BackgroundSurvivors of pediatric central nervous system (CNS) tumors are at risk for neurocognitive and social difficulties throughout childhood. This study characterized social cognition (perception and reasoning from social cues) and adjustment in adulthood.MethodsA total of 81 adult survivors of pediatric CNS tumors (51% female; mean [SD] age, 28.0 [5.8] years), were recruited across four groups: (1) no radiation therapy (RT) [n = 21], (2) infratentorial (IT) tumors + focal RT [n = 20], (3) IT tumors + craniospinal irradiation [n = 20], and (4) supratentorial tumors + focal RT [n = 20]. Prevalence of social cognitive and adjustment impairments was compared to test norms. Multivariable models examined clinical and neurocognitive predictors of social cognition and its impact on functional outcomes.ResultsSurvivors demonstrated elevated risk of severe social cognitive impairments (social perception Morbidity Ratio [95% CI] 5.70 [3.46–9.20]), but self‐reported few social adjustment problems. Survivors of IT tumors treated with craniospinal irradiation performed nearly 1 SD worse than survivors treated without RT on multiple measures of social cognition (e.g., social perception: β = −0.89, p = .004). Impaired executive functioning and nonverbal reasoning were associated with worse social cognitive performance (e.g., social perception: β = −0.75, p < .001; β = –0.84, p < .001, respectively). Better social perception was associated with higher odds of attaining full‐time employment (odds ratio, 1.52 [1.17–1.97]) and at least some college education (odds ratio, 1.39 [1.11–1.74]).ConclusionsAdult survivors of CNS tumors are at elevated risk of severely impaired social cognition, but do not perceive social adjustment difficulties. Better understanding of potential mechanisms underlying social cognitive deficits may inform intervention targets to promote better functional outcomes for at‐risk survivors.
Background Young adults in the general population are at risk of experiencing loneliness, which has been associated with physical and mental health morbidities. The prevalence and consequences of loneliness in young adult survivors of childhood cancer remain unknown. Methods A total of 9664 young adult survivors of childhood cancer (median age at diagnosis 10.5 years [interquartile range (IQR), 5–15], 27.1 years at baseline [IQR, 23–32]) and 2221 siblings enrolled in the Childhood Cancer Survivor Study completed a self‐reported survey question assessing loneliness on the Brief Symptom Inventory‐18 at baseline and follow‐up (median follow‐up, 6.6 years). Multivariable models evaluated the prevalence of loneliness at baseline only, follow‐up only, and baseline + follow‐up, and its associations with emotional distress, health behaviors, and chronic conditions at follow‐up. Results Survivors were more likely than siblings to report loneliness at baseline + follow‐up (prevalence ratio [PR] 2.2; 95% confidence interval [CI], 1.7–3.0) and at follow‐up only (PR, 1.4; 95% CI, 1.1–1.7). Loneliness at baseline + follow‐up was associated with elevated risk of anxiety (relative risk [RR], 9.8; 95% CI, 7.5–12.7), depression (RR, 17.9; 95% CI, 14.1–22.7), and current smoking (odds ratio [OR], 1.7; 95% CI, 1.3–2.3) at follow‐up. Loneliness at follow‐up only was associated with suicidal ideation (RR, 1.5; 95% CI, 1.1–2.1), heavy/risky alcohol consumption (RR, 1.3; 95% CI, 1.1–1.5), and new‐onset grade 2–4 chronic conditions (RR, 1.3; 95% CI, 1.0–1.7). Conclusions Young adult survivors of childhood cancer have elevated risk of experiencing loneliness, which is associated with future emotional distress, risky health behaviors, and new‐onset chronic conditions.
e24147 Background: Psychosocial late effects of childhood cancer are often studied in isolation despite high rates of co-morbidity. We examined patterns of psychosocial morbidity and their associations with subsequent chronic health conditions, quality of life, and mortality in adult survivors of childhood cancer. Methods: St. Jude Lifetime Cohort participants (n = 4,009; median[range] 30.6[18.0-64.8] years of age; 20.4[5.5-52.3] years from diagnosis; 51% female) completed baseline questionnaires. Latent class analysis characterized psychosocial morbidity using 18 individual indicators across four domains: functional independence (e.g., independent living), emotional health (e.g., depressive symptoms), health behaviors (e.g., alcohol use), and socioeconomic status (e.g., employment). Generalized linear models, adjusted for age, sex, and race/ethnicity, examined longitudinal associations between class membership at cohort entry and persistent/new onset Grade 2-4 chronic health conditions from baseline to follow-up (n = 2,355, median f/u = 5.8 years). In separate adjusted models, associations with persistently poor/worsening quality of life at follow-up [SF-36 t-score <40] (n = 2,276, median f/u = 5.7 years) were examined. Cox Proportional models were used to examine associations between class membership and all-cause mortality adjusting for age, sex, and race/ethnicity. Results: Four latent classes were identified: (1) functional non-independence (21%); (2) risky health behaviors (15%); (3) poor emotional health (14%); and (4) low psychosocial morbidity (49%). Survivors in the functional non-independence and poor emotional health classes had increased risk of persistent/new onset Grade 2-4 cardiac (RR = 1.23, 95% CI 1.09-1.40; RR = 1.16, 95% CI 1.04-1.31), pulmonary (RR = 1.28, 95% CI 1.14-1.42, RR = 1.15; 95% CI 1.02-1.29), neurologic (RR = 2.22, 95% CI 1.93-2.56; RR = 1.97, 95% CI 1.70-2.28), and musculoskeletal conditions (RR = 1.85, 95% CI 1.58-2.15; RR = 1.46, 95% CI 1.21-1.75) compared to low psychosocial morbidity. Each class of psychosocial morbidity was significantly associated with persistently poor/worsening quality of life from baseline to follow-up compared to low psychosocial morbidity. Compared to the low psychosocial morbidity class, functional non-independence (HR = 3.37, 95% CI 2.43-4.67), risky health behaviors (HR = 1.77, 95% CI 1.21-2.59), and poor emotional health (HR = 2.70, 95% CI 1.89-3.84) classes were associated with increased risk of all-cause mortality. Conclusions: Baseline psychosocial morbidities experienced by survivors of childhood cancer are associated with persistent and new onset chronic health conditions, poor/worsening quality of life, and mortality. Interventions targeting psychosocial late effects may mitigate adverse health outcomes in survivors.
10020 Background: Survivors of pediatric cancer, including those without CNS-directed treatment, are at risk of neurocognitive impairment and peripheral or autonomic neuropathies; conditions that co-occur in non-cancer populations. Using the St. Jude Lifetime Cohort, we investigated associations between these sequelae to inform contributors to long-term cancer-related neurocognitive impairment. Methods: Clinically assessed survivors of pediatric cancer (N=2,138, mean age 31 [SD 13], 23[11] years from diagnosis, 51% male) not treated with CNS-directed therapy completed neurocognitive testing. Modified total neuropathy score peripheral sensory and motor subscales were combined with functional tasks and severity graded using a modified NCI CTCAE. Cardiac autonomic neuropathy was defined as impaired heart rate reserve (<80% age- sex-predicted or ≤62% with beta blocker). Separate log binomial regression models estimated risk of neurocognitive impairment (age adjusted z-score <10th percentile) associated with grade 2+ sensory, motor or autonomic neuropathy. Path analysis examined if pain with daily interference mediated associations between motor or sensory neuropathy and neurocognitive impairment. Results: 838 (39%) survivors had autonomic, 115 (5.4%) had motor and 162 (7.6%) had sensory neuropathy. Compared to those with no neuropathy, survivors with motor or sensory neuropathy had a higher risk of impairment in sustained attention, visual-motor processing speed, short- and long-term memory, and executive function (Table, p’s<0.01). Autonomic neuropathy was associated with a higher risk of impairment in visuo-motor processing speed (p=0.03). Pain partially mediated associations between sensory neuropathy and sustained attention (10% mediated, p=0.04), visual-motor processing speed (8% p=0.02), and executive function (14% p=0.02). Pain was not related to motor neuropathy. Conclusions: Peripheral and autonomic neuropathies are associated with significant risk of neurocognitive impairment in adult survivors of pediatric cancer. Research is needed to further understand shared mechanisms (e.g., pain, inflammation) to design targeted interventions to improve neuropathic symptoms and neurocognitive function. [Table: see text]
PURPOSE: Survivors of pediatric glioma are at risk of developing physical and neurocognitive sequelae secondary to their tumor and its treatment. The contribution of these conditions to attainment of functional independence has not previously been examined. METHODS: 1,284 adult survivors of pediatric glioma (48% male, median [range] 30 [18-51] years at assessment, 22 [15-34] years since diagnosis) completed the CCSS Neurocognitive Questionnaire with impairment defined as scores > 90th %ile of sibling norms. Treatment exposures were categorized as surgery only, chemotherapy (± surgery), or cranial radiation (± chemotherapy/surgery). Self-reported chronic health conditions (CHCs) were graded by organ system using NCI’s CTCAE v4.3. Latent class analysis utilized six factors (employment, marital status, independent living, driver’s license, assistance with routine needs, assistance with personal care needs) to identify classes of functional independence. Multivariable modified Poisson regression evaluated relative risk (RR) of neurocognitive impairment between the classes, adjusting for sex, race, age at assessment, and age at diagnosis. Path analysis explored the impact of treatment exposures on functional independence, mediated by Grade 2-4 CHCs and neurocognitive impairment. RESULTS: Three latent classes of functional independence were identified: independent (58%), moderately independent (20%), and non-independent (22%). Compared to the independent class, non-independent survivors were at elevated risk for impaired task efficiency (RR=3.86, 95% CI, 2.97-5.01), memory (RR=2.39, 95% CI, 1.91-2.98), organization (RR=2.04, 95% CI, 1.64-2.54), and emotional regulation (RR=1.67, 95% CI, 1.30-2.15). Path analysis revealed significant direct paths from cranial radiation (β=0.14), impaired task efficiency (β=0.42), and sensorimotor (β=0.22) and endocrine conditions (β=0.24) to non-independence. Cranial radiation also was indirectly associated with non-independence through impaired task efficiency (β=0.06), and sensorimotor (β=0.06) and endocrine conditions (β=0.10). CONCLUSIONS: Neurocognitive impairment and chronic health conditions partially mediate the association between treatment exposures and attainment of independence in adulthood, identifying potential intervention targets to promote independence in long-term survivors.
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