Comparison of neuropsychological functioning in pediatric posterior fossa tumor survivors: Medulloblastoma, low‐grade astrocytoma, and healthy controls

Abstract

Background Neuropsychological comparison of medulloblastoma (MB) and cerebellar low‐grade astrocytoma (LGA) survivors to controls can clarify treatment‐related neurocognitive late effects. While both brain tumor groups undergo surgery to the posterior fossa, children with MB additionally receive craniospinal irradiation with boost and chemotherapy. This study provides an updated comparison of neuropsychological functioning in these two groups and examines effects of demographic risk factors upon outcomes. Procedure Forty‐two children (16 MB, nine LGA, and 17 controls) completed measures of intellectual functioning, verbal learning/memory, visual–motor integration, and fine‐motor functioning. The effects of age at diagnosis, time since diagnosis, gender, fatigue, and social status on neuropsychological functioning were examined. Results MB survivors demonstrated the worst neurocognitive late effects, but they were less severe and extensive than in prior studies. LGA survivors’ mean scores were below normative expectations in working memory, processing speed, and fine‐motor functioning. In this overall sample, processing speed difficulties were independent of fine‐motor functioning and fatigue. Higher parental education was associated with better intellectual functioning, working memory, delayed recall, and visual–motor integration. Neuropsychological function was not associated with gender, age at diagnosis, or time since diagnosis. Conclusion The results support that contemporary treatment approaches with craniospinal irradiation plus boost and chemotherapy confer the greatest risk for late effects, while surgical resection is associated with subtle but important neurocognitive difficulties. Ultimately, this study furthers our understanding of factors impacting neuropsychological function in pediatric MB and LGA survivors and contributes to empirical support for close monitoring and targeted interventions into survivorship.

Comparison of Neurocognitive Functioning and Fine Motor Skills in Pediatric Cancer Survivors and Healthy Children

“…Our study, conducted on a fairly large sample of participants, confirms the results of other studies based on smaller samples showing that children who have survived cancer have cognitive and motor deficits [ 14 , 16 ]. Meanwhile, the large and varied clinical sample both in terms of the cancer survivor group and the control group could provide the solid rationale for improving and updating rehabilitation procedures aiming at restoring the neurocognitive and fine motor skills and potentially choosing the best pipeline for each individual patient, thus leading to potential improvements in cognitive outcomes and quality of life.…”

“…A lot of research has demonstrated negative outcomes for pediatric brain cancer survivors, among which a decrease in cognitive, visual-motor, and visuospatial functioning were the most common [ 14 ]. This might be related to several factors: location of tumor as well as tumor origin and progression, type of therapy (for instance resection of a part of the brain for the pediatric cancer of the central nervous system), chemotherapy and radiation therapy, the consequences of treatment and hospitalization, age and time of the diagnosis, duration of treatment, and many other factors [ 15 , 16 , 17 ]. A systematic review showed that tumor histopathology and subsequent adjuvant therapy as well as the age of diagnosis influenced later neuropsychological difficulties in CNS tumor survivors [ 18 ].…”

Sleep Disturbance and Its Association With Sluggish Cognitive Tempo and Attention in Pediatric Brain Tumor Survivors

“…Conversely, studies of small samples of children and adolescents with craniopharyngioma have not demonstrated a relationship between excessive daytime sleepiness and cognitive outcomes such as attention and executive functions ( Jacola et al, 2016 ). A recent study identified a relationship between cognitive speed and fatigue among pediatric survivors of posterior fossa tumors ( Levitch et al, 2022 ), but this investigation did not isolate sleep disturbances as separate from fatigue. Sleep and fatigue are distinct concepts in pediatric oncology, with fatigue defined more as a lack of energy and feeling of exhaustion not necessarily associated with sleepiness ( Walter et al, 2015 ).…”

Neurobehavioral Impairment in Pediatric Brain Tumor Survivors: A Meta-Analysis

“…Moreover, pediatric brain tumor survivors (PBTS) typically also have neurocognitive and behavioral problems [4][5][6][7][8][9]. Given that cranial radiotherapy (RT) is associated with a high risk of neurotoxicity in PBTS, many survivorship studies have focused on the cognitive outcomes of PBTS [8][9][10][11][12][13][14], but very few studies have investigated the neurobehavioral outcomes.…”