Psychological disorders and the need for special education services were more commonly seen in childhood neuroblastoma survivors, a new study found.
Compared with age- and sex-matched controls who were siblings of cancer survivors, children living at least 5 years after diagnosis with the rare pediatric brain tumor had significantly higher rates of social withdrawal or peer conflict (26% versus 17%), attention deficits (21% versus 13%), headstrong behavior (19% versus 13%), anxiety or depression (19% versus 14%), and antisocial behavior (16% versus 12%), reported Nina Kadan-Lottick, MD, of Yale Comprehensive Cancer Center in New Haven, Connecticut, and colleagues in Cancer.
Special education services in childhood or adolescence were also significantly more likely among neuroblastoma survivors (prevalence ratio [PR] 2.25, 95% CI 1.84-2.74, P<0.001), who were less likely to attend college than control patients (PR 1.71, 95% CI 1.17-2.50, P=0.007).
“These findings are novel because this is the first large study that could look at how neuroblastoma patients are doing in terms of psychological and educational outcomes,” said Kadan-Lottick, in a statement. “Before recent advances in treatment, this survivor population was much smaller and we were not able to analyze these sorts of long-term outcomes.”
Since 1975, the 5-year survival in neuroblastoma has increased from 46% to 71%.
Looking specifically at treatment exposure, the authors found no association with worse psychological outcomes for common chemotherapy agents — cisplatin, retinoic acid, vincristine — used in the treatment of neuroblastoma. And they saw no association related to treatment intensity either. Kadan-Lottick’s group noted that this could possibly imply that the impairments seen are a “general effect of the cancer/survivorship experience.”
Only cranial irradiation was associated with one of the five Behavior Problem Index (BPI) domains (PR 2.03, 95% CI 1.32-2.37, P=0.003).
“The goal is not simply to get our patients to be cancer-free but also to optimize their mental, emotional, and social functioning as they move into adolescence and adulthood,” said Kadan-Lottick. “Our hope is that these findings will help inform strategies for early screening and intervention to identify those survivors at highest risk for developing psychological and educational impairment later on in life.”
Chronic health conditions in neuroblastoma survivors predicted impairment in BPI domains, with those patients having two or more health conditions being predictive in four domains (P<0.001).
Those with pulmonary disease had an increased risk of psychological impairment for all five domains (P≤0.004):
- anxiety or depression (PR 1.92, 95% CI 1.31-2.65)
- anti-social behavior (PR 1.83, 95% CI 1.17-2.27)
- headstrong behavior (PR 1.75, 95% CI 1.16-1.91)
- attention deficit (PR 1.71, 95%, CI 1.17-2.36)
- peer conflict or social withdrawal (PR 1.62, 95% CI 1.20-2.09)
Peripheral neuropathy significantly predicted increased risk of impairment in three domains: anxiety or depression, headstrong behavior, and attention deficits. As did endocrine disease: antisocial behavior, headstrong behavior, and peer conflict or social withdrawal.
And comparing household incomes ($60,000-plus versus $20,000-$39,999) also revealed that lower income was associated with headstrong behavior, attention deficit, and peer conflict or social withdrawal.
The study looked at 859 neuroblastoma patients who were diagnosed from 1970 to 1999 and who survived for 5 years or more. All patients were younger than 7 years old at diagnosis and most were infants. They were followed for a median of 13.3 years. The control group comprised 872 siblings of childhood cancer survivors, who were also younger than 18.
Most neuroblastoma survivors (37%) had been treated with a combination of surgery and chemotherapy, with 32.8% receiving surgery only, and 7.5% receiving surgery and radiation therapy. Roughly a fifth of patients (20.6%) received all three modalities. No associations between psychological disorders or educational outcomes were noted across the different treatment types. A small subset (2.1%) of patients received no treatment or were treated with other combinations.
The study was funded by the National Cancer Institute.
Kadan-Lottick and co-authors reported no conflicts of interest.