Psychosocial profile of pediatric brain tumor survivors with neurocognitive complaints

Abstract

Purpose: With more children surviving a brain tumor, neurocognitive consequences of the tumor and its treatment become apparent, which could affect psychosocial functioning. The present study therefore aimed to assess psychosocial functioning of pediatric brain tumor survivors (PBTS) in detail.

Methods: Psychosocial functioning of PBTS (8-18 years) with parent-reported neurocognitive complaints was compared to normative data on health-related quality of life (HRQOL), self-esteem, psychosocial adjustment, and executive functioning (one-sample t tests) and to a sibling control group on fatigue (independent-samples t test). Self-, parent-, and teacher-report questionnaires were included, where appropriate, providing complementary information.

Results: Eighty-two PBTS (mean age 13.4 years, SD 3.2, 49 % males) and 43 healthy siblings (mean age 14.3, SD 2.4, 40 % males) were included. As compared to the normative population, PBTS themselves reported decreased physical, psychological, and generic HRQOL (d = 0.39-0.62, p < 0.008). Compared to siblings, increased fatigue-related concentration problems (d = 0.57, p < 0.01) were reported, although self-reported self-esteem and psychosocial adjustment seemed not to be affected. Parents of PBTS reported more psychosocial (d = 0.81, p < 0.000) and executive problems (d = 0.35-0.43, p < 0.016) in their child than parents of children in the normative population. Teachers indicated more psychosocial adjustment problems for female PBTS aged 8-11 years than for the female normative population (d = 0.69, p < 0.025), but they reported no more executive problems.

Conclusions: PBTS with parent-reported neurocognitive complaints showed increased psychosocial problems, as reported by PBTS, parents, and teachers.

Implications for cancer survivors: Systematic screening of psychosocial functioning is necessary so that tailored support from professionals can be offered to PBTS with neurocognitive complaints.

Keywords: Brain tumor; Late effects of cancer treatment; Pediatric oncology; Psychosocial; Quality of life.

Fig. 1

Flowchart of inclusion. Note self-reported questionnaires were completed by 81 PBTS and 40 sibling controls. Parent data were available for all 82 PBTS, and teacher data were available for 73 of the included PBTS

Fig. 2

Profile of psychosocial functioning in pediatric brain tumor survivors in standardized effect sizes as compared to the mean of the control group (0.00). *Significant difference between PBTS and controls after the Bonferroni correction, effect sizes presented in red and bold. Note. Effect sizes ‘d’ were calculated using the pooled standard deviation. Scores have been adjusted in a way that for all domains, lower scores reflect worse psychosocial functioning. For self-esteem, weighted average effect sizes of the SPPC and SPPA are depicted. For teacher report of psychosocial adjustment (SDQ), scores for males and females are reported separately due to more females in our sample as compared to the control group. HRQOL = health-related quality of life, physical = physical well-being subscale of the Kidscreen-27, psych = psychological well-being subscale of the Kidscreen-27, autonomy = autonomy and parents subscale of the Kidscreen-27, peers = peers and social support subscale of the Kidscreen-27, school = school environment subscale of the Kidscreen-27, generic = generic health-related quality of life subscale of the Kidscreen-10, scholastic = scholastic competence subscale of the SPPC/SPPA, social = social acceptance subscale of the SPPC/SPPA, athletic = athletic competence subscale of the SPPC/SPPA, appearance = physical appearance subscale of the SPPC/SPPA, conduct = behavioral conduct subscale of the SPPC/SPPA, self-worth = global self-worth subscale of the SPPC/SPPA, friendship = close friendship subscale of the SPPA, psy adj = psychosocial adjustment, total score SDQ, fatigue = subjective fatigue subscale of the CIS, concentr = concentration subscale of the CIS, motivation = motivation subscale of the CIS, activity = physical activity subscale of the CIS, behavioral EF = behavioral executive functioning BRIEF, behavioral = behavioral regulation index of the BRIEF, metacog = metacognition index of the BRIEF. (Color figure online)