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Functional and Social Independence in Survivors of Pediatric CNS Tumors

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Key Points

  • Overall, 40% of survivors were categorized as independent, 34% as moderately independent, and 26% as nonindependent.
  • Nonindependence was associated with craniospinal irradiation and younger age at diagnosis.

In a report from the St. Jude Lifetime Cohort Study published in the Journal of Clinical Oncology, Brinkman et al found that 60% of adult survivors of pediatric central nervous system (CNS) tumors do not achieve full functional or social independence in adult life.

In the study, functional and social independence was assessed in 306 survivors, including 130 with astrocytoma, 77 with medulloblastoma, 36 with ependymoma, and 63 with other pediatric CNS tumors. Survivors had a median age of 25.3 years (range = 18.9–53.1 years), with a median time since diagnosis of 16.8 years (range = 10.6–41.8 years).

Functional/social independence was assessed in the categories of employment, living independently, assistance with personal care, assistance with routine needs, obtaining a driver’s license, and marital status. Physical performance impairment was defined as scores < 10th percentile in aerobic capacity, strength, flexibility, balance, mobility, and adaptive function.

Factors in Nonindependence

Overall, 40% of survivors were classified as independent, 34% as moderately independent, and 26% as nonindependent. In multivariate analysis, nonindependence vs independence was associated with craniospinal irradiation (odds ratio [OR] = 4.20, 95% confidence interval [CI] = 1.69­–10.44), younger age at diagnosis (OR = 1.24, 95% CI = 1.14–­1.35), and hydrocephalus with shunting (OR = 2.57, 95% CI = 1.31­­­­–5.05). In further multivariate analysis, impaired aerobic capacity (OR = 5.47, 95% CI = 1.78–16.76), leg strength (OR = 15.28, 95% CI = 2.61–89.56), flexibility (OR = 3.66, 95% CI = 1.11–12.03), and adaptive physical function (OR = 11.54, 95% CI = 3.57–37.27) were associated with an increased risk of nonindependence. Assessment with the Medical Outcomes Survey 36-Item Short Form indicated poorer quality of life in physical but not mental domains among nonindependent survivors.

The investigators concluded, “60% of survivors of pediatric CNS tumors do not achieve complete independence as adults. Reduction in intensity of primary therapies and interventions that target physical performance and adaptive deficits may help survivors to achieve greater independence.”

The study was supported by a National Cancer Institute grant. Tara M. Brinkman, PhD, of the Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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