Neurocognitive consequences of a paediatric brain tumour and its treatment: a meta‐analysis

Abstract

METHOD Studies were located that reported on performance of PBTS (age range 6-16y).Meta-analytic effect sizes were calculated for Full-scale IQ, Performance IQ, and Verbal IQ as measured by the WISC-III, and mean hit reaction time, errors of omission, and errors of commission as measured by the CPT. Exploratory analyses investigated the possible impacts of treatment mode, tumour location, age at diagnosis, and time since diagnosis on intelligence.RESULTS Twenty-nine studies were included: 22 reported on the WISC-III in 710 PBTS and seven on CPT results in 372 PBTS. PBTS performed below average (p s <0.001) on Full-scale IQ (Cohen's d=)0.79), Performance IQ (d=)0.90), and Verbal IQ (d=)0.54). PBTS committed more errors of omission than the norm (d=0.82, p<0.001); no differences were found for mean hit reaction time and errors of commission. Cranial radiotherapy, chemotherapy, and longer time since diagnosis were associated with lower WISC-III scores (p s <0.05).INTERPRETATION PBTS have seriously impaired intellectual functioning and attentiveness. Being treated with cranial radiotherapy and ⁄ or chemotherapy as well as longer time since diagnosis leads to worse intellectual functioning.In the USA the incidence of cancer in children aged 0 to 14 years is almost three per 100 000. 1 Approximately 17 to 22.5% of children with cancer have a brain tumour. 1,2 Advances in medicine have led to an increasing number of children surviving cancer. The 5-year survival rate of children diagnosed with a brain tumour under the age of 15 increased from 57% for patients diagnosed from 1975 to 1977 to 74% for patients diagnosed from 1996 to 2004. 3 With more children becoming long-term survivors, the need has grown to understand fully the nature and magnitude of the late effects of the tumour and treatment. Compared with survivors of other malignancies, survivors of brain tumours in childhood bear the greatest risk of neurocognitive impairment. 4 Numerous studies have shown that 40 to 100% of paediatric brain tumour survivors (PBTS) show some form of neurocognitive deficit. 5 Frequently reported impairments in PBTS are declining levels of general intelligence and attention deficits. Deficits in these areas can have a deleterious effect on academic achievement and psychosocial functioning. [6][7][8] Besides the burden of the tumour itself, the treatment can contribute to neurocognitive impairments. Radiotherapy is especially considered to have an impact on neurocognitive functioning.9,10 Chemotherapy, however, has also been found to be associated with poor outcomes in PBTS. 11 In addition to the treatment, tumour location can affect the neurocognitive outcome of PBTS, with infratentorial tumours being associated with worse outcomes than supratentorial tumours. 12Furthermore, age at diagnosis is known to have an impact on neurocognitive outcome. 13 The young brain is especially vulnerable to the adverse effects of treatment because of the rapid cell proliferation, dendritic and axonal outgrowth, as well as myelination, which ta...

Early Cognitive Outcomes Following Proton Radiation in Pediatric Patients With Brain and Central Nervous System Tumors

“…30 Some photon RT studies have reported declines in Working Memory, 1,4 but such declines were not seen here. Reported impairments in Verbal and Performance IQ 2 cannot be directly compared to the present study because those scores (from the WISC-III) are no longer available in the later edition (the WISC-IV 24 ) used here; however, because the WISC-III Performance IQ includes measures of processing speed, the present results are consistent with reduction in Performance IQ following PRT.…”

“…Those reports generally show a progressive cognitive decline that is evident at 1–2 years post-treatment and is more severe for younger age, larger volume of radiation, and higher dose. 1,2 Medulloblastoma studies have estimated annual declines in FSIQ following treatment with photon CSI of between 1.6 and 4.3 points per year, with the better results for older children (age at diagnosis > 7–8 years). 7,8,28,29 One study derived a quadratic model predicting an overall annual decline in FSIQ of about 2 points per year, manifesting in older children after an age-dependent delay (about 2 years for those with mean age 11 years at diagnosis).…”

“…1,2 Of particular note are declines in certain components of the overall IQ, including processing speed. 3,4 The severity of such impairments has been associated with the dose and the volume of brain irradiated.…”

Play-based procedural preparation and support intervention for cranial radiation

“…Decreasing sedation use has a long-term effect on the well-being of the child and family by protecting the patient from potential physiological and cognitive deficits [2, 10, 11, 13, 19]. In addition, decreasing sedation use may have financial benefits for the institution.…”

“…To ensure precise positioning, sedation may be required. However, daily sedation in children may be associated with risks for respiratory depression, aspiration, central line infections [8, 9], learning disabilities, decreased attentiveness, and decreased cognitive functioning [10, 11]. …”