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The performance status of the child with cancer is an important outcome consideration in pediatric oncology research and practice. However, no single measure for children has been available. This is a report of the development and standardization of such a scale. The play-performance scale for children is a parent-rated instrument which records usual play activity as the index of performance. Performance status ratings were obtained on three groups of children: patients (n = 98), patients' siblings (n = 29), and an independent sample of hospital employees' children (n = 40). Children with all types and stages of childhood malignant neoplasms were represented. Test results established the parent as a competent, reliable rater and demonstrated the validity of the scale. Interrater reliability was examined using correlational statistics and percentage agreement. Agreement between parents was good, and there were no systematic rater biases. In addition, parents' ratings significantly discriminated differences in levels of functioning (mean score, patients 75.4 versus siblings 97.4). Correlational and analysis of variance (ANOVA) procedures demonstrated that the play-performance scale was significantly related to the global performance measures of experienced clinicians and was sensitive to change. Inpatients received a mean score of 42.3, outpatients 90.7, and normals 98.2. These findings indicate that the scale is both feasible and effective. It is concise, can be administered repeatedly even to extremely ill patients, and uses parents as observer reporters. The play-performance scale for children provides quantifiable, reproducible, and meaningful data, which is necessary for effective monitoring and management of the child with cancer.

Cranial irradiation and chemotherapy may have significant long-term deleterious effects on children with brain tumors. Intellectual deterioration, endocrinopathies, leukoencephalopathy, extraneural metastases, and oncogenesis may all complicate the treatment of central nervous system neoplasia. These long-term effects of therapy have important implications, as some are amenable to treatment and others may be prevented by the careful monitoring of drug and radiation administration. Until recently, the survivals of children with brain tumors were limited, so that concerns over long-term effects of therapy were unnecessary. As children with certain types of brain tumors now have a better prognosis, these long-term and possibly remediable effects have important implications. This article emphasizes radiation effects on intellect, endocrine function, and oncogenesis. Recommendations for baseline and longitudinal evaluations of children with brain tumors are suggested.Cancer 561841-1846, 1985.HE SURVIVAL of children with certain types of brain T tumors has increased over the last two decades.Recent data from the Surveillance Epidemiology End Results (SEER) registries suggested that 5-year survival rates of children with medulloblastomas, low-grade supratentorial astrocytomas, and cerebellar astrocytomas ranged from 40% to 90%. Eight hundred sixty-five children with brain tumors diagnosed from 1973 through 1981 from this registry had an overall 40% 5-year survival rate.' Pari pussu with these prolonged survivals has come the recognition of the potential long-term consequences of this therapy on the surviving children. Intellectual deterioration, endocrine deficiencies, leukoencephalopathy, and oncogenesis are areas of concern.The two most remarkable long-term sequelae of cranial irradiation with or without chemotherapy are the adverse effects on intelligence and endocrine function. Unfortunately, prospective evaluations of children with brain