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Published on: May 26, 2023
Long-term complications and quality of life in children with intraspinal tumors
Andrea Poretti1, Daniel Zehnder, Eugen Boltshauser
1Division of Neurology, University Children's Hospital of Zurich, Zurich, Switzerland.
Insights
Pediatric intraspinal tumors offer a good cure rate, but some survivors experience neurological deficits. Most survivors report a good quality of life, with emotional functioning being the main area of difference.
Area of Science:
- Pediatric oncology
- Neuro-oncology
- Long-term outcomes research
Background:
- Pediatric intraspinal tumors can cause lasting neurological deficits.
- The long-term social, psychological, and quality of life impacts were previously undocumented.
Purpose of the Study:
- To assess the long-term outcomes of pediatric patients treated for intraspinal tumors.
- To evaluate neurological, orthopedic, cognitive, and psychosocial sequelae.
- To determine the impact on health-related quality of life (HRQoL).
Main Methods:
- Follow-up study of 28 pediatric patients (under 16) treated between 1975-2005.
- Comprehensive qualitative and quantitative assessment of 20 survivors (median follow-up 8.4 years).
- Assessed complications, behavioral/psychological adjustment, and HRQoL.
Main Results:
- High tumor control rates: 10-year overall survival 96%, progression-free survival 84%.
- 50% of survivors had persistent neurological deficits (e.g., paresis, bladder/bowel dysfunction).
- Survivors reported minimal daily activity impairment and slightly lower HRQoL than controls, with emotional functioning significantly affected.
Conclusions:
- Pediatric intraspinal tumors generally have a high cure rate.
- Most survivors achieve a self-rated HRQoL comparable to healthy individuals.
- Severe neurological complications can impact quality of life, but overall outcomes are positive.
Background:
Spinal cord compression by pediatric intraspinal tumors may result in persisting neurological deficits. The impact such late effects have on social and psychological adjustment and quality of life has not been documented previously.
Method:
To study the long-term outcome of pediatric patients with intraspinal tumors, we followed 28 consecutive patients under 16 years of age who were treated in a single institution from 1975 to 2005. In 20 of 26 survivors (median follow-up time 8.4 years, range 0.8-31.3 years) who agreed to participate, neurological, orthopedic, and cognitive complications and their impact on behavioral and psychological adjustment, and health-related quality of life (HRQoL) were comprehensively assessed qualitatively and quantitatively. Primary therapy for spinal cord decompression was surgery in ten patients, chemotherapy in nine, and radiotherapy in one.
Results:
Tumor control was good (10-year overall survival rate of 96%; 10-year progression-free survival rate of 84%). Persistent neurological complications occurred in 10 (50%) patients (paraparesis, n = 7; monoparesis, n = 3; neurogenic bladder dysfunction, n = 4; neurogenic bowel dysfunction, n = 2). Two of the ten patients with paresis depended on wheelchair. Seven (35%) patients developed scoliosis and six of these required spondylodesis. Survivors reported no major impairments in daily activities and rated their HRQoL only slightly lower than healthy controls. The only statistically significant difference was in emotional functioning.
Discussion:
Most patients with intraspinal tumors have a good chance of cure. Apart from few patients, especially those with severe neurological complications, self-rated HRQoL is comparable to that of healthy controls.
