Neurocognitive outcomes in adult survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study
Menée à partir de données portant sur 837 adultes ayant survécu à un neuroblastome (âge médian : 25 ans) et sur 728 témoins (âge médian : 32 ans), cette étude analyse leurs déficiences neurocognitives en lien avec les traitements anticancéreux
Background: Despite survival improvements, there is a paucity of data on neurocognitive outcomes in neuroblastoma survivors. This study addresses this literature gap. Methods: Neurocognitive impairments in survivors were compared to sibling controls from the Childhood Cancer Survivor Study (CCSS) using the CCSS Neurocognitive Questionnaire. Impaired emotional regulation, organization, task efficiency, and memory defined as scores ≥90th percentile of sibling norms. Modified Poisson regression models evaluated associations with treatment exposures, era of diagnosis, and chronic conditions. Analyses were stratified by age at diagnosis (≤1 and >1 year) as proxy for lower versus higher risk disease. Results: Survivors (N = 837; median [range] age, 25 [17–58] years, age diagnosed, 1 [0–21] years) were compared to sibling controls (N = 728; age, 32 [16–43] years). Survivors had higher risk of impaired task efficiency (≤1 year relative risk [RR], 1.48; 95% confidence interval [CI], 1.08–2.03; >1 year RR, 1.58; 95% CI, 1.22–2.06) and emotional regulation (≤1 year RR, 1.51; 95% CI, 1.07–2.12; >1 year RR, 1.44; 95% CI, 1.06–1.95). Impaired task efficiency associated with platinum exposure (≤1 year RR, 1.74; 95% CI, 1.01–2.97), hearing loss (≤1 year RR, 1.95; 95% CI, 1.26–3.00; >1 year RR, 1.56; 95% CI, 1.09–2.24), cardiovascular (≤1 year RR, 1.83; 95% CI, 1.15–2.89; >1 year RR, 1.74; 95% CI, 1.12–2.69), neurologic (≤1 year RR, 2.00; 95% CI, 1.32–3.03; >1 year RR, 2.29; 95% CI, 1.64–3.21), and respiratory (>1 year RR, 2.35; 95% CI, 1.60–3.45) conditions. Survivors ≤1 year; female sex (RR, 1.54; 95% CI, 1.02–2.33), cardiovascular (RR, 1.71; 95% CI, 1.08–2.70) and respiratory (RR, 1.99; 95% CI, 1.14–3.49) conditions associated impaired emotional regulation. Survivors were less likely to be employed full-time (p < .0001), graduate college (p = .035), and live independently (p < .0001). Conclusions: Neuroblastoma survivors report neurocognitive impairment impacting adult milestones. Identified health conditions and treatment exposures can be targeted to improve outcomes.
Cancer 2023