Long-term psychological and educational outcomes for survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study

Daniel J. Zheng, Kevin R. Krull, Yan Chen, Lisa Diller, Yutaka Yasui, Wendy Leisenring, Pim Brouwers, Rebecca Howell, Jin Shei Lai, Lyn Balsamo, Kevin C. Oeffinger, Leslie L. Robison, Gregory Armstrong, Nina S. Kadan-Lottick

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Neuroblastoma survivors may be at elevated risk for psychological impairments because of their young age at diagnosis and neurotoxic treatment, but this is not well described. METHODS: A total of 859 ≥5-year survivors of neuroblastoma younger than 18 years (diagnosed in 1970-1999), who had a median age at diagnosis of 0.8 years (range: 0.0-7.3 years) and a median follow-up of 13.3 years (range: 8.0-17.9 years), were compared with 872 siblings of childhood cancer survivors who were younger than 18 years with the parent-reported Behavior Problem Index (BPI) for psychological functioning. Age- and sex-adjusted multivariate log-binomial models were used to identify factors associated with impairment in BPI domains (scores worse than the sibling 10th percentile). The impact of psychological impairment on educational outcomes was examined among survivors. RESULTS: Compared with siblings, neuroblastoma survivors had an increased prevalence of impairment in the domains of anxiety/depression (19% vs 14%; P =.003), headstrong behavior (19% vs 13%; P <.001), attention deficits (21% vs 13%; P <.001), peer conflict/social withdrawal (26% vs 17%; P <.001), and antisocial behavior (16% vs 12%; P =.01). Common treatment exposures (vincristine, cisplatin, and retinoic acid) were not associated with impairment. Having 2 or more chronic health conditions predicted impairment in 4 domains (P <.001). Specifically, pulmonary disease predicted impairment in all 5 domains (P ≤.004). Endocrine disease (P ≤.004) and peripheral neuropathy (P ≤.02) each predicted impairment in 3 domains. Psychological impairment was associated with special education service usage and educational attainment less than college. CONCLUSIONS: Neuroblastoma survivors are at elevated risk for psychological impairment, which is associated with special education service usage and lower adult educational attainment. Those with chronic health conditions may represent a high-risk group for targeted screening and intervention. Cancer 2018.

Original languageEnglish (US)
Pages (from-to)3220-3230
Number of pages11
JournalCancer
Volume124
Issue number15
DOIs
StatePublished - Aug 1 2018

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Neuroblastoma
Survivors
Psychology
Siblings
Neoplasms
Special Education
Endocrine System Diseases
Health
Vincristine
Statistical Models
Peripheral Nervous System Diseases
Tretinoin
Cisplatin
Lung Diseases
Anxiety
Depression
Therapeutics

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Zheng, D. J., Krull, K. R., Chen, Y., Diller, L., Yasui, Y., Leisenring, W., ... Kadan-Lottick, N. S. (2018). Long-term psychological and educational outcomes for survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study. Cancer, 124(15), 3220-3230. https://doi.org/10.1002/cncr.31379

Long-term psychological and educational outcomes for survivors of neuroblastoma : A report from the Childhood Cancer Survivor Study. / Zheng, Daniel J.; Krull, Kevin R.; Chen, Yan; Diller, Lisa; Yasui, Yutaka; Leisenring, Wendy; Brouwers, Pim; Howell, Rebecca; Lai, Jin Shei; Balsamo, Lyn; Oeffinger, Kevin C.; Robison, Leslie L.; Armstrong, Gregory; Kadan-Lottick, Nina S.

In: Cancer, Vol. 124, No. 15, 01.08.2018, p. 3220-3230.

Research output: Contribution to journalArticle

Zheng, DJ, Krull, KR, Chen, Y, Diller, L, Yasui, Y, Leisenring, W, Brouwers, P, Howell, R, Lai, JS, Balsamo, L, Oeffinger, KC, Robison, LL, Armstrong, G & Kadan-Lottick, NS 2018, 'Long-term psychological and educational outcomes for survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study', Cancer, vol. 124, no. 15, pp. 3220-3230. https://doi.org/10.1002/cncr.31379
Zheng, Daniel J. ; Krull, Kevin R. ; Chen, Yan ; Diller, Lisa ; Yasui, Yutaka ; Leisenring, Wendy ; Brouwers, Pim ; Howell, Rebecca ; Lai, Jin Shei ; Balsamo, Lyn ; Oeffinger, Kevin C. ; Robison, Leslie L. ; Armstrong, Gregory ; Kadan-Lottick, Nina S. / Long-term psychological and educational outcomes for survivors of neuroblastoma : A report from the Childhood Cancer Survivor Study. In: Cancer. 2018 ; Vol. 124, No. 15. pp. 3220-3230.
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abstract = "BACKGROUND: Neuroblastoma survivors may be at elevated risk for psychological impairments because of their young age at diagnosis and neurotoxic treatment, but this is not well described. METHODS: A total of 859 ≥5-year survivors of neuroblastoma younger than 18 years (diagnosed in 1970-1999), who had a median age at diagnosis of 0.8 years (range: 0.0-7.3 years) and a median follow-up of 13.3 years (range: 8.0-17.9 years), were compared with 872 siblings of childhood cancer survivors who were younger than 18 years with the parent-reported Behavior Problem Index (BPI) for psychological functioning. Age- and sex-adjusted multivariate log-binomial models were used to identify factors associated with impairment in BPI domains (scores worse than the sibling 10th percentile). The impact of psychological impairment on educational outcomes was examined among survivors. RESULTS: Compared with siblings, neuroblastoma survivors had an increased prevalence of impairment in the domains of anxiety/depression (19{\%} vs 14{\%}; P =.003), headstrong behavior (19{\%} vs 13{\%}; P <.001), attention deficits (21{\%} vs 13{\%}; P <.001), peer conflict/social withdrawal (26{\%} vs 17{\%}; P <.001), and antisocial behavior (16{\%} vs 12{\%}; P =.01). Common treatment exposures (vincristine, cisplatin, and retinoic acid) were not associated with impairment. Having 2 or more chronic health conditions predicted impairment in 4 domains (P <.001). Specifically, pulmonary disease predicted impairment in all 5 domains (P ≤.004). Endocrine disease (P ≤.004) and peripheral neuropathy (P ≤.02) each predicted impairment in 3 domains. Psychological impairment was associated with special education service usage and educational attainment less than college. CONCLUSIONS: Neuroblastoma survivors are at elevated risk for psychological impairment, which is associated with special education service usage and lower adult educational attainment. Those with chronic health conditions may represent a high-risk group for targeted screening and intervention. Cancer 2018.",
author = "Zheng, {Daniel J.} and Krull, {Kevin R.} and Yan Chen and Lisa Diller and Yutaka Yasui and Wendy Leisenring and Pim Brouwers and Rebecca Howell and Lai, {Jin Shei} and Lyn Balsamo and Oeffinger, {Kevin C.} and Robison, {Leslie L.} and Gregory Armstrong and Kadan-Lottick, {Nina S.}",
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T1 - Long-term psychological and educational outcomes for survivors of neuroblastoma

T2 - A report from the Childhood Cancer Survivor Study

AU - Zheng, Daniel J.

AU - Krull, Kevin R.

AU - Chen, Yan

AU - Diller, Lisa

AU - Yasui, Yutaka

AU - Leisenring, Wendy

AU - Brouwers, Pim

AU - Howell, Rebecca

AU - Lai, Jin Shei

AU - Balsamo, Lyn

AU - Oeffinger, Kevin C.

AU - Robison, Leslie L.

AU - Armstrong, Gregory

AU - Kadan-Lottick, Nina S.

PY - 2018/8/1

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N2 - BACKGROUND: Neuroblastoma survivors may be at elevated risk for psychological impairments because of their young age at diagnosis and neurotoxic treatment, but this is not well described. METHODS: A total of 859 ≥5-year survivors of neuroblastoma younger than 18 years (diagnosed in 1970-1999), who had a median age at diagnosis of 0.8 years (range: 0.0-7.3 years) and a median follow-up of 13.3 years (range: 8.0-17.9 years), were compared with 872 siblings of childhood cancer survivors who were younger than 18 years with the parent-reported Behavior Problem Index (BPI) for psychological functioning. Age- and sex-adjusted multivariate log-binomial models were used to identify factors associated with impairment in BPI domains (scores worse than the sibling 10th percentile). The impact of psychological impairment on educational outcomes was examined among survivors. RESULTS: Compared with siblings, neuroblastoma survivors had an increased prevalence of impairment in the domains of anxiety/depression (19% vs 14%; P =.003), headstrong behavior (19% vs 13%; P <.001), attention deficits (21% vs 13%; P <.001), peer conflict/social withdrawal (26% vs 17%; P <.001), and antisocial behavior (16% vs 12%; P =.01). Common treatment exposures (vincristine, cisplatin, and retinoic acid) were not associated with impairment. Having 2 or more chronic health conditions predicted impairment in 4 domains (P <.001). Specifically, pulmonary disease predicted impairment in all 5 domains (P ≤.004). Endocrine disease (P ≤.004) and peripheral neuropathy (P ≤.02) each predicted impairment in 3 domains. Psychological impairment was associated with special education service usage and educational attainment less than college. CONCLUSIONS: Neuroblastoma survivors are at elevated risk for psychological impairment, which is associated with special education service usage and lower adult educational attainment. Those with chronic health conditions may represent a high-risk group for targeted screening and intervention. Cancer 2018.

AB - BACKGROUND: Neuroblastoma survivors may be at elevated risk for psychological impairments because of their young age at diagnosis and neurotoxic treatment, but this is not well described. METHODS: A total of 859 ≥5-year survivors of neuroblastoma younger than 18 years (diagnosed in 1970-1999), who had a median age at diagnosis of 0.8 years (range: 0.0-7.3 years) and a median follow-up of 13.3 years (range: 8.0-17.9 years), were compared with 872 siblings of childhood cancer survivors who were younger than 18 years with the parent-reported Behavior Problem Index (BPI) for psychological functioning. Age- and sex-adjusted multivariate log-binomial models were used to identify factors associated with impairment in BPI domains (scores worse than the sibling 10th percentile). The impact of psychological impairment on educational outcomes was examined among survivors. RESULTS: Compared with siblings, neuroblastoma survivors had an increased prevalence of impairment in the domains of anxiety/depression (19% vs 14%; P =.003), headstrong behavior (19% vs 13%; P <.001), attention deficits (21% vs 13%; P <.001), peer conflict/social withdrawal (26% vs 17%; P <.001), and antisocial behavior (16% vs 12%; P =.01). Common treatment exposures (vincristine, cisplatin, and retinoic acid) were not associated with impairment. Having 2 or more chronic health conditions predicted impairment in 4 domains (P <.001). Specifically, pulmonary disease predicted impairment in all 5 domains (P ≤.004). Endocrine disease (P ≤.004) and peripheral neuropathy (P ≤.02) each predicted impairment in 3 domains. Psychological impairment was associated with special education service usage and educational attainment less than college. CONCLUSIONS: Neuroblastoma survivors are at elevated risk for psychological impairment, which is associated with special education service usage and lower adult educational attainment. Those with chronic health conditions may represent a high-risk group for targeted screening and intervention. Cancer 2018.

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