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Neurocognitive and psychosocial outcomes in adult survivors of childhood soft‐tissue sarcoma: A report from the St. Jude Lifetime Cohort
Author(s) -
Tonning Olsson Ingrid,
Brinkman Tara M.,
Wang Mingjuan,
Ehrhardt Matthew J.,
Banerjee Pia,
Mulrooney Daniel A.,
Huang IChan,
Ness Kirsten K.,
Bishop Michael W.,
Srivastava Deokumar,
Robison Leslie L.,
Hudson Melissa M.,
Krull Kevin R.
Publication year - 2020
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32694
Subject(s) - medicine , neurocognitive , psychosocial , quality of life (healthcare) , cohort , population , poisson regression , neuropsychology , pediatrics , demography , cognition , psychiatry , nursing , environmental health , sociology
Background To the authors' knowledge, few studies to date have examined long‐term neurocognitive outcomes in survivors of childhood soft‐tissue sarcoma. Methods A total of 150 survivors (41% of whom were female with a mean current age of 33 years [SD, 8.9 years] and a time since diagnosis of 24 years [SD, 8.7 years]) and 349 community controls (56% of whom were female with a mean current age of 35 years [SD, 10.2 years]) completed comprehensive neuropsychological testing, echocardiography, electrocardiography, pulmonary function tests, endocrine evaluation, and physical examination. Patient‐reported outcomes of health‐related quality of life (HRQOL) and social attainment were collected. Survivors were compared with norms and controls on neurocognitive outcomes using general linear models, and on HRQOL and social attainment using modified Poisson models. The impacts of treatment and chronic health conditions on outcomes were examined using multivariable general linear models (effect size was expressed as unstandardized β estimates that reflected the unit of change from a mean of 0 and an SD of 1) and modified Poisson models (effect size expressed as relative risks). Results Compared with controls and population norms, survivors demonstrated lower performance on measures of verbal reasoning (mean z score, −0.45 [SD, 1.15]; P < .001) mathematics (mean z score, −0.63 [SD, 1.07]; P < .001), and long‐term memory (mean z score, −0.37 [SD, 1.14]; P < .001). Cumulative anthracycline exposure (per 100 mg/m 2 ) was found to be associated with poorer verbal reasoning (β = −0.14 z scores; P = .04), reading (β = −0.09 z score; P = .04), and patient‐reported vitality (relative risk, 1.32; 95% CI, 1.09‐1.59). Neurologic and neurosensory chronic conditions were associated with poorer mathematics (neurologic conditions: β = −0.63 z score [ P = 0.02]; and hearing impairment: β = −0.75 z scores [ P < 0.01]). Better cognitive performance was associated with higher social attainment. Conclusions Long‐term survivors of soft‐tissue sarcoma are at risk of neurocognitive problems and poor HRQOL associated with anthracycline treatment and chronic health conditions.