the long term outcome of childhood brain tumours; impact of radiotherapy, sally davis
TRANSCRIPT
The long-term outcome of childhood brain tumours: impact of radiotherapy
Dr Sally DavisRegistered Clinical
Psychologist
Background
Second most common form of childhood cancer
Increase in incidence NZ amongst highest (3.42/100,000
children) Increased survival rates & quality of
survival? Identified cognitive deficits Beyond 5 years post-treatment???
Aims
Long-term (> 5 years) effects of radiotherapy (RT)
Specific areas of neuropsychological functioning
Adaptive functioning (QOL, Coping)
Relationships between treatment factors, late effects, and performance
Information gathered
Treatment factors Age at diagnosis Time since
surgery Duration of
symptoms Hydrocephalus Shunt Meningitis Cerebellar
mutism syndrome
Amount of tumour removed
Length of hospital stay
Late effects Balance
problems Hearing loss Left/right sided
weakness Ataxia Alopecia Growth hormone
deficiency Vision
loss/blurry vision Speech problems Gait disturbance
Posterior fossa
Benign versus malignant
Benign (PA) low-grade (Grade
I and II) slow growing small with
distinct borders don’t spread to
distant sites easily removed
surgically surgery alone is
often effective as little risk of further growth
Malignant (MB) aggressive
(Grade IV) grow rapidly large, lacking
distinct borders infiltrate
surrounding tissue
difficult to surgically remove completely
remaining tissue following surgery continues to grow
Participants
20 Medulloblastoma (MB) Mean age at dx = 10 yrs Mean no. of yrs post-dx = 17 yrs
19 Pilocytic astrocytoma (PA) Mean age at dx = 12 yrs Mean no. of yrs post-dx = 14 yrs
20 control subjects
Methodology
Measures Numerous (15) neuropsychological tests Coping Response Inventory (Moos, 1993) Quality of Life Inventory (Frisch, 1994)
Data Analysis T-tests ANOVA (one-way between groups) MANOVA Chi-square tests Bivariate correlations (two-tailed)
Data analysis
Measures MB PA Control
Neuropsychometrics mean sd mean sd mean sd
Verbal IQ 96.15 11.78 104.05 13.53 111.90 7.87
Performance IQ 97.30 15.81 111.68 10.17 116.85 10.90
Full Scale IQ 96.40 14.14 108.63 11.86 115.35 8.62
CVLT trial 1-5 -1.18 0.98 -0.21 1.10 0.28 0.98
Long delay free recall -1.38 1.10 -0.45 1.04 -0.43 0.80
VPA total 3 -1.44 1.67 -0.06 1.04 0.11 0.64
Rey copy -1.66 2.47 -1.66 2.01 -0.71 1.34
Rey recall -1.86 1.11 -0.67 0.96 -0.14 0.95
COWA total -2.37 2.02 -1.37 1.75 -0.59 1.55
Trails B -3.00 2.82 -0.69 1.13 0.27 1.02
PSI (Index score) 76.20 10.60 92.80 14.52 105.65 11.95
LM I -0.83 1.10 -0.09 1.18 0.17 0.87
LM II -1.13 1.15 -0.14 1.13 0.50 0.81
NB: pink box sig different (p<.01) from MB group, yellow box sig different (p<.05) from MB group
Data analysis contd.
Measures MB PA Control
QOL – raw scores mean sd mean sd mean sd
Health 1.9 2.731 1.541 3.361 2.727 2.529
Self esteem 2.1 2.489 1.916 3.322 3.772 1.445
Goal/value 2.75 2.291 2.666 2.16 3.272 1.75
Money 1.45 1.637 0.4583 1.91 1 1.745
Work 1.95 1.986 1.208 2.225 1.818 2.322
Play 1.45 2.584 3.041 2.742 3.272 2.433
Learn 1.05 2.258 1.291 2.367 3.227 1.716
Love 1.05 3.72 2.291 3.758 1.909 3.584
Friend 3.45 2.459 3.833 3.157 4.181 1.942
Relate 4.5 1.933 3.041 2.955 3.318 2.589
Home 3.7 1.894 2.833 2.389 2.136 1.807
Neighbour 2 1.622 1.541 1.864 2.545 2.303
QOL overall 2.3 0.7327 2.0420.858
7 1.909 0.6838
NB: pink box = sig different (p<.05) from MB group, yellow box indicates nearing significant difference
Main findings
RT has a profound long-term negative impact on neuropsychological functioning
Deficits in MB and PA groups found in: Information Processing Speed Attention Executive functioning Memory Fine motor speed
Main findings contd.
Younger at diagnosis = greater risk of neuropsychological deficits
Hydrocephalus and shunt ↓ performance
No significant relationship between neuropsychological performance and total RT dose or amount of tumour removed
Main findings contd.
↑ total number of pre- and post-surgical complications was related to ↓ performance
↑ duration of symptoms prior to diagnosis had a negative impact on Learning
Increased time since surgery was related to an increased satisfaction in QOL
Limitations
These include:
Small sample sizes Self-selection Participants treated between 1980
and 2003
Implications
Are families being fully informed of the long-term impact of treatment required?
LEAP began July 2006 (Akld, Chch, Wgtn) National paediatric oncology initiative Clinical psychologist and paediatric
oncologist Long-term follow-up for survivors of
childhood cancer (20 years post-treatment)
“Ultimately, cure is about controlling the disease, but is also
about preserving dreams and maximising potential.” (Eiser,
2004)
Thank you to: Dr Suzanne Barker-Collo
Dr Lynette Tippett