Attainment of functional and social independence in adult survivors of pediatric CNS tumors

A report from the st jude lifetime cohort study

Tara M. Brinkman, Kirsten K. Ness, Zhenghong Li, I. Chan Huang, Kevin R. Krull, Amar Gajjar, Thomas E. Merchant, James L. Klosky, Robyn E. Partin, Ingrid Tonning Olsson, Frederick Boop, Paul Klimo, Wassim Chemaitilly, Raja B. Khan, Deokumar Srivastava, Leslie L. Robison, Melissa M. Hudson, Gregory Armstrong

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose Beyond survival, achieving independence is a primary goal for adult survivors of pediatric CNS tumors. However, the prevalence of and risk factors for failure to achieve independence, assessed with multiple concurrent indicators, have not been examined. Patients and Methods Functional and social independence was assessed in 306 survivors (astrocytoma [n = 130], medulloblastoma [n = 77], ependymoma [n = 36], and other [n = 63]; median current age, 25.3 years [range, 18.9 to 53.1 years]; time since diagnosis, 16.8 years [range, 10.6 to 41.8 years]). Six observed indicators were used to identify latent classes of independence, which included employment, living independently, assistance with personal care, assistance with routine needs, obtaining a driver’s license, and marital status. Physical performance impairments were defined as scores, 10th percentile on measures of aerobic capacity, strength, flexibility, balance, mobility, and adaptive function. Multinomial logistic regression estimated odds ratios (ORs) and 95% CIs were calculated for associations of disease/treatment exposures and impairments in physical performance with nonindependence. Results Three classes of independence were identified as independent (40%), moderately independent (34%), and nonindependent (26%). In multivariable models, craniospinal irradiation (OR, 4.20; 95% CI, 1.69 to 10.44) and younger age at diagnosis (OR, 1.24; 95% CI, 1.14 to 1.35) were associated with risk of nonindependence versus independence. Beyond impaired IQ, limitations in aerobic capacity (OR, 5.47; 95% CI, 1.78 to 16.76), flexibility (OR, 3.66; 95% CI, 1.11 to 12.03), and adaptive physical function (OR, 11.54; 95% CI, 3.57 to 37.27) were associated with nonindependence versus independence. Nonindependent survivors reported reduced physical but not mental health-related quality of life compared with independent survivors. Conclusion Sixty percent of survivors of pediatric CNS tumors do not achieve complete independence as adults. Reduction in intensity of primary therapies and interventions that target physical performance and adaptive deficits may help survivors to achieve greater independence.

Original languageEnglish (US)
Pages (from-to)2762-2769
Number of pages8
JournalJournal of Clinical Oncology
Volume36
Issue number27
DOIs
StatePublished - Sep 20 2018

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Survivors
Cohort Studies
Odds Ratio
Pediatrics
Neoplasms
Craniospinal Irradiation
Ependymoma
Medulloblastoma
Astrocytoma
Marital Status
Licensure
Mental Health
Logistic Models
Quality of Life
Survival
Therapeutics

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Attainment of functional and social independence in adult survivors of pediatric CNS tumors : A report from the st jude lifetime cohort study. / Brinkman, Tara M.; Ness, Kirsten K.; Li, Zhenghong; Huang, I. Chan; Krull, Kevin R.; Gajjar, Amar; Merchant, Thomas E.; Klosky, James L.; Partin, Robyn E.; Olsson, Ingrid Tonning; Boop, Frederick; Klimo, Paul; Chemaitilly, Wassim; Khan, Raja B.; Srivastava, Deokumar; Robison, Leslie L.; Hudson, Melissa M.; Armstrong, Gregory.

In: Journal of Clinical Oncology, Vol. 36, No. 27, 20.09.2018, p. 2762-2769.

Research output: Contribution to journalArticle

Brinkman, TM, Ness, KK, Li, Z, Huang, IC, Krull, KR, Gajjar, A, Merchant, TE, Klosky, JL, Partin, RE, Olsson, IT, Boop, F, Klimo, P, Chemaitilly, W, Khan, RB, Srivastava, D, Robison, LL, Hudson, MM & Armstrong, G 2018, 'Attainment of functional and social independence in adult survivors of pediatric CNS tumors: A report from the st jude lifetime cohort study', Journal of Clinical Oncology, vol. 36, no. 27, pp. 2762-2769. https://doi.org/10.1200/JCO.2018.77.9454
Brinkman, Tara M. ; Ness, Kirsten K. ; Li, Zhenghong ; Huang, I. Chan ; Krull, Kevin R. ; Gajjar, Amar ; Merchant, Thomas E. ; Klosky, James L. ; Partin, Robyn E. ; Olsson, Ingrid Tonning ; Boop, Frederick ; Klimo, Paul ; Chemaitilly, Wassim ; Khan, Raja B. ; Srivastava, Deokumar ; Robison, Leslie L. ; Hudson, Melissa M. ; Armstrong, Gregory. / Attainment of functional and social independence in adult survivors of pediatric CNS tumors : A report from the st jude lifetime cohort study. In: Journal of Clinical Oncology. 2018 ; Vol. 36, No. 27. pp. 2762-2769.
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abstract = "Purpose Beyond survival, achieving independence is a primary goal for adult survivors of pediatric CNS tumors. However, the prevalence of and risk factors for failure to achieve independence, assessed with multiple concurrent indicators, have not been examined. Patients and Methods Functional and social independence was assessed in 306 survivors (astrocytoma [n = 130], medulloblastoma [n = 77], ependymoma [n = 36], and other [n = 63]; median current age, 25.3 years [range, 18.9 to 53.1 years]; time since diagnosis, 16.8 years [range, 10.6 to 41.8 years]). Six observed indicators were used to identify latent classes of independence, which included employment, living independently, assistance with personal care, assistance with routine needs, obtaining a driver’s license, and marital status. Physical performance impairments were defined as scores, 10th percentile on measures of aerobic capacity, strength, flexibility, balance, mobility, and adaptive function. Multinomial logistic regression estimated odds ratios (ORs) and 95{\%} CIs were calculated for associations of disease/treatment exposures and impairments in physical performance with nonindependence. Results Three classes of independence were identified as independent (40{\%}), moderately independent (34{\%}), and nonindependent (26{\%}). In multivariable models, craniospinal irradiation (OR, 4.20; 95{\%} CI, 1.69 to 10.44) and younger age at diagnosis (OR, 1.24; 95{\%} CI, 1.14 to 1.35) were associated with risk of nonindependence versus independence. Beyond impaired IQ, limitations in aerobic capacity (OR, 5.47; 95{\%} CI, 1.78 to 16.76), flexibility (OR, 3.66; 95{\%} CI, 1.11 to 12.03), and adaptive physical function (OR, 11.54; 95{\%} CI, 3.57 to 37.27) were associated with nonindependence versus independence. Nonindependent survivors reported reduced physical but not mental health-related quality of life compared with independent survivors. Conclusion Sixty percent of survivors of pediatric CNS tumors do not achieve complete independence as adults. Reduction in intensity of primary therapies and interventions that target physical performance and adaptive deficits may help survivors to achieve greater independence.",
author = "Brinkman, {Tara M.} and Ness, {Kirsten K.} and Zhenghong Li and Huang, {I. Chan} and Krull, {Kevin R.} and Amar Gajjar and Merchant, {Thomas E.} and Klosky, {James L.} and Partin, {Robyn E.} and Olsson, {Ingrid Tonning} and Frederick Boop and Paul Klimo and Wassim Chemaitilly and Khan, {Raja B.} and Deokumar Srivastava and Robison, {Leslie L.} and Hudson, {Melissa M.} and Gregory Armstrong",
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T1 - Attainment of functional and social independence in adult survivors of pediatric CNS tumors

T2 - A report from the st jude lifetime cohort study

AU - Brinkman, Tara M.

AU - Ness, Kirsten K.

AU - Li, Zhenghong

AU - Huang, I. Chan

AU - Krull, Kevin R.

AU - Gajjar, Amar

AU - Merchant, Thomas E.

AU - Klosky, James L.

AU - Partin, Robyn E.

AU - Olsson, Ingrid Tonning

AU - Boop, Frederick

AU - Klimo, Paul

AU - Chemaitilly, Wassim

AU - Khan, Raja B.

AU - Srivastava, Deokumar

AU - Robison, Leslie L.

AU - Hudson, Melissa M.

AU - Armstrong, Gregory

PY - 2018/9/20

Y1 - 2018/9/20

N2 - Purpose Beyond survival, achieving independence is a primary goal for adult survivors of pediatric CNS tumors. However, the prevalence of and risk factors for failure to achieve independence, assessed with multiple concurrent indicators, have not been examined. Patients and Methods Functional and social independence was assessed in 306 survivors (astrocytoma [n = 130], medulloblastoma [n = 77], ependymoma [n = 36], and other [n = 63]; median current age, 25.3 years [range, 18.9 to 53.1 years]; time since diagnosis, 16.8 years [range, 10.6 to 41.8 years]). Six observed indicators were used to identify latent classes of independence, which included employment, living independently, assistance with personal care, assistance with routine needs, obtaining a driver’s license, and marital status. Physical performance impairments were defined as scores, 10th percentile on measures of aerobic capacity, strength, flexibility, balance, mobility, and adaptive function. Multinomial logistic regression estimated odds ratios (ORs) and 95% CIs were calculated for associations of disease/treatment exposures and impairments in physical performance with nonindependence. Results Three classes of independence were identified as independent (40%), moderately independent (34%), and nonindependent (26%). In multivariable models, craniospinal irradiation (OR, 4.20; 95% CI, 1.69 to 10.44) and younger age at diagnosis (OR, 1.24; 95% CI, 1.14 to 1.35) were associated with risk of nonindependence versus independence. Beyond impaired IQ, limitations in aerobic capacity (OR, 5.47; 95% CI, 1.78 to 16.76), flexibility (OR, 3.66; 95% CI, 1.11 to 12.03), and adaptive physical function (OR, 11.54; 95% CI, 3.57 to 37.27) were associated with nonindependence versus independence. Nonindependent survivors reported reduced physical but not mental health-related quality of life compared with independent survivors. Conclusion Sixty percent of survivors of pediatric CNS tumors do not achieve complete independence as adults. Reduction in intensity of primary therapies and interventions that target physical performance and adaptive deficits may help survivors to achieve greater independence.

AB - Purpose Beyond survival, achieving independence is a primary goal for adult survivors of pediatric CNS tumors. However, the prevalence of and risk factors for failure to achieve independence, assessed with multiple concurrent indicators, have not been examined. Patients and Methods Functional and social independence was assessed in 306 survivors (astrocytoma [n = 130], medulloblastoma [n = 77], ependymoma [n = 36], and other [n = 63]; median current age, 25.3 years [range, 18.9 to 53.1 years]; time since diagnosis, 16.8 years [range, 10.6 to 41.8 years]). Six observed indicators were used to identify latent classes of independence, which included employment, living independently, assistance with personal care, assistance with routine needs, obtaining a driver’s license, and marital status. Physical performance impairments were defined as scores, 10th percentile on measures of aerobic capacity, strength, flexibility, balance, mobility, and adaptive function. Multinomial logistic regression estimated odds ratios (ORs) and 95% CIs were calculated for associations of disease/treatment exposures and impairments in physical performance with nonindependence. Results Three classes of independence were identified as independent (40%), moderately independent (34%), and nonindependent (26%). In multivariable models, craniospinal irradiation (OR, 4.20; 95% CI, 1.69 to 10.44) and younger age at diagnosis (OR, 1.24; 95% CI, 1.14 to 1.35) were associated with risk of nonindependence versus independence. Beyond impaired IQ, limitations in aerobic capacity (OR, 5.47; 95% CI, 1.78 to 16.76), flexibility (OR, 3.66; 95% CI, 1.11 to 12.03), and adaptive physical function (OR, 11.54; 95% CI, 3.57 to 37.27) were associated with nonindependence versus independence. Nonindependent survivors reported reduced physical but not mental health-related quality of life compared with independent survivors. Conclusion Sixty percent of survivors of pediatric CNS tumors do not achieve complete independence as adults. Reduction in intensity of primary therapies and interventions that target physical performance and adaptive deficits may help survivors to achieve greater independence.

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