Risk factors for neurocognitive impairment, emotional distress, and poor quality of life in survivors of pediatric rhabdomyosarcoma: A report from the Childhood Cancer Survivor Study

Abstract

Background: Prevalence and risk of poor psychological outcomes following rhabdomyosarcoma (RMS) are not well-established.

Methods: Participants in this cross-sectional, case-control study (n = 713 survivors, 42.5% female; mean [SD] age, 30.5 [6.6] years; n = 706 siblings, 57.2% female; mean age, 32.8,[7.9] years) completed measures of neurocognition, emotional distress, and health-related quality of life (HRQOL). Multivariable logistic regression models identified treatments, health behaviors, and chronic conditions associated with impairment.

Results: Relative to siblings, more survivors reported neurocognitive impairment (task efficiency: 21.1% vs. 13.7%, emotional regulation: 16.7% vs. 11.0%, memory: 19.3% vs. 15.1%), elevated emotional distress (somatic distress: 12.9% vs. 4.7%, anxiety: 11.7% vs. 5.9%, depression: 22.8% vs. 16.9%) and poorer HRQOL (physical functioning: 11.1% vs. 2.8%, role functioning due to physical problems: 16.8% vs. 8.2%, pain: 17.5% vs. 10.0%, vitality: 22.3% vs. 13.8%, social functioning: 14.4% vs. 6.8%, emotional functioning: 17.1% vs. 10.6%). Cranial radiation increased risk for impaired task efficiency (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.14-4.63), whereas chest and pelvic radiation predicted increased risk of physical functioning (OR, 2.68; 95% CI, 1.16-6.21 and OR, 3.44; 95% CI, 1.70-6.95, respectively). Smoking was associated with impaired task efficiency (OR, 2.06; 95% CI, 1.14-3.70), memory (OR, 2.23; 95% CI, 1.26-3.95), anxiety (OR, 2.71; 95% CI, 1.36-5.41) and depression (OR, 1.77; 95% CI, 1.01-3.11). Neurologic conditions increased risk of anxiety (OR, 2.30; 95% CI, 1.04-5.10), and hearing conditions increased risk of depression (OR, 1.79; 95% CI, 1.05-3.03). Neurologic and hearing conditions, respectively, were associated with impaired memory (OR, 2.44; 95% CI, 1.20-4.95 and OR, 1.87; 95% CI, 1.05-3.35) and poor health perception (OR, 2.62; 95% CI, 1.62-1.28 and OR, 2.33; 95% CI, 1.34-4.06).

Conclusions: RMS survivors are at significant risk for poor psychological outcomes. Advancing therapies for local control, smoking cessation, and managing chronic medical conditions may mitigate poor outcomes following RMS.

Keywords: cognition; psychological distress; quality of life; rhabdomyosarcoma; surveys and questionnaires; survivorship.

Figure 1

Adjusted risk for neurocognitive impairment, emotional distress and poor HRQOL in siblings and RMS survivors. Adjusted proportions (x-axis) and 95% confidence limits are shown for siblings (squares) and survivors (diamonds) for each outcome measure (y-axis). Proportions were adjusted for sex, race and age at evaluation. The model for Physical Function did not converge, and was adjusted for age at evaluation and sex only.

Figure 2

Health behaviors and demographic risk factors in association with psychological impairment in RMS survivors Each panel shows odds ratios (OR) and 95% confidence limits (x-axes) for behavioral-related and demographic risk factors (y-axes) in association each of the outcome measures, including CCSS-NCQ (A), BSI-18 (B) and SF-36 (C). The dotted vertical line marks OR=1, i.e., no significant association. Black circles represent significant associations (eTable 4).

Figure 3

Radiation-treatment exposures in association with psychological impairment in RMS survivors Each panel shows odds ratios (OR) and 95% confidence limits (x-axes) for each radiation-treatment exposure risk factor (y-axes) for each of the outcome measures, including CCSS-NCQ (A), BSI-18 (B) and SF-36 (C). The dotted vertical line marks OR=1, i.e., no significant association. Black circles represent significant associations. Models included chemotherapy agents, having a secondary malignant neoplasm, along with age at evaluation, age at diagnosis and sex (eTables 5–7).

Figure 4

Chronic conditions in association with psychological impairment in RMS survivors Each panel shows odds ratios (OR) and 95% confidence limits across treatment-related predictors (y-axes) for each of the outcome measures, including CCSS-NCQ (A), BSI-18 (B) and SF-36 (C). The dotted vertical line marks OR=1, i.e., no significant association. Black circles represent significant associations. The models also included age at evaluation, age at diagnosis, and sex (eTables 8–10).