Tumor Survivors Research Articles

Kidney Function and Body Composition in Adult Survivors of Unilateral, Non-Syndromic Wilms Tumor: A Report From the St. Jude Lifetime Cohort Study.

The relationships among treatment exposures, body composition, and estimated glomerular filtration rate (eGFR) in adult survivors of Wilms tumor have not been well studied. We evaluated body composition with dual-energy x-ray absorptiometry (DXA) and eGFR with the updated Chronic Kidney Disease Epidemiology Collaboration equations (creatinine only-eGFRCr, cystatin C only-eGFRCysC, creatinine and cystatin C-eGFRCr+CysC) without race in 134 adults previously treated for unilateral, non-syndromic Wilms tumor at St. Jude Children's Research Hospital between 1964 and 2004 with chemotherapy and with (hemiabdomen [HA] or whole abdomen [WA]) or without radiation therapy (RT). Z-scores for DXA variables were calculated using data from the National Health and Nutrition Examination Survey. WART was associated with a lower relative total (p = 0.004) and trunk (p < 0.001) lean mass, eGFRCr (p = 0.008), eGFRCysC, (p < 0.001), and eGFRCr+CysC (p < 0.001), and higher values of cystatin C (p < 0.001). Linear regression demonstrated that relative total lean mass (p = 0.009) and relative trunk lean mass (p < 0.001) Z-scores, and eGFRCr (p = 0.013) were lower among those who received WART compared to No RT patients. WART is associated with lower relative total and trunk lean mass Z-scores and eGFR, regardless of the equation used, and is lower in survivors treated with WART compared to unirradiated survivors of unilateral, non-syndromic WT. Assessments using other GFR measures may provide greater insight into the mechanism and magnitude of kidney function loss among WART-treated WT survivors.

Imaging Assessment of the Pituitary Gland and Long-Term Endocrinological Abnormalities in Pediatric Brain Cancer Survivors.

Pediatric brain cancer survivors often experience hypothalamic-pituitary dysfunction due to cranial irradiation and chemotherapy. While hormone deficiencies have been studied, the changes in pituitary size and shape on long-term MRI and their relationship to endocrine dysfunction remain under-explored. To evaluate pituitary gland height, volume, and shape in relation to long-term endocrine abnormalities in pediatric brain tumor survivors. Retrospective cohort study. A total of 56 pediatric brain tumor survivors (50% male) with an average follow-up of 10.8 ± 1.6 years; 44.6% underwent radiotherapy, and 48% were treated with chemotherapy. One-third of the cohort experienced at least one pituitary hormone deficiency. 3 T, including volumetric 1 mm sagittal post-contrast T1 images. Pituitary height, volume, and shape (concave, horizontal, convex) were measured. Endocrine abnormalities were diagnosed through routine serum hormone testing. The t test, chi-square test, and Pearson test with significance at P < 0.05 were used. Receiver-operating characteristic (ROC) analysis assessed the association of imaging parameters and pituitary dysfunction. Radiation and chemotherapy treatment were significantly associated with pituitary hormone deficiencies. There were significant differences in pituitary height and volume in patients with pituitary hormone deficiencies compared with normal pituitary function (4.0 ± 1.3 vs. 5.5 ± 1.5 mm, and 354.2 ± 198.0 vs. 568.3 ± 184.4 mm3, respectively). There was a significant association between radiation therapy and pituitary gland shape, with 60.0% of patients who received radiation therapy exhibiting a pituitary shape categorized as concave, 32.0% as horizontal, and 8.0% as convex, compared to 9.7%, 74.2%, and 16.1%, respectively. ROC analysis for association with pituitary hormone deficiency was 0.81, 0.8, and 0.74 for pituitary height, volume, and shape, respectively. Cranial irradiation and chemotherapy in pediatric brain tumors are associated with endocrine dysfunction, with decreased pituitary height, volume, and concave shape in long-term MRI surveillance are associated with such late endocrine dysfunction. 4 TECHNICAL EFFICACY: Stage 2.

Longitudinal Assessment of Cognitive Function in Survivors of Testicular Germ Cell Tumor

Longitudinal Assessment of Cognitive Function in Survivors of Testicular Germ Cell Tumor

NCOG-01. VOCATIONAL STATUS OF PATIENTS WITH GLIOMA AT 5 YEARS AFTER DIAGNOSIS

Abstract BACKGROUND Glioma (WHO grade 2-3) commonly affects adults, with a mean age at diagnosis of 41 years old. Given the demographic age of these brain tumor (BT) survivors, employment is the primary source of income, medical benefits, and financial stability. Unfortunately, job performance problems can occur at any time after diagnosis. This study aims to describe the vocational status and symptoms of these patients approximately five years following diagnosis. METHODS The study employed a cross-sectional cohort design among persons with glioma treated with radiation approximately 5 years from the original diagnosis. Vocational-Independence Scale was used to ascertain employment status. Patients were asked about their experience returning to work after treatment. Symptoms were measured using the MDASI-BT Module. RESULTS Thirty-nine participants completed the study. The median age was 44 years old (range 26-78). Nineteen were diagnosed with oligodendroglioma, 18 with astrocytoma. Thirty-seven (95%) were working full-time at the time of diagnosis. Approximately five years following diagnosis, only 49% of participants are employed, working at least 15 hours per week (n=19). The remainder are unemployed (n=15, 39%), in a volunteer position (n=2, 5.1%), or working &amp;lt;15 hours per week (n=3, 7.7%). Interview data suggest those who are unemployed (n=9, 23%), retired early (n=2, 5%), or had reduced roles (n=11, 28%), were unable to return to prior roles due to symptoms they were experiencing 1-2 years after treatment. The frequently reported symptoms were fatigue (n=29, 74%), sleep disturbance (n = 24, 62%), distress (n = 25, 64%), drowsiness (n = 26, 67%), sadness (n = 25, 64%), issues with speaking (n = 25, 64%), short-term memory issues (n=35, 90%), and difficulty with concentration (n=20, 74%). CONCLUSION In addition to financial stability, employment is a valuable contributor to the quality of life, maintenance of identity, and physical and emotional health. Future research should examine and evaluate interventions that promote the return to work or engagement in the community.

Situación actual de supervivientes de tumores del sistema nervioso central en un hospital español

IntroductionDespite the increasing number of central nervous system (CNS) tumour survivors, long-term (LT) sequelae remain a substantial burden on their health through various life stages. The aim of our study was to evaluate late morbidity, health-related quality of life (HRQoL), self-esteem, functional status, adaptive behaviour, physical activity and social outcomes such as education, employment, relationship status and possession of a driver's license, in addition to the role of LT effects of radiotherapy on these outcomes. MethodsThe study included 111 CNS tumour survivors with a minimum of 10 years of followup. The assessment of patients included a comprehensive clinical evaluation and psychological questionnaires: SF-36 for HRQoL and Rosenberg self-esteem scale. Functional status was assessed with the Lansky/Karnosky scales and adaptive behaviour with the Vineland-II scale. Patients also completed one questionnaire that assessed physical activity and another that assessed other social variables. ResultsThe mean current age of CNS tumour survivors was 20 years (range, 12-34). The median time since diagnosis was 13 years (range, 10-26). The median age at diagnosis was 6 years (range, 1-18). The most prevalent LT sequelae were neurologic (55%), followed by neuropsychiatric (53.1%) and endocrine (49.5%) sequelae. Survivors treated with radiotherapy (n=52) had poorer outcomes in terms of adaptive behaviour, educational attainment and relationship status compared to those who did not receive radiotherapy, but we did not find differences in quality of life or self-esteem scores between these groups. ConclusionWe found a high prevalence of LT sequelae in CNS tumour survivors, especially in those who received radiotherapy. In these patients, LT sequelae have a significant impact on functional status and social outcomes, but not on quality of life or self-esteem.

Short-term sensorimotor training incorporating cognitive tasks for pediatric survivors of posterior fossa tumors: a pilot study.

Posterior fossa tumors account for half of all childhood brain tumors, prompting the search for effective and affordable interventions to combat the neurocognitive and motor sequelae of the tumor and its treatment. The main aim of this pilot study was to evaluate the feasibility and effects of sensorimotor training incorporating cognitive tasks for a group of pediatric survivors of posterior fossa tumors. A total of 48 participants (Mage= 12.3 ± 3.25 years, 41.7% female; 56% with malignant tumors) in remission after completing treatment for posterior fossa tumors were enrolled. Participants received 3 weeks of sensorimotor training targeting visual-motor and cognitive abilities on a FitLight Trainer™. The protocol consisted of 2-3 15-minute training sessions per week, with each session including tasks designed to promote: (1) eye-hand and eye-foot coordination and motor control (simple sensorimotor reaction task); (2) inhibitory control (inhibition task); (3) inhibitory control and working memory (color task). Participants completed an average of six sessions, indicating a moderate adherence rate. Results showed a significant reduction in visuomotor reaction time across age and tumor subgroups in nearly all tasks, which might indicate improvement in the targeted functions, with performance characteristics varying across subgroups. The results suggest that training might be a feasible intervention to promote visual-motor performance in pediatric survivors of posterior fossa tumors across age and tumor type groups, however, further research should address the assessment issues and other limitations of the present study, to provide a more substantial justification for the use of this training.

Measuring the impact of treatment on memory functions in pediatric posterior fossa tumor survivors using diffusion tensor imaging

Background and purposeThe aim of the present prospective exploratory study was to investigate the long-term impact of treatment on brain structure integrity and memory functions in pediatric posterior fossa tumor (PFT) survivors using diffusion tensor imaging (DTI), to determine whether the latter could provide useful biomarkers of memory impairment. Material and MethodsSixty participants were included in this study, divided into three groups: 22 irradiated PFT, 17 non-irradiated PFT, and 21 healthy controls. All underwent memory tests and multimodal MRI, including a DTI sequence. Mean diffusivity and fractional anisotropy values were extracted for bilateral brain structures involved in memory, in order to carry out between-group comparisons and calculate correlations with memory test scores and radiotherapy doses. Statistical tests were two-sided, and p values < 0.05 were considered statistically significant. ResultsDTI metrics were significantly higher for irradiated PFT survivors than in non-irradiated PFT survivors and controls (p < 0.05). Memory test scores were significantly lower for PFT survivors, particularly irradiated patients (p < 0.02), and were correlated with DTI metrics.(−0.27 < r < -0.62, p < 0.04). DTI metrics were correlated with either total or maximum dose for some structures. ConclusionPreliminary results of this study point to microstructural damage in memory-related brain areas in PFT survivors, particularly in irradiated patients, and identify DTI metrics as potential biomarkers of memory deficit.

Environmental Enrichment and Health Outcomes Among Low-Grade Glioma Brain Tumor Survivors.

BACKGROUND: Brain tumor survivors who received radiotherapy (RT) are at a disproportionately increased risk of accelerated aging and symptom burden. We aim to examine the association between environmental enrichment (EE) and health outcomes among low-grade glioma survivors who received brain RT. METHODS: The study used a cross-sectional cohort design, enrolling participants approximately 5 years from diagnosis. The construct of EE consisted of social network, physical activity, employment status, and financial stability. Berkman-Syme Social Network Index, International Physical Activity Questionnaire, Vocational Index Scale, and a Socioeconomic Questionnaire were used to measure the construct of EE. Health outcome measures included the Montreal Cognitive Assessment, Symbol Digit Modality Test, clinical brain magnetic resonance images (pre-RT, approximately 2-3 years after RT, and approximately 5 years after RT), Karnofsky Performance Status Scale, and the MD Anderson Symptom Inventory Brain Tumor Module. Ordinal logistic regression estimated the association between levels of EE and health outcomes. RESULTS: Thirty-nine participants completed the study and experienced varying levels of EE. The median age was 44 years old, ranging from 26 to 78 years old. Nineteen individuals were diagnosed with oligodendroglioma, and 18 were diagnosed with astrocytoma. Thirteen participants had low EE, 17 had moderate EE, and 9 had high EE. Although not statistically significant, we observed patterns of increasing health outcomes (Montreal Cognitive Assessment, Symbol Digit Modality Test, and Karnofsky Performance Status Scale) related to increasing levels of EE. CONCLUSION: This study is an initial exploration into the role of EE in health outcomes and survivorship programs for persons with glioma. Future research should assess EE before treatment or at the time of diagnosis and be longitudinal to accurately ascertain the association between EE and health outcomes. Comprehensive neuro-oncology survivorship programs structured to facilitate EE may reduce symptom burden, promote neuroplasticity, and improve cognitive and functional outcomes after brain radiation.

Feasibility of transcranial Doppler to evaluate vasculopathy among survivors of childhood brain tumors exposed to cranial radiation therapy.

The ability of transcranial Doppler (TCD) to detect asymptomatic cerebrovascular disease among childhood brain tumor survivors following exposure to cranial radiation therapy has not been established. Survivors of childhood brain tumors, more than 3years since diagnosis and exposed to greater than 30Gy cranial radiation, underwent a history and physical exam, laboratory biomarkers of cerebrovascular disease (cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), high-sensitivity CRP, hemoglobin A1C, apoprotein A, and apoprotein B), and a TCD evaluation of their cerebral arteries. In all 165 cerebral arteries from 13 patients (medulloblastoma=10; germ cell tumor=3; females=5; mean age at diagnosis=8.0years; mean age at time of study=20.9years) were examined. Twenty-eight of 165 (17%) were considered abnormal by pre-specified criteria. Total 114 cerebral arteries from 13 patients were assessed for greater than 50% stenosis velocities. Arteries most likely to be considered abnormal included the distal bilateral vertebral arteries (right 38%, left 30%), basilar artery 30%, bilateral siphon internal carotid arteries (right 30%, left 23%), bilateral middle cerebral arteries (23% bilaterally), and bilateral anterior cerebral arteries (7% bilaterally). Two vessels had mean flow velocities consistent with 50% stenosis (1.8%). No vessels were found to have greater than 80% stenosis. TCD may be a useful and practical tool to examine asymptomatic cerebrovascular disease among childhood brain tumor survivors after exposure to cranial radiation therapy. Posterior circulation vessels appear to have the highest burden of disease in this group of brain tumor survivors, a majority of whom had medulloblastoma.

Risk of severe esophageal stricture among childhood cancer survivors – A population-based case-cohort study within the Adult Life after Childhood Cancer in Scandinavia (ALiCCS)

PurposeDue to limited data on treatment-related risk factors associated with esophageal stricture in childhood cancer survivors, this study aimed to assess such factors in long-term survivors. MethodsA case-cohort study was conducted involving 36 cases of five-year childhood cancer survivors with esophageal stricture and a sub-cohort of 540 survivors diagnosed with cancer in 1970–2007 as identified within the Nordic ‘Adult Life after Childhood Cancer in Scandinavia’ program. Individualized treatment details were retrieved from medical records. Radiation doses to each body region and average dose to the esophagus were reconstructed for patients that received radiotherapy. We used a modified Cox proportional hazard model to evaluate associations between esophageal stricture and risk factors by calculating incidence rate ratio (IRR), with 95 % confidence intervals (CIs). ResultsAn increased rate of esophageal stricture was found in survivors who received total body irradiation (IRR=13.7, 95 %CI 4.6–41.1), chest- and neck-directed radiotherapy (IRR=23.5, 95 %CI 8.5−64.7) and doses of ≥12 Gy to the esophagus (IRR=26.8, 95 % CI=9.0–80.3) compared to non-irradiated survivors. Treatment with chemotherapy was also associated with esophageal stricture (IRR=8.4, 95 % CI=2.9–24.4). Notably, leukemia survivors faced an elevated rate (IRR=3.8, 95 % CI 1.8–8.1) compared with survivors of CNS and other solid tumors. ConclusionsOur findings indicate an increased risk of esophageal stricture among childhood cancer survivors, with both neck- and chest-directed radiotherapy and chemotherapy as important risk factors.

Second Primary Malignant Neoplasms in Survivors of Retinoblastoma in a Single Ocular Oncology Practice.

A retrospective review of patients treated for retinoblastoma who developed a non-pineoblastoma second primary malignant neoplasm (SPMN) was performed. The demographics, clinical features and treatments for retinoblastoma, pathologic types of non-pineoblastoma second primary malignant neoplasm (SPMN), intervals between the retinoblastoma diagnosis and treatment and diagnosis of non-pineoblastoma SPMN, treatment provided for the SPMN, and the survival outcomes of the patients were evaluated. Of 550 patients treated initially for retinoblastoma, this series used the 15 (2.7) that developed a non-pineoblastoma SPMN, 14 of which (93.3%) had been treated for bilateral retinoblastoma. All patients had carried a germline mutations in theRB1gene. The median time from retinoblastoma diagnosis to SPMN diagnosis was 19.0 years (extremes 3.4 and 39.4 years). Six of the fifteen patients died during the follow-up of their SPMN. The median interval between initial retinoblastoma diagnosis and death in the 6 patients who died of their SPMN was 18.8 years (extremes 6.2 and 34.6 years) and between diagnosis of the SPMN and death was 1.2 years (extremes 0.25 and 4 years). Of the patients who had been treated with External Beam Radiotherapy (EBRT), 13 developed a SPMN within the previously irradiated field.

Adherence to guideline-recommended cardiac screening in Medicaid-enrolled survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).

56 Background: Childhood cancer survivors face increased risks of heart failure and myocardial dysfunction associated with cancer treatment exposure. Children’s Oncology Group (COG) guidelines recommend periodic cardiac screening for survivors exposed to anthracycline or radiation. However, the extent of adherence to cardiac screening among Medicaid-enrolled survivors—a group typically characterized by socioeconomic disadvantages—remains unclear. Additionally, as Medicaid expansion under the Affordable Care Act has occurred in most, but not all states, cardiac screening adherence may vary based on survivors' state of residence. Methods: Data from the CCSS were linked to administrative Medicaid insurance claims from 2015 to 2019. We included at-risk survivors (i.e., received radiation to chest or heart, total body irradiation, and/or anthracyclines), aged 18-64 years, continuously covered by Medicaid during 2015-2019, and without a history of grade 3-4 cardiovascular conditions by 2019 to ensure the identified cardiac tests were for screening purposes. Our primary outcome assessed adherence to COG guidelines (V4.0) based on age- and therapy dose-specific frequency of cardiac testing (i.e., echocardiogram, multigated acquisition scan, or magnetic resonance imaging) during the study period. Multivariable logistic models assessed sociodemographic, clinical, and policy-related factors associated with adherence, with adjusted probability differences (i.e., marginal effects [MEs]) reported. Results: We identified 1,062 survivors at risk of cardiovascular conditions, with 57.0% female, 52.8% young adults (ages 18-39 years), and 72.8% non-Hispanic White. During 2015-2019, 285 (26.8%) survivors received any cardiac test, and 102 (9.6%) adhered to COG guideline-based frequency of cardiac testing. In multivariable models, survivors residing in states that expanded Medicaid in 2014 and later has 4.3 percentage points (ppts, 95% CI=0.58.1, p =0.025) and 6.1 ppts (95% CI=0.611.6, p =0.031) increased likelihood of adhering to guideline-based frequency of cardiac testing respectively compared to states that did not. Compared to leukemia survivors, the likelihood of adhering to guideline-based frequency of cardiac testing was higher in survivors of central nervous system tumors (ME=7.6 ppt, 95% CI=2.712.6, p =0.002), Hodgkin lymphoma (ME=10.7 ppt, 95% CI=1.320.1, p =0.026), and non-Hodgkin lymphoma (ME=9.4, 95% CI=1.017.8, p =0.028). Conclusions: Adherence to risk-based cardiac testing is low among Medicaid-enrolled survivors of childhood cancer, and associated with residence in a Medicaid expansion state and cancer type. Policy reforms toward improving affordable, continuous health insurance coverage are important means to increase adherence to guideline-based cardiac tests among survivors.

Efficacy of a brief mindfulness-based intervention for brain tumor survivors experiencing depressive symptoms: a pilot study

Efficacy of a brief mindfulness-based intervention for brain tumor survivors experiencing depressive symptoms: a pilot study

A systematic review of interventions for neurocognitive dysfunctions in patients and survivors of a pediatric brain tumor.

Due to a high burden of neurocognitive impairment on patients with a pediatric brain tumor, interventions mitigating these symptoms are highly needed. Currently, evidence on the efficacy and feasibility of such interventions remains scarce. A systematic literature study was performed based on four different databases (PubMed, Web of Science Core Collection, Embase, and PsycArticles). Resulting articles (n=2232) were screened based on title and abstract, and full text. We included 28 articles, investigating cognitive effects of either a lifestyle intervention (n=6), a cognitive training (n=15), or pharmacological intervention (n=7). The most frequently studied interventions were the Cogmed and methylphenidate. Most interventions showed short-term efficacy. Fewer interventions also showed long-term maintenance of positive results. Despite positive trends of these interventions, results are heterogeneous, suggesting relatively limited efficacy of existing interventions and more potential of more individualized as well as multimodal approaches for future interventions.

A - 140 The Association between Executive Functioning and Adaptive Outcomes in Pediatric Brain Tumor Survivors

Abstract Objective Pediatric brain tumor (PBT) survivors are at high risk for cognitive and adaptive challenges. We aimed to examine the relationship between executive functioning (EF) and adaptive functioning in PBT survivors to identify critical cognitive skills that are associated with functional impact to inform intervention and transition to adulthood. Method Retrospective neuropsychological data was collected for 95 clinically referred PBT survivors (8–24 years). A composite EF measure was created based on the average of selected EF subtest scores. The associations between EF skills, parent-report of child adaptive functioning, and full-scale IQ were analyzed using descriptive statistics, correlations, and multiple regression. Results Adaptive functioning was significantly related to parent (r = −0.701, p &amp;lt; 0.001) and teacher ratings (r = −0.372, p = 0.004) of EF, the testing composite measure of EF (r = 0.455, p = 0.033), as well as FSIQ (r = 0.386, p &amp;lt; 0.001), general cognitive ability (r = 0.328, p = 0.003), working memory (r = 0.279, p = 0.007), and processing speed (r = 0.425, p &amp;lt; 0.001). Parent reports of EF were not significantly related to the EF testing composite score, but both significantly predicted adaptive functioning (p &amp;lt; 0.001). Of parent-reported domains of EF, self-monitoring was most predictive of overall adaptive functioning (B = −0.415, p = 0.017). FSIQ and age did not impact the relationship between parent reports of EF and adaptive functioning. Conclusions Overall, EF on both parent reports and testing, especially self-monitoring, was predictive of adaptive functioning in PBT survivors, regardless of age and overall intellectual functioning. Future research should further examine the impact of individual and treatment factors.

A - 58 Grit and Resilience Predict Emotional Functioning in Pediatric Cancer Survivors

Abstract Objective Grit—one’s “perseverance and passion for long-term goals” (Duckworth et al., 2007)—is distinct from resilience, one’s ability to bounce back after negative events. In healthy populations, both promote emotional well-being and quality-of-life (Datu et al., 2019; Sharkey et al., 2017). Limited research has investigated how grit and resilience affect emotional functioning after pediatric cancer. We hypothesized resilience would mediate grit’s effects on emotional functioning in pediatric cancer survivors. Methods Our clinically referred sample of 214 pediatric cancer survivors ages 4–25 years was predominantly lower- to upper-middle class (73%) and racially diverse (Caucasian = 53%, Hispanic = 25%, Black = 12%). We administered the parent-report Behavior Assessment System for Children, Third Edition (BASC-3; variables: Resiliency, Anxiety, Depression), parent-report Short Grit Scale, and self-report BASC-3 (variables: Sense of Inadequacy, Locus of Control). Multiple regression and simple mediation analyses were conducted. Results Overall, the sample demonstrated average grit and resilience. Leukemia and brain tumor survivors demonstrated greater grit and resilience than survivors of other cancers. Grit predicted Anxiety (p = 0.026), Depression (p = 0.001), and Sense of Inadequacy (p ≤ 0.001). Resiliency had a significant indirect effect on grit’s prediction of Anxiety (β = −0.107, 95% CI [−0.206, −0.011]) and Depression (β = −0.192, 95% CI [−0.271, −0.117]), but not Sense of Inadequacy (β = −0.055, 95% CI [−0.200, 0.102]). Conclusion Higher levels of grit predicted better emotional outcomes in pediatric cancer survivors. Grit affected anxiety and depression in this sample via resiliency. Exploratory analyses regarding cancer type and age at diagnosis will be described. Findings support the need for further research on “positive neuropsychology” factors affecting neuropsychological outcomes in pediatric cancer survivors.

Psychosocial and executive functioning late effects in pediatric brain tumor survivors after proton radiation.

Pediatric brain tumor survivors can experience detrimental effects from radiation treatment. This cross-sectional, large cohort study examined late psychosocial and executive functioning effects in pediatric patients treated ≥ 3years after proton radiation therapy (PRT). Parents of 101 pediatric brain tumor survivors completed the Behavior Assessment System for Children and the Behavior Rating Inventory of Executive Function. Standard scores were compared to published normative means, rates of impairment (T-score > 65) were calculated, and demographic and clinical characteristics were examined. Mean age at PRT was 8.12years and mean interval from PRT to assessment was 6.05years. Half were female (49.5%), 45.5% received craniospinal irradiation (CSI), and 58.4% were diagnosed with infratentorial tumors. All mean T-scores were within normal range. Mean T-scores were significantly elevated compared to the norm on the withdrawal, initiate, working memory, and plan/organize scales. Rates of impairment were notably high in working memory (24.8%), initiate (20.4%), withdrawal (18.1%), and plan/organize (17.0%). Greater withdrawal was significantly associated with CSI and also with chemotherapy and diagnosis of hearing loss. Mean T-scores were significantly lower than the norm on the hyperactivity, aggression, conduct problems, and inhibition scales. No significant problems were identified with social skills or depression. Interval since treatment was not correlated with any scale. Although psychosocial and executive functioning was within the normal range, on average, social withdrawal and metacognitive executive functioning (working memory, initiating, planning/organizing) were areas of concern. Targeted yearly screening and proactive executive skill and social interventions are needed for this population.

CN68 From surviving cancer to getting on with life: Adult testicular germ cell tumor survivors’ perspectives on transition from follow-up care to long-term survivorship

CN68 From surviving cancer to getting on with life: Adult testicular germ cell tumor survivors’ perspectives on transition from follow-up care to long-term survivorship

Evaluating Scholastic Achievement in Pediatric Brain Tumor Survivors Compared With Healthy Controls

BackgroundRadiotherapy (RT) causes cognitive deficits in pediatric brain tumor survivors (PBTS). Traditionally, this is measured using neuropsychological testing, which lack pre-diagnosis baseline and do not necessarily trigger action. This pilot project investigated a novel patient-centered outcome of scholastic performance using state-collected educational data. MethodsWe retrospectively analyzed scholastic achievements in children residing in Florida. Eligibility in the treatment group received brain-directed RT between 2007 – 2020 at our institution. Controls were matched at a 3:1 ratio by age, grade, district, and free or reduced lunch (FRL) eligibility. The Florida Department of Education provided educational records for both groups. Generalized linear mixed-effects models were used to predict scholastic outcomes with covariates age, time (binary value of pre- or post-RT), treatment group, and the primary independent variable as the interaction term between time and treatment. Scholastic data was matched with institutional clinical data. ResultsFifty PBTS and 150 matched controls were included for analysis. Median age of PBTS was 12, 12% identified as Black, and 18% as Hispanic. Fifty-two percent were FRL eligible. Forty percent received craniospinal irradiation, and 56% received chemotherapy. Post-RT PBTS had 21 times the odds of receiving accommodations (p=0.006), twice the odds of being retained (p=0.010), and 42% lower odds than controls receiving a passing mathematics score (p=0.068). ConclusionsTo our knowledge, this is the first American experience to successfully link individual scholastic and clinical data. Scholastic performance serves as a meaningful patient-centered outcome complementing the existing suite of neuropsychological testing.

Neighborhood resources are associated with neuropsychological outcomes among pediatric brain tumor survivors

Background: Cancer-related cognitive impairment in survivors of pediatric brain tumors is a public health concern, yet studies seldom explore the role of social determinants of health beyond treatment effects. We investigated the influence of neighborhood resources using the Child Opportunity Index (COI) on neuropsychological functioning in survivors. Methods: Intelligence (IQ) and untimed reading and math proficiency were assessed retrospectively in 190 survivors. Multiple regression analyses explored associations among the COI composite and indices (Education, Health-Environment, Social-Economic) and neuropsychological outcomes, controlling for cumulative neurological risk and treatment exposures (Neurological Predictor Scale; NPS) and parental education. Results: Performance was on average within normal limits: IQ (M = 94.08, SD = 15.85, d=.37) with 13.4% of scores below impairment thresholds; reading (M = 95.08, SD = 17.36, d=.28) and math calculation (M = 91.84, SD = 18.82, d=.43) with 16.92% and 20.63% of scores below impairment thresholds, respectively. Each COI domain predicted reading and IQ after controlling for NPS, parental education, and age at diagnosis; however, the Education domain was the only significant predictor of math outcomes. Conclusion: The COI domains significantly predicted IQ and untimed academic skills in survivors, revealing the critical role of neighborhood resources on cognition above and beyond parental education and treatment factors. This is among the first studies to illuminate the influence of neighborhood resources on cognition in survivors. Future research should examine neighborhood context, an understudied construct, with importance in the move toward precision medicine.