The association of hospital visits with executive functioning among childhood cancer survivors.

Abstract

133 Background: Childhood cancer survivors are at increased risk of executive dysfunction related to treatment. In addition to the direct effect of treatment, hospital visits may also impact development. Children with complicated health issues visit Emergency Departments (ED) multiple times and spend a very high number of days in the hospital, which can interfere with normal development. Methods: Information from 77 childhood cancer survivors, ranging in age from 6-18, was examined. Parents completed several surveys, including the Behavior Rating Inventory of Executive Functioning (BRIEF). Additional information was collected from the medical record and administrative data sets, including total number of days in the hospital and number of ED visits. Multiple linear regressions were used to determine the relationship between total hospital days/number of ED visits and BRIEF scores, as well as potential confounders, such as socioeconomic factors and treatment factors. Results: The survivors were 11 years old, on average, at the time of participation and evenly divided between boys (49.4%) and girls (50.6%). In the sample, 26% had been treated with cranial radiation and 55% had been treated with intrathecal chemotherapy. On average, this group had 47.0 inpatient days in the hospital with 6.8 visits to the ED. There was a positive correlation between both number of ED visits and number of inpatient days with executive functioning (GEC; r = .33, p = .004; r = .23, p = .05, respectively). In multiple linear regressions, after controlling for time since diagnosis, a higher number of ED visits was associated with greater reported executive dysfunction ( R2= .12; F (2, 74) = 5.2, p = .008). Conclusions: An association was found between ED visits and length of hospitalizations on parent-reported executive functioning. ED visits and hospitalization are often related to medical complications, and may reflect severity of illness, but may also influence children’s ability to participate in school and other aspects of normal development. Follow-up prospective studies with a longer duration are needed to understand the course of this relationship in terms of predicting long-term risk.