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Outcome of children with low-grade cerebellar astrocytoma: long-term complications and quality of life

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Abstract

Objects

To study the long-term outcome of surgically treated low-grade cerebellar astrocytomas in children.

Materials and methods

We followed 31 consecutive patients under 16 years of age who were diagnosed between 1980 and 2005 in a single institution. In 21 of 31 survivors (median follow-up time 7.9 years; range 5.6–27.4 years) who agreed to participate, tumor control, neurological and cognitive complications, and their impact on behavioral and emotional adjustment and health-related quality of life (HRQoL) were comprehensively assessed qualitatively and quantitatively.

Results

Neurological sequelae were found in 43%. However, age-appropriate ability to perform daily life activities was normal in all patients. Remarkably, cognitive deficits leading to significant school problems occurred in 19% and behavioral and emotional adjustment disturbances in 27%. In comparison with healthy controls, the survivors rated their HRQoL similarly or even higher.

Conclusion

Childhood low-grade cerebellar astrocytomas have an excellent cure rate by tumor surgery alone. When compared with other pediatric brain tumors, the risk of neurological, cognitive, emotional, and behavioral complications is relatively small. HRQoL is similar to that of healthy controls.

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Author information

Authors and Affiliations

  1. Division of Oncology, University Children’s Hospital of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Tycho J. Zuzak, Barbara Drexel & Michael A. Grotzer

  2. Division of Neurology, University Children’s Hospital of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Andrea Poretti & Eugen Boltshauser

  3. Division of Psychosomatics and Psychiatry, University Children’s Hospital of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Daniel Zehnder

Authors
  1. Tycho J. Zuzak
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  2. Andrea Poretti
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  3. Barbara Drexel
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  4. Daniel Zehnder
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  5. Eugen Boltshauser
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  6. Michael A. Grotzer
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Corresponding author

Correspondence to Michael A. Grotzer.

Appendix I: Semistructured interview questions

Appendix I: Semistructured interview questions

Diagnosis

How much do you know about your disease? Did you, or do you, take a particular interest in it?

Is there anything concerning your disease which is difficult for you? If yes, what?

Is there anything concerning your disease which was difficult for you and which you now consider to be less difficult? Or vice versa?

Present medication

Do you take any medicine now? Which ones? Are there medicines which you have taken in the past and which you do not take any more?

Are you disturbed by having to take these medicines every day?

Do you have, or have you had, any side effects due to the therapy?

Physical appearance

Are you satisfied with your appearance? What disturbs you most about your appearance? If you could, would you change anything about your appearance? If yes, what?

General body fitness–cognitive functions

Do you feel your physical ability is affected by your illness? How much?

Do you take part in any sport? Which one? Is there any sport you like but which you cannot take part in?

Can you concentrate well at school, at work? Do you believe your ability to concentrate has been impaired by your illness? What about your speed in solving tasks or in understanding new things?

Do you often have gaps in your memory?

Emotions

What positive feelings do you have towards your illness? What negative feelings about your illness?

Are you afraid of getting ill again?

School

Which school do you or did you attend?

How do you get on at school? Do you have any difficulties? If so, are they due to your illness? Do you like going to school? If yes, why?

How often do you not attend school?

Do you feel comfortable in your class?

Did anything change in your relationship to your schoolmates after your illness? If yes, what?

Have people in your school or at work been informed about your illness? Did you tell them about it?

Job

Which job did you train for or would you like to train for? Is this the job of your dreams?

Have you started an apprenticeship? Did you finish it? If not, why?

Did you, or do you, attend university?

What work do you do now? Are you happy with it? If not, why?

Did you have any other job before? Why did you change your job?

Hobbies

Do you have any hobbies? What are they?

Do you pursue your hobbies alone or with friends?

Are you a member of any club?

Do you play music?

Have you got a particularly strong interest in anything?

Do you have a pet?

Social situation

Do you live with your parents, with friends, or alone?

Do you live in a special home (hostel)?

How is your relationship with your parents or brothers and sisters? Do you often get angry with them? Would you prefer to live away from home?

Do you have a girlfriend or boyfriend or have you ever had one?

If you have no relationship: do you miss it? Can you imagine your future without a partner?

Do you have a good boyfriend or girlfriend? Are you in touch with him or her? How often?

How do you relate to your teachers–schoolmates–colleagues?

How do you relate to the doctor treating you? Who is he or she? Does he or she support you? Does he or she give enough time to you? Does he or she explain to you what he or she is going to do?

Are you independent in your daily life? Do you need help with particular things?

What is your source of income (wages–parents–state)? Do you receive a benefit? If yes, would you prefer any other source of income?

Future

How do you see your future?

What would you most like to happen?

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Zuzak, T.J., Poretti, A., Drexel, B. et al. Outcome of children with low-grade cerebellar astrocytoma: long-term complications and quality of life. Childs Nerv Syst 24, 1447–1455 (2008). https://doi.org/10.1007/s00381-008-0692-7

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