and young adults); health; and lifestyle issues. The incidence of abnormalities in the domains studied were compared to published population statistics. 16% of survivors underwent observation alone, and 84% surgery (58% complete resection). 57% of survivors experienced cognitive deficits. Young children (50%) and adolescents (42%) had low cognitive functioning scores, correlating with poor academic (p < 0.01) and standardised school educational tests’ performance. 42% of mainstream school attendees required learning support; 33% examination assistance; 50% completed secondary education and 22% a tertiary degree, but had attention (young child and adolescent), and memory (young adult) issues. 65.9% of survivors had at least one neurological concern, highest in adolescents (70%). Language deficits (42.9%), pain, fatigue, and hearing loss (28.6 %) in young children; and vision/sleep difficulties (35%); fatigue (30%) and mobility (25%) in adolescents were reported. Young adults suffered headaches (47.1%) and fatigue (29.4%). Young children (57%) suffered more emotional disturbance than adolescents (16%). Anxiety (23%) and depression (14%) reflected poor QoL on Emotion Thermometer scales in all survivors. These findings challenge the ‘benign’ label of pLGG and highlights the importance of close psychosocial surveillance in helping survivors achieve their best emotional and educational potential.