Resources are associated with functional outcome and brain morphometry in childhood cancer survivors

Childhood cancer survivors exhibit a high prevalence of long-term cognitive and motor impairments as well as structural brain alterations. Examining late effects from a multimodal perspective is essential as individual and contextual resources (e.g. self-efficacy, optimism; parental support, socioeconomic status) as well as risk factors (e.g. disease and treatment related factors) likely impact neurodevelopment such as functional outcome (cognition, motor function) and brain structure in childhood cancer survivors. It is purely understood how individual and contextual resources are associated with functional outcome and brain structure and whether resources can moderate the relationship between functional outcome and brain structure. A deeper understanding of these interrelations can help to identify components for multimodal interventions to strengthen neurodevelopment after childhood cancer in the long-term. This exploratory study investigates associations between resources (individual and contextual) and neurodevelopmental outcomes and how resources moderate functional outcome, and brain morphometry in childhood cancer survivors.

56 childhood cancer survivors (N = 45 non central nervous system cancer survivors (non-CNS), N = 11 CNS cancer survivors (CNS)) and 45 typically developing children all aged 7-16 years; M = 10.85, SD = 2.52)) underwent structural MRI, cognitive and motor assessments and filled out questionnaires on individual and contextual resources at least one year after the end of cancer treatment. Correlations were computed, followed by principal components analysis to minimize factors (given the small sample and number of variables), and subsequent moderation analyses were conducted.

More and stronger correlations occurred between resources and functional outcome as well as resources and brain morphometry in survivors (non-CNS: N correlations = 16, r = 0.32-0.61; CNS: N correlation = 9, r = 0.78-0.97) compared with typically developing children (N correlation = 2, r = 0.34-0.37), with the strongest effects in CNS cancer survivors. Interaction effects suggest that resources may moderate the associations between cognition and motor function (β=-0.834-0.894, p_uncorr=0.003-0.047), as well as between cognition and brain morphometry (β=-1.185 to -1.109, p_uncorr=0.034-0.046). The associations across resources, cognition, motor function, and brain morphometry were more pronounced in CNS and non-CNS cancer survivors (non-CNS: N = 34, r=0.33-0.61; CNS: N = 29, r=0.72-1.00) compared to typically developing children (N = 17, r=0.31-0.47).

These exploratory findings propose that individual and contextual resources are associated with functional outcome and brain morphometry following childhood cancer, suggesting that resource-oriented, multimodal interventions should be considered for neurodevelopmental rehabilitation.