Impact of socioeconomic status and chemotherapy on neurocognitive performance in children with brain tumors

IF 2.4 Q2 CLINICAL NEUROLOGY
Leslie Chang, Palak P Patel, Yifan Zhang, Alan Cohen, Kenneth Cohen, Lisa Jacobson, Matthew Ladra, Rachel K Peterson, Sahaja Acharya
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引用次数: 1

Abstract

Abstract Background Although the relationship between radiation and neurocognition has been extensively studied in the pediatric brain tumor population, it is increasingly recognized that neurocognitive impairment is multifactorial. Therefore, we quantified the effect of socioeconomic status (SES) and chemotherapy on neurocognitive impairment and decline post-treatment. Methods Eligible patients included those diagnosed with a brain tumor at < 22 years of age with ≥1 neurocognitive assessment. Neurocognitive impairment was defined as performance 1.5 standard deviations below the normative mean using age-standardized measures of intellectual function. Neurocognitive decline was defined as a negative slope. Neurocognitive outcomes included Wechsler indices of Full-Scale Intelligence Quotient (IQ). Logistic regression identified variables associated with neurocognitive impairment. Longitudinal data was analyzed using linear mixed models. Results Eligible patients (n = 152, median age at diagnosis = 9.6 years) had a mean neurocognitive follow-up of 50.2 months. After accounting for age and receipt of craniospinal irradiation, patients with public insurance had 8-fold increased odds of impaired IQ compared to private insurance (odds ratio [OR]: 7.59, P < .001). After accounting for age, change in IQ was associated with chemotherapy use (slope: −0.45 points/year with chemotherapy vs. 0.71 points/year without chemotherapy, P = .012). Conclusions Public insurance, an indicator of low SES, was associated with post-treatment impairment in IQ, highlighting the need to incorporate SES measures into prospective studies. Chemotherapy was associated with change in IQ. Further work is needed to determine whether impairment associated with low SES is secondary to baseline differences in IQ prior to brain tumor diagnosis, brain tumor/therapy itself, or some combination thereof.
社会经济地位和化疗对脑肿瘤患儿神经认知表现的影响
背景虽然在儿童脑肿瘤人群中辐射与神经认知的关系已被广泛研究,但越来越多的人认识到神经认知障碍是多因素的。因此,我们量化了社会经济地位(SES)和化疗对治疗后神经认知功能障碍和衰退的影响。方法入选的患者包括:经诊断为脑肿瘤的患者;年龄22岁,神经认知评估≥1分。神经认知障碍定义为使用年龄标准化智力功能测量的表现低于规范平均值1.5个标准差。神经认知衰退被定义为负斜率。神经认知结果包括韦氏全面智商指数(IQ)。逻辑回归确定了与神经认知障碍相关的变量。纵向数据采用线性混合模型进行分析。结果符合条件的患者(n = 152,诊断时中位年龄= 9.6岁)平均神经认知随访50.2个月。在考虑年龄和接受颅脊髓照射后,公共保险患者的智商受损几率是私人保险患者的8倍(优势比[OR]: 7.59, P <措施)。考虑到年龄后,IQ的变化与化疗使用相关(斜率:化疗组- 0.45分/年vs.未化疗组0.71分/年,P = 0.012)。结论公共保险作为低社会经济地位的一个指标,与治疗后的智商损害有关,强调了将社会经济地位测量纳入前瞻性研究的必要性。化疗与智商的变化有关。需要进一步的工作来确定低社会经济地位相关的损害是否继发于脑肿瘤诊断、脑肿瘤/治疗本身或两者的某种组合之前的智商基线差异。
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来源期刊
Neuro-oncology practice
Neuro-oncology practice CLINICAL NEUROLOGY-
CiteScore
5.30
自引率
11.10%
发文量
92
期刊介绍: Neuro-Oncology Practice focuses on the clinical aspects of the subspecialty for practicing clinicians and healthcare specialists from a variety of disciplines including physicians, nurses, physical/occupational therapists, neuropsychologists, and palliative care specialists, who have focused their careers on clinical patient care and who want to apply the latest treatment advances to their practice. These include: Applying new trial results to improve standards of patient care Translating scientific advances such as tumor molecular profiling and advanced imaging into clinical treatment decision making and personalized brain tumor therapies Raising awareness of basic, translational and clinical research in areas of symptom management, survivorship, neurocognitive function, end of life issues and caregiving
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