Abstract
The research has shown that children surviving cancer are at risk for long-term emotional and behavioral problems secondary to the cumulative effects of cranial irradiation and chemotherapy. The purpose of this study was to investigate the emotional and behavioral outcome of children diagnosed with brain tumor and treated with cranial irradiation and chemotherapy by looking at the association between treatment, time, age, and cognitive-related variables on externalizing and internalizing behaviors at 3 years posttreatment. Fifty-four brain tumor survivors were administered a neuropsychological test battery, whereas the parents filled out the CBCL and Conners' Parent Rating Scale. The results indicate that chemotherapy treatment with vincristine, cytoxan, cisplantinum, and/or VP16 was related to poorer internalizing and externalizing behavioral outcome, especially attention, social withdrawal, and anxious–depressive symptomatology. Age at time of diagnosis or treatment, time since discontinuation of treatment, type and/or total dose of radiation therapy was not significantly correlated with any of the behavioral outcome scales. Verbal memory and learning deficits accounted for a significant portion of the variance in social withdrawal, whereas lower scores in overall intellectual functioning and verbal fluency was related to disturbances in attention, inhibition, and social functioning. The findings suggest that children treated with 1 or a combination of any of the aforementioned chemotherapy agents who exhibit declines in intellectual functioning and memory are at increased risk for long-term behavioral problems 3 years after treatment cessation. These findings support the importance for early psychotherapeutic and supportive intervention services immediately after treatment cessation, with the goal of circumventing these potentially debilitating emotional problems.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18. Burlington: University of Vermont, Department of Psychiatry.
Carpentieri, S. C., Mulhern, R. K., Douglas, S., Hanna, S., & Fairclough, D. L. (1993). Behavioral resiliency among children surviving brain tumors: A longitudinal study. Journal of Clinical Child Psychology, 22, 236–246.
Chadderton, R. D., West, C. G., Schulz, S., Quirke, D. C., Gattamaneni, R., & Taylor, R. (1995). Radiotherapy in the treatment of low-grade astrocytomas. Child's Nervous System, 11443–448.
Chapman, C. A., Waber, D. P., Bernstein, J. H., Pomeroy, S. L., LaVally, B., Sallan, S. E., et al. (1995). Neurobehavioral and neurologic outcome in long-term survivors of posterior fossa brain tumors: Role of age and perioperative factors. Journal of Child Neurology, 10, 209–212.
Conners, C. K. (1997). Conners' Rating Scales–Revised: Technical manual. New York: Multi-Health Systems.
Dennis, M., Spiegler, B. J., Hetherington, C. R.,& Greenberg, M. L. (1996). Neuropsychological sequelae of the treatment of children with medulloblastoma. Journal of Neuro-Oncology, 29, 91–101.
Elkin, T., Scott, J., Thompson, M., Schoenfeld, J., Thompson, P., Gaston, R., et al. (1999 February). Cranial radiation therapy dosage effects on intellect in pediatric medulloblastoma patients. Poster presentation at the International Neuropsychological Society, 27th Annual meeting. Boston, MA.
Fletcher, J. M., & Copeland, D. R. (1988). Neurobehavioral effects of central nervous system prophylactic treatment of cancer in children. Journal of Clinical and Experimental Neuropsychology, 10495–538.
Foley, B., Barakat, L. P., Herman-Liu, A., Radcliffe, J., & Molloy, P. (2000). The impact of childhood hypothalamic/chiasmatic brain tumors on child adjustment and family functioning. Children's Health Care, 29, 209–223.
Goldwein, J.W., Radcliffe, J., Johnson, J., Moshang, T., Packer, R. J., Sutton, L. N., et al. (1996). Updated results of a pilot study of low dose craniospinal irradiation plus chemotherapy for children under five with cerebellar primitive neuroectodermal tumors (medulloblastoma). International Journal of Radiation Oncology Biology Physics, 34, 899–903.
Granowetter, L. (1994). Pediatric oncology: A medical overview. In D. J. Bearison & R. K. Mulher (Eds.), Pediatric psychooncologv: Psychological perspectives on children with cancer. New York: Oxford University Press.
Grill, J., Renaux, V. K., Bulteau, C., Viguier, D., Levy-Piebois, C., Sainte-Rose, C., et al. (1999). Long-term intellectual outcome in children with posterior fossa tumors according to radiation doses and volumes. International Journal of Radiation Oncology, Biology, Physics, 45, 137–145.
Kazak, A. E. (1994). Imglications of survival: Pediatric oncology patients and their families. In D. J. Bearison & R. K. Mulher (Eds.), Pediatric psychooncology: Psychological perspectives on children with cancer. New York: Oxford University Press.
Kazak, A. E., Christakis, D., Alderfer, M., & Coiro, M. J. (1994). Young adolescent cancer survivors and their parents: Adjustment, learning problems, and gender. Journal of Family Psychology, 874–84.
Koocher, G., O'Malley, J., Gogan, J., & Foster, D. (1980). Psychological adjustment among pediatric cancer survivors. Journal of Child Psychology and Psychiatry, 21, 163–173.
Kupst, M. J.,& Schulman, J. L. (1988). Long-term coping with pediatric leukemia: A six-year follow-up study. Journal of Pediatric Psychology, 13, 7–22.
Lannering, B., Marky, I., Lundberg, A., & Olsson, E. (1990). Longterm sequelae after pediatric brain tumors: Their effect on disability and quality of life. Medical and Pediatric Oncology, 18304–310.
Lebaron, S., Zeltzer, P. M., Zeltzer, L. K., Scott, S., & Martlin, A. E. (1988). Assessment of quality of survival in children with medulloblastoma and cerebellar astrocytoma. Cancer, 62, 1215–1222.
Moore, B. D., Ater, J. L., & Copeland, D. R. (1992). Improved neuropsychological outcome in children with brain tumors diagnosed during infancy and treated without cranial irradiation. Journal of Child Neurology, 7, 281–290.
Moore, I., Glasser, M., & Ablin, A. (1987). The late psychosocial consequences of childhood cancer. Journal of Pediatric Nursing, 3150–158.
Mulhern, R. K., Carpentieri, S., Shema, S., Stone, P., & Fairclough, D. (1993). Factors associated with social and behavioral problems among children recently diagnosed with brain tumor. Journal of Pediatric Psychology, 18, 339–350.
Mulhern, R. K., Kepner, J. L., Thomas, P. R., Armstrong, D., Friedman, H. S., & Kun, L. E. (1998). Neuropsychologic functioning of survivors of childhood medulloblastoma randomized to receive conventional or reduced-dose craniospinal irradiation: A pediatric oncology group study. Journal of Clinical Oncology, 16, 1723–1728.
Mulhern, R. K., Reddick, W., Palmer, S. L., Glass, J.O., Elkin, T.D., Kun, L. E., et al. (1999). Neurocognitive deficits in medulloblastoma survivors and white matter loss. Annals of Neurology, 46834–841.
Newacheck, P., & Stoddard, J. (1994). Prevalence and impact of childhood chronic illnesses. Journal of Pediatrics, 124, 440–447.
Packer, R. J., Sutton, L. N., Atkins, T. E., Radcliffe, J., Bunin, G. R., D'Angio, G., et al. (1989). A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: 2-year results. Journal of Neurosurgery, 70, 707–713.
Radcliffe, J., Bennett, D., Kazak, A. E., Foley, B., & Phillips, P. C. (1996). Adjustment in childhood brain tumor survival: Child, mother, and teacher report. Journal of Pediatric Psychology, 21529–539.
Ris, M. D., & Nob, R. B. (1994). Long-term neurobehavioral outcome in pediatric brain tumor patients: Review and methodological critique. Journal of Clinical and Experimental Neuropsychology, 1621–42.
Wechsler, D. (1991). Wechsler Intelligence Scale for children–Third Edition. New York: The Psychological corporation, Harcourt Brace Jovanovich.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Holmquist, L.A., Scott, J. Treatment, Age, and Time-Related Predictors of Behavioral Outcome in Pediatric Brain Tumor Survivors. Journal of Clinical Psychology in Medical Settings 9, 315–321 (2002). https://doi.org/10.1023/A:1020791018897
Issue Date:
DOI: https://doi.org/10.1023/A:1020791018897