Evolving therapies, neurocognitive outcomes and functional independence in adult survivors of childhood glioma
Menée à partir de donnés portant sur 1 284 adultes ayant survécu à un gliome pédiatrique (âge médian : 30 ans ; durée médiane depuis le diagnostic : 22 ans), cette étude analyse leurs fonctions neurocognitives et leur degré d'indépendance fonctionnelle en lien avec les traitements anticancéreux reçus
Background: Treatment of childhood glioma has evolved to reduce radiotherapy exposure with the goal of limiting late toxicity. However, the associations between treatment changes and neurocognition, and the contribution of neurocognition and chronic health conditions (CHCs) to attainment of adult independence, remain unknown. Methods: Adult survivors of childhood glioma diagnosed 1970-1999 in the Childhood Cancer Survivor Study (n = 1,284; median [min-max] 30 [18-51] years at assessment; 22 [15-34] years from diagnosis) self-reported neurocognitive impairment and CHCs. Multivariable models evaluated associations between changes in treatment exposures (surgery only, chemotherapy [±surgery], cranial radiation [±chemotherapy/surgery]) and neurocognitive impairment. Latent class analysis with five indicators (employment, independent living, assistance with routine/personal care needs, driver’s license, marital/partner status) identified classes of functional independence. Path analysis tested associations among treatment exposures, neurocognitive impairment, CHCs, and functional independence. Statistical tests were 2-sided. Results: Cranial radiation exposure decreased over time [51% (1970s), 46% (1980s), 27% (1990s)]. However, compared to siblings, survivors with any treatment exposure were at elevated risk for neurocognitive impairment, including surgery only (e.g., memory: relative risk [RR]=2.22; task efficiency: RR = 1.88; both P’s<.001). Three classes of functional independence were identified: independent (58%), moderately independent (20%), and non-independent (22%). Cranial radiation was associated with non-independence through impaired task efficiency (
β
= 0.06), sensorimotor (
β
= 0.06) and endocrine (
β
= 0.10) CHCs, and through the associations between these CHCs and task efficiency (each
β
= 0.04). Sensorimotor and endocrine CHCs were associated with non-independence through memory. Conclusion: Most long-term glioma survivors achieve adult independence. However, functional non-independence is associated with treatment-related neurocognitive impairment and CHCs.