Ototoxicity and cognitive outcomes among very young children treated for brain tumors: Findings from a multisite, prospective, longitudinal trial
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Published on: October 18, 2011
Heather M Conklin1, Nicole A Salman1, Johnnie K Bass2
1Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Insights
Sensorineural hearing loss (SNHL) from brain tumor treatment negatively impacts young children's IQ, adaptive functioning, and attention. Early detection and intervention are crucial for mitigating these cognitive risks.
Area of Science:
- Pediatric Oncology
- Neuroscience
- Audiology
Background:
- Brain tumor treatment can cause sensorineural hearing loss (SNHL) in children.
- SNHL is linked to cognitive declines, posing significant risks for young patients.
Purpose of the Study:
- To investigate the specific impact of treatment-related ototoxicity on cognitive outcomes in young children treated for brain tumors.
- To quantify the association between SNHL and neurocognitive functioning in this vulnerable population.
Main Methods:
- A prospective, multisite, longitudinal study (SJYC07) followed 135 young children (mean age 1.7 years) diagnosed with malignant brain tumors.
- Serial audiology and neurocognitive assessments were performed over five years, with SNHL dichotomized (Chang grade ≥1a vs. 0).
- Neurocognitive outcomes included intellectual functioning, adaptive functioning, and attention, assessed via standardized tests and parent ratings.
Main Results:
- 67% of patients developed mild-to-severe SNHL, more common in younger children at diagnosis.
- SNHL was associated with a negative change in IQ trajectory, particularly for those with supratentorial tumors.
- Adaptive functioning declined post-SNHL, especially in younger patients, and attention problems increased across the cohort.
Conclusions:
- SNHL significantly contributes to IQ decline and worsening adaptive functioning and attention in young brain tumor survivors.
- Findings underscore the need for treatment modifications and targeted interventions to support cognitive health.
- Caregiver education regarding SNHL and its cognitive sequelae is essential for comprehensive pediatric brain tumor care.
Background:
Brain tumor treatment can result in sensorineural hearing loss (SNHL) that is associated with cognitive declines in school-age children. Young children treated for brain tumors are at heightened cognitive risk. This study examines the unique contribution of treatment-related ototoxicity to cognitive outcomes in young children treated for brain tumors.
Methods:
135 young children (mean age = 1.7 years) with a newly diagnosed malignant brain tumor were treated with chemotherapy, with or without focal proton or photon radiation therapy. Serial audiology and neurocognitive assessments were conducted for 5 years as part of a prospective, multisite, longitudinal trial (SJYC07; NCT00602667). SNHL was dichotomized as present versus not present (Chang grade ≥1a vs. 0). Neurocognitive assessments included intellectual functioning and parent ratings of adaptive functioning and attention.
Results:
67% of patients experienced mild-to-severe SNHL, which was associated with younger age at diagnosis (P < .001) but not sex, treatment, or study risk arm (P > .10). Pre-treatment, higher intelligence quotient (IQ) was associated with older age and higher socioeconomic status (P < .01), with a negative change in IQ trajectory after SNHL that was worse for children with supratentorial tumors. Pre-treatment, higher adaptive functioning was associated with older age (P = .0001), with a negative change in adaptive functioning trajectory after SNHL that was worse for those treated at a younger age. Attention problems increased after SNHL for the entire group (P = .0099).
Conclusions:
SNHL is associated with IQ decline and worsening adaptive functioning and attention in young children treated for brain tumors. These findings have important implications for treatment modifications, interventions, and caregiver education.
