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Assessing Cognitive Functioning in Children With Brain Tumors: Interaction of Neighborhood Social Determinants of
Alannah R Srsich1, Manali Zope1, Peter M Fantozzi1
1Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Children treated for brain tumors (CTBT) in low-opportunity neighborhoods face higher cognitive impairment risks. Neighborhood social determinants of health (SDOH) and neurological risk significantly impact cognitive outcomes in pediatric cancer survivors.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Health Services Research
Background:
- Investigates the interplay between neighborhood social determinants of health (SDOH) and neurological risk in children treated for brain tumors (CTBT).
- Examines how factors like redlining and neighborhood opportunity influence cognitive outcomes in this vulnerable population.
Purpose of the Study:
- To determine the impact of SDOH and neurological risk on cognitive functioning in pediatric brain tumor survivors.
- To explore the moderating effects of neighborhood context on the relationship between neurological burden and cognitive outcomes.
Main Methods:
- Retrospective chart review of 161 CTBT (aged 5-17).
- Cognitive outcomes assessed via neuropsychological tests.
- SDOH evaluated using Childhood Opportunity Index (COI) and redlining data; neurological risk measured by the Neurological Predictor Scale (NPS).
Main Results:
- Children in low-opportunity neighborhoods showed significantly lower intellectual functioning, processing speed, perceptual reasoning, and verbal reasoning.
- The Childhood Opportunity Index moderated the association between neurological risk and intellectual functioning.
- Reduced impact of redlining correlated with better intellectual functioning.
Conclusions:
- Cognitive outcomes in CTBT survivors are influenced by both neurological burden and neighborhood SDOH.
- Survivors from lower opportunity environments exhibit higher rates of cognitive impairment.
- A risk-informed approach to survivorship care should integrate contextual and medical factors.
Background:
This study investigated how neighborhood-level social determinants of health (SDOH), including redlining and neurological risk, interact to influence cognitive outcomes in children treated for brain tumors (CTBT).
Methods:
A retrospective chart review of 161 CTBT aged 5-17 was conducted. Cognitive outcomes were measured using standardized neuropsychological assessments, and SDOH were assessed using the Childhood Opportunity Index (COI) and redlining data. The Neurological Predictor Scale (NPS) measured treatment-related neurological risk.
Results:
Compared to moderate and high-opportunity neighborhoods, children in low-opportunity neighborhoods exhibited lower intellectual functioning (IF) (F[2, 154] = 17.7, p < 0.01, η2 = 0.19), processing speed (F[2, 89] = 4.41, p = 0.015, η2 = 0.09), perceptual reasoning (F[2, 64] = 3.60, p = 0.03, η2 = 0.10), and verbal reasoning (F[2, 90] = 10.09, p < 0.01, η2 = 0.18) scores. COI moderated the association between NPS and IF(F[2, 147] = 4.47, p = 0.013), with a negative effect of NPS on IF in high-opportunity neighborhoods (t = -3.82, p < 0.01). Children from neighborhoods less affected by redlining demonstrated better IF performance, U = 94.50, Z = -2.30, p = 0.021.
Conclusions:
The findings highlight the importance of considering both treatment-related neurological burden and neighborhood-level SDOH when evaluating cognitive outcomes in CTBT. Survivors from lower opportunity environments demonstrated the highest rates of cognitive impairment, whereas the interaction between neurological risk and outcomes was significant only among youth from high-opportunity neighborhoods. These results support a risk-informed approach to survivorship care that considers both contextual and medical factors.
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