Demographic, medical, and neighborhood barriers to clinical neuropsychological services in pediatric medulloblastoma patients treated in the United States.

Background: Medulloblastoma is the most commonly occurring malignant brain tumor of childhood. Treatment includes a combination of surgery, radiation therapy, and chemotherapy, all of which are associated with cognitive impairments. Despite appreciation of the value of neuropsychological evaluations to assess for cognitive impairments, there are barriers to these evaluations. This study aimed to identify potential demographic, medical, or neighborhood factors associated with barriers to neuropsychological evaluations.

Methods: Retrospective chart review identified pediatric patients with a medulloblastoma diagnosed between 2005 and 2024. Demographic, medical, and neighborhood factors were gleaned from the medical records.

Results: Of the 67 identified patients, only 36 (53.73%) completed a clinical neuropsychological evaluation. Patients who obtained a neuropsychological evaluation were more likely to be non-Hispanic [X² (1,62) = 9.20, p = <.01], diagnosed at younger ages [t(60) = - 8.40, p =  < 0.001], treated with photon radiation therapy [X² (1,62) = 15.24, p =  < 0.001], live closer to the hospital [t(60) = 3.19, p = 0.001], and live in communities with higher health-related resources [t(60) = - 2.09, p = 0.02]. The two groups did not differ by any of the medical/clinical factors.

Conclusions: Neuropsychological evaluations assess for cognitive changes following cancer directed treatment, clarify other diagnostic possibilities (e.g., learning or attention difficulties), and facilitate access to appropriate accommodations and school- and community- based services. Although neuropsychological evaluations are recommended as standard of care following treatment for medulloblastoma, we identified demographic, medical, and neighborhood-level factors that serve as barriers to clinical neuropsychological evaluations. Implications for clinical care and recommendations to address these barriers are discussed.