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Neurocognitive consequences of a paediatric brain tumour and its treatment: a meta-analysis
Marieke A de Ruiter1, Rosa van Mourik, Antoinette Y N Schouten-van Meeteren
1Pediatric Psychosocial Department, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands. m.a.deruiter@amc.nl
Insights
Paediatric brain tumour survivors (PBTS) show significantly impaired intellectual and attentional functioning. Treatments like cranial radiotherapy and chemotherapy, along with longer time since diagnosis, worsen cognitive outcomes.
Area of Science:
- Neuropsychology
- Pediatric Oncology
- Cognitive Science
Background:
- Paediatric brain tumour survivors (PBTS) often experience long-term neurocognitive deficits.
- Assessing intellectual and attentional functioning is crucial for understanding the impact of brain tumors and their treatments.
Purpose of the Study:
- To systematically review and meta-analyze studies on the intellectual and attentional functioning of PBTS.
- To evaluate performance using the Wechsler Intelligence Scale for Children (WISC-III) and the Conners' Continuous Performance Test (CPT).
Main Methods:
- A meta-analysis of 29 studies involving 710 PBTS (WISC-III) and 372 PBTS (CPT).
- Calculated effect sizes for WISC-III IQ scores and CPT measures (reaction time, errors).
- Explored impacts of treatment modality, tumor location, age at diagnosis, and time since diagnosis.
Main Results:
- PBTS performed significantly below average on Full-scale IQ (d=-0.79), Performance IQ (d=-0.90), and Verbal IQ (d=-0.54).
- PBTS exhibited more errors of omission (d=0.82) on the CPT, with no significant differences in reaction time or errors of commission.
- Cranial radiotherapy, chemotherapy, and longer time since diagnosis correlated with lower WISC-III scores.
Conclusions:
- PBTS demonstrate substantially impaired intellectual functioning and attentiveness.
- Cranial radiotherapy, chemotherapy, and extended time post-diagnosis are associated with poorer cognitive outcomes in PBTS.
Aim:
This meta-analysis provides a systematic review of studies into intellectual and attentional functioning of paediatric brain tumour survivors (PBTS) as assessed by two widely used measures: the Wechsler Intelligence Scale for Children (3rd edition; WISC-III) and the Conners' Continuous Performance Test (CPT).
Method:
Studies were located that reported on performance of PBTS (age range 6-16y). Meta-analytic effect sizes were calculated for Full-scale IQ, Performance IQ, and Verbal IQ as measured by the WISC-III, and mean hit reaction time, errors of omission, and errors of commission as measured by the CPT. Exploratory analyses investigated the possible impacts of treatment mode, tumour location, age at diagnosis, and time since diagnosis on intelligence.
Results:
Twenty-nine studies were included: 22 reported on the WISC-III in 710 PBTS and seven on CPT results in 372 PBTS. PBTS performed below average (p(s) <0.001) on Full-scale IQ (Cohen's d=-0.79), Performance IQ (d=-0.90), and Verbal IQ (d=-0.54). PBTS committed more errors of omission than the norm (d=0.82, p<0.001); no differences were found for mean hit reaction time and errors of commission. Cranial radiotherapy, chemotherapy, and longer time since diagnosis were associated with lower WISC-III scores (p(s) <0.05).
Interpretation:
PBTS have seriously impaired intellectual functioning and attentiveness. Being treated with cranial radiotherapy and/or chemotherapy as well as longer time since diagnosis leads to worse intellectual functioning.
