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Cognitive and Psychosocial Outcome in Children and Adolescents Treated for Extracranial Malignant Solid Tumors and
Hugo Câmara-Costa1,2,3, Zoé Barrault2,3,4, Audrey Longaud4
1Rehabilitation Department for Children with Acquired Brain Injury, Paris Est Val De Marne Hospitals (Saint Maurice Site), Saint Maurice, France.
Insights
Pediatric cancer survivors showed few objective cognitive deficits but reported significant subjective issues like executive dysfunction and fatigue. This highlights the need for targeted interventions and screening for these childhood cancer survivors.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Child Psychology
Background:
- Limited research exists on cognitive and psychosocial outcomes in pediatric cancer survivors.
- Adult survivors often experience impairments in cognition, psychosocial well-being, and quality of life (QoL).
Purpose of the Study:
- To evaluate cognitive performance and psychosocial outcomes in pediatric survivors of extracranial solid tumors and lymphomas.
- To identify factors associated with poorer outcomes in this population.
Main Methods:
- Prospective evaluation of 278 pediatric cancer survivors (mean age 11.7 years) using standardized cognitive and psychosocial assessments.
- Data collected included sociodemographic, disease, and treatment information.
- Cognitive function assessed via Wechsler Intelligence Scales; psychosocial outcomes via parent/patient-reported measures for executive function, behavior, QoL, fatigue, and depression.
Main Results:
- Mean Full Scale Intellectual Quotient was within the general population range, but Perceptual Reasoning Index was slightly lower.
- Parent and self-reports indicated higher rates of executive dysfunction, inattention, fatigue, and reduced QoL.
- Lower parental education and pre-existing developmental delays were associated with poorer cognitive outcomes.
Conclusions:
- Pediatric cancer survivors generally do not present with objective cognitive deficits.
- Subjective complaints of cognitive and psychosocial difficulties are prevalent.
- Systematic screening and tailored clinical interventions are crucial for this population.
Objective:
Recent studies show evidence of cognitive and psychosocial impairments and reduced quality of life (QoL) in adult survivors of childhood extracranial solid tumors and lymphomas, but limited research has addressed these issues in pediatric populations.
Study Design:
The French RISK-N prospective study (2014-2021) evaluated 278 survivors of extracranial solid tumors or lymphomas (47% female, mean age at diagnosis and assessment: 6.2 and 11.7 years). Patients with pre-existing neurological conditions were excluded. Sociodemographic, disease-related, and treatment data were collected. Cognitive performance was assessed using Wechsler Intelligence Scales for Children (WISC-IV, WISC-V). Psychosocial outcomes included parent and/or patient-reported executive functions (Behavior Rating Inventory of Executive Function), behavior (Conner's Parent Rating Scale), QoL (Pediatric Quality of Life Inventory), fatigue (Multidimensional Fatigue Scale), and depression (Children's Depression Inventory). Information on schooling and educational/rehabilitative interventions was also recorded.
Results:
Diagnoses included lymphoma (25%), nephroblastoma (19%), neuroblastoma (19%), osteosarcoma (7%), other sarcomas (18%), and other tumors (12%). Mean Full Scale Intellectual Quotient [M(SD) = 99.44(15.62)] was as expected in the general population [M(SD) = 100(15)], but the WISC-IV Perceptual Reasoning Index was slightly lower [M(SD) = 95.4(15.0), <1.5 SD 14%]. Parent- and self-reports indicated greater executive dysfunction, inattention, fatigue, and reduced QoL. In multivariable regression models, poorer cognitive outcomes were associated with lower parental education and developmental/learning delays before diagnosis.
Conclusions:
Objective cognitive deficits were uncommon among pediatric cancer survivors, contrasting with a relatively high level of subjective cognitive and psychosocial complaints, highlighting the need for systematic screening and tailored clinical interventions.
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