Psychological adjustment outcomes among pediatric brain tumor survivors: A meta‐analysis

Sharkey, Christina; Espeleta, Hannah C.; Traino, Katherine A.; Roberts, Caroline M.; Perez, Megan N.; Bakula, Dana M.; Chaney, John M.; Alderson, R. Matt; Mullins, Larry L.

doi:10.1002/pbc.28644

Cited by 20 publications

(23 citation statements)

References 57 publications

(144 reference statements)

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“…8 Some studies have identified female sex and younger age at diagnosis as risk factors, but results have been mixed. [14][15][16] Protective factors include family social support, friend and peer connectedness, 17,18 survivor self-esteem, 13 and higher SES. 13,19 Survivors' physical health status and personal relationships, both of which have been disrupted due to the pandemic, have a particularly significant impact on quality of life.…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID‐19 on adolescent and emerging adult brain tumor survivors and their parents

Fisher

Patronick

Gerhardt

et al. 2021

Pediatric Blood & Cancer

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Background The COVID‐19 pandemic has prompted unprecedented challenges, contributing to greater difficulties among families of children with special health care needs, such as pediatric brain tumor survivors. We examined the impact of the pandemic on psychosocial functioning of adolescent and emerging adult survivors and their parents. We hypothesized that COVID‐19 disruptions and survivor social connectedness would be associated with survivor‐reported posttraumatic stress and family outcomes, including family functioning, parenting, and parent mental health. Procedure Fifty‐five families (44 survivors, 48 parents) were recruited via phone and email to participate in the study. Survivors were ages 13–25 (M = 19.62, SD = 3.47) and at least 5 years post diagnosis. Parents completed the COVID‐19 Exposure and Family Impact Survey (CEFIS), and survivors completed the Environmental influences on Child Health Outcomes (ECHO) COVID‐19 child self‐report form, which assessed pandemic impacts on their psychosocial functioning. Results Parents reported a mean of 7.52 (SD = 2.83) disruptions to their families’ lives. The pandemic negatively affected survivors’ life satisfaction ( M diff = 0.46, t (44) = 3.96, p < .001), with 92% reporting reduced social connectedness ( n = 39). Total disruptions due to COVID‐19 and survivor social connectedness predicted survivor‐reported posttraumatic stress, above and beyond survivors’ pre‐pandemic psychosocial risk. Most parents reported positive changes in their parenting ( n = 31, 67.4%) and family cohesion ( n = 30, 66.7%). However, they also reported worsened mood ( n = 28, 62.3%) and increased anxiety ( n = 31, 71.1%). Conclusions Parents and survivors reported positive and negative impacts of COVID‐19, which had downstream consequences on survivor psychosocial functioning. Follow‐up care should consider potential adverse effects on social connectedness and stress symptoms.

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Section: Introductionmentioning

confidence: 99%

Impact of COVID‐19 on adolescent and emerging adult brain tumor survivors and their parents

Fisher

Patronick

Gerhardt

et al. 2021

Pediatric Blood & Cancer

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“…In addition to neurocognitive late effects, PBTS are also at significant risk for poor psychological adjustment and quality of life 13,14 . The literature indicates that PBTS are at greater risk for internalizing difficulties, as compared to healthy peers and survivors of other cancers, with particularly strong meta‐analytic evidence for differences in depressive symptoms between PBTS and healthy comparisons 5,13,15,16 . These psychological problems appear to last well into adulthood, impacting the quality of life of long‐term survivors 4,5,10 .…”

Section: Introductionmentioning

confidence: 99%

“…These psychological problems appear to last well into adulthood, impacting the quality of life of long‐term survivors 4,5,10 . However, reports vary widely across the literature, suggesting that specific psychological sequelae may be dependent on factors such as age, symptoms assessed, and informant 2,13,14 …”

Section: Introductionmentioning

confidence: 99%

“…Although the limited research on behavioral problems is mixed, 13 some reports show both parents and teachers endorse difficulties with aggression, antisocial behaviors, and behavioral regulation at home and at school among PBTS 2,15,17 . Social effects have also been identified, with systematic reviews indicating that PBTS are at risk for poorer social competency and reduced social acceptance by peers 2,18,19 .…”

Section: Introductionmentioning

confidence: 99%

“…Demographic characteristics, such as female sex and lower socioeconomic status, as well as disease variables, including tumor location, predict greater neurocognitive impairments and psychological adjustment difficulties 2,5 . Younger age at diagnosis and greater time since diagnosis also appear to be associated with greater deficits across domains of functioning 13,20,21 . Further, medical outcomes, including cerebellar mutism syndrome and ventriculoperitoneal shunt placement due to hydrocephalus, have been linked with worse neurocognitive outcomes 9,22 .…”

Section: Introductionmentioning

confidence: 99%

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Assessing neuropsychological phenotypes of pediatric brain tumor survivors

et al. 2021

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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.

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Dose‐dependent cranial irradiation associations with brain structures and neuropsychological outcomes in children with posterior fossa brain tumors

Baron Nelson,

O'Neil,

Cho

et al. 2024

Brain and Behavior

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BackgroundPosterior fossa irradiation with or without whole brain irradiation results in high doses of radiation to the thalamus, hippocampus, and putamen, structures critical to cognitive functioning. As a result, children with brain tumors treated with cranial irradiation (CRT) may experience significant cognitive late effects. We sought to determine the effect of radiation to those structures on neuropsychological outcome.MethodsForty‐seven children with a history of posterior fossa tumor (17 treated with surgery; 11 with surgery and chemotherapy; and 19 with surgery, chemotherapy, and CRT) underwent neuroimaging and neuropsychological assessment at a mean of 4.8 years after treatment, along with 17 healthy sibling controls. The putamen, thalamus, and hippocampus were segmented on each participant's magnetic resonance imaging for diffusion indices and volumes, and in the radiation treatment group, radiation dose to each structure was calculated.ResultsPerformance on visuoconstruction and spatial learning and memory was lower in patient groups than controls. Volume of the thalamus, when controlling for age, was smaller in the patient group treated with CRT than other groups. Higher radiation doses to the putamen correlated with higher fractional anisotropy in that structure. Higher radiation dose to the hippocampus correlated with lower spatial learning, and higher dose to thalami and putamina to lower verbal and nonverbal reasoning.ConclusionsAll children with posterior fossa tumors, regardless of treatment modality, had cognitive deficits compared to their sibling controls. Posterior fossa irradiation may affect thalamic volume and aspects of verbal and nonverbal cognitive functioning.

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Psychological adjustment outcomes among pediatric brain tumor survivors: A meta‐analysis

Cited by 20 publications

References 57 publications

Impact of COVID‐19 on adolescent and emerging adult brain tumor survivors and their parents

Impact of COVID‐19 on adolescent and emerging adult brain tumor survivors and their parents

Assessing neuropsychological phenotypes of pediatric brain tumor survivors

Dose‐dependent cranial irradiation associations with brain structures and neuropsychological outcomes in children with posterior fossa brain tumors

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