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Neurocognitive outcomes in long-term survivors of Wilms tumor: a report from the St. Jude Lifetime Cohort

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Abstract

Purpose

To examine prevalence and predictors of neurocognitive outcomes, social attainment, emotional distress, and health-related quality of life (HRQOL) in long-term survivors of pediatric Wilms tumor (WT).

Methods

One hundred fifty-eight WT survivors (59% female; mean [SD] age 33 [9.1] years; time since diagnosis 29 [9.1] years) and 354 community controls (55.6% female; 35 [10.2] years) completed comprehensive neuropsychological testing and physical examination, including echocardiography/electrocardiography, pulmonary function tests, and endocrine evaluation. Self-report of emotional distress, HRQOL, and social attainment were collected. Impairment was defined in relation to both controls and normative data. Generalized linear models were developed to examine impact of treatment and chronic health conditions on outcomes.

Results

WT survivors performed poorer than norms and controls in 6 of 16 cognitive variables and 1 of 8 HRQOL variables, with scores ranging from − 0.64 (mathematics) to − 0.21 (verbal fluency) standard deviations below expectations. Compared to controls, WT survivors were less likely to graduate college (odds ratio 2.23, 95% confidence interval 1.46–3.41) and had more moderate to severe neurologic conditions (18.4% vs 8.2%, p < 0.001), which were associated with poor memory (β = − 0.90, p < 0.001), attention (β = − 1.02, p < 0.001), and HRQOL general health (β = − 0.80, p = 0.0015). Treatment variables and cardiopulmonary morbidity (higher in survivors) were not associated with outcomes.

Conclusions

Survivors of WT demonstrate impairment in neurocognitive function and have lower social attainment during adulthood, with poorer neurocognitive function associated with neurologic morbidity.

Implications for Cancer Survivors

Survivors of WT should be offered neurocognitive evaluations and rehabilitation. Neurologic conditions should be routinely assessed, and appropriate support offered to reduce risk for functional limitations.

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Funding

This study was supported by the National Cancer Institute (CA195547, M. Hudson and L. Robison Principal Investigators). Support to St. Jude Children’s Research Hospital was also provided by the Cancer Center Support (CORE) grant (CA21765, C. Roberts, Principal Investigator) and the American Lebanese Syrian Associated Charities (ALSAC). Neither was involved in the design, analysis, or interpretation of results.

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Authors and Affiliations

  1. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105-3678, USA

    Ingrid Tonning Olsson, Tara M. Brinkman, Geehong Hyun, Pia Banerjee, Daniel A. Mulrooney, I-Chan Huang, Daniel M. Green, Leslie L. Robison, Melissa M. Hudson & Kevin R. Krull

  2. Department of Psychology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Tara M. Brinkman & Kevin R. Krull

  3. Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Daniel A. Mulrooney, Daniel M. Green & Melissa M. Hudson

  4. Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Deokumar Srivastava

Authors
  1. Ingrid Tonning Olsson
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  2. Tara M. Brinkman
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  3. Geehong Hyun
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  4. Pia Banerjee
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  6. I-Chan Huang
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  8. Deokumar Srivastava
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  9. Leslie L. Robison
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  10. Melissa M. Hudson
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  11. Kevin R. Krull
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Correspondence to Kevin R. Krull.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was reviewed and approved by the Institutional Review Board of St Jude Children’s Research Hospital, Memphis, TN, USA. Written consent was obtained from all participants.

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Tonning Olsson, I., Brinkman, T.M., Hyun, G. et al. Neurocognitive outcomes in long-term survivors of Wilms tumor: a report from the St. Jude Lifetime Cohort. J Cancer Surviv 13, 570–579 (2019). https://doi.org/10.1007/s11764-019-00776-8

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