Exploring the Discrepancy Between Subjective and Objective Measures of Executive Functions in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia.

Purpose: Childhood acute lymphoblastic leukemia (ALL) is associated with executive dysfunction in long-term survivorship. This is evidenced by subjective and objective measures of executive functions (EFs). However, the two measures do not always align, and the EF discrepancy in this population is understudied. This cross-sectional study aimed to examine the association between global measures of subjective and objective EF in young adult (YA) survivors of childhood ALL. Second, we aimed to explore how psychological distress, fatigue, self-efficacy, and estimated IQ relate to the discrepancy between these measures. Methods: A total of 53 subjects (age 18-34) participated in a clinical trial baseline assessment (clinicaltrials.gov NCT04541056). The Behavior Rating Inventory of Executive Function for Adults assessed subjective EFs. Results from six neurocognitive tests were combined to represent objective EFs. Discrepancy scores were calculated by subtracting the objective EF composite score from the subjective EF score. Spearman's correlations and simple and multiple linear regression analyses were performed to explore associations and predictors for the global EF discrepancy. Results: Subjective and objective measures of EF were moderately correlated (r_s = 0.407). The regression analyses showed that psychological distress (R² = 0.44), fatigue (R² = 0.29), and self-efficacy (R² = 0.24) significantly predicted the global EF discrepancy (p < .001). Only psychological distress explained unique variation (B = -0.46). Conclusion: Neurocognitive tests and self-reports offer valuable insights into EF assessment for YA survivors. Psychological distress emerged as the most central contributor to the overall EF discrepancy. Consequently, screening for anxiety and depression alongside subjective EF complaints will be of significance.