The relationship between psychosocial risk and neurocognitive functioning early after childhood central nervous system tumour diagnosis.

Abstract

Neurocognitive impairments are common in paediatric central nervous system (CNS) tumours and can relate to clinical and demographic factors. The impact of social or environmental factors, such as family psychosocial risk, is less well understood. We examined neurocognitive functioning in children with CNS tumours shortly after diagnosis and associations with psychosocial risk. This cohort study included children who underwent neuropsychological assessments within three months of diagnosis. Proportion, chi-square and t-tests were used to compare neurocognitive outcomes to norms and evaluate prevalence of neurocognitive impairment (International Cognition and Cancer Task Force criteria: two scores at z ≤ -1.5, one score at z ≤ -2 or both). Regression analyses examined associations between psychosocial risk, age at diagnosis and neurocognitive outcomes, controlling for medical factors. We included 125 children (47 females; mean age at diagnosis = 9.7 years) assessed at an average of 2.08 months after diagnosis. A larger proportion of patients demonstrated neurocognitive impairments than normative expectations (p = .002), with a greater likelihood for children from increased psychosocial risk groups (p = .014). Increased psychosocial risk was associated with lower parent-reported executive functioning (p = .028), but not with other neurocognitive outcomes. Midline tumour location was related to better working memory; history of obstructive hydrocephalus was related to poorer verbal memory and chemo/radiotherapy initiation was related to poorer processing speed (p's < .05). A sub-group of children with CNS tumours show neurocognitive impairments shortly after diagnosis. Children with increased family psychosocial risk were at higher risk of impairment. Psychosocial risk can help identify neurocognitively vulnerable children, highlighting the importance of both neuropsychological and psychosocial screening.