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Executive functioning, academic skills, and quality of life in pediatric patients with brain tumors post-proton radiation therapy

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Abstract

Radiation therapy (RT) is integral in the treatment of pediatric brain tumors; however, photon RT (XRT) often results in intellectual decline, executive functioning (EF) deficits, academic underachievement/failure, and lower health-related quality of life (HRQoL). Proton RT (PRT) provides more targeted therapy, minimizing damage to the developing brain, yet few studies have examined its neuropsychological effects. This study investigated the role of EF in academic skills and HRQoL in a sample of children treated with PRT. A mediation model was proposed in which academic skills mediated relations between aspects of EF and school-based HRQoL (sHRQoL). Sixty-five children (x̅age = 12.4; 43.9% male) treated with PRT completed follow-up neuropsychological testing as part of routine care. Measures included assessment of intellectual functioning, EF, attention, and academic skills (reading, math, spelling). Parents reported on children’s EF and attention problems. sHRQoL was assessed via child self-report. Children who underwent PRT demonstrated relatively intact intelligence, academics, attention, EF, and sHRQoL, but were at risk for reduced processing speed. Poorer working memory and processing speed were related to lower sHRQoL. Better EF and faster processing speed were associated with better academic skills, which were linked to higher sHRQoL. Better working memory was associated with better math performance, which was linked to higher sHRQoL; this relationship did not hold for reading or spelling. Results highlight the importance of EF skills in academic performance and sHRQoL, and the need for routine screening of EF deficits and proactive supports. Supports may include cognitive rehabilitation and in-class accommodations. Overall, results compare favorably to XRT outcomes reported in the literature.

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Notes

  1. Confidence interval results are as follows: overall EF → academic skills → sHRQoL (LLCIreading = − 0.63, ULCIreading = − 0.02; LLCImath = − 0.75, ULCImath = − 0.08; LLCIspelling = − 0.55, ULCIspelling = − 0.01); processing speed → academic skills → sHRQoL (LLCIreading = 0.01, ULCIreading = 0.31; LLCImath = 0.02, ULCImath = 0.34; LLCIspelling = 0.01, ULCIspelling = 0.26); working memory → math performance → sHRQoL (LLCImath = − 0.01, ULCImath = 0.45).

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Disclaimers

N.J.T. was on the medical advisory board of ProCure until 2008 and has stock options in ProCure that are currently without value. N.J.T.’s spouse continues to serve on the medical advisory board of ProCure. K.A.K. has stock or other ownership in Merk, Johnson and J ohnson, CVS, Pfiser, Eli Lily, and Novo Nordisk. K.A.K. has a consulting or advisory role in Roche. Actual or potential conflicts of interest do not exist for any other author.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA

    Lea M. Ventura, Julie A. Grieco, Casey L. Evans & Margaret B. Pulsifer

  2. Department of Pediatrics, Massachusetts General Hospital, Boston, MA, 02114, USA

    Karen A. Kuhlthau

  3. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA

    Shannon M. MacDonald, Nancy J. Tarbell & Torunn I. Yock

  4. Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA

    Lea M. Ventura

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  1. Lea M. Ventura
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Correspondence to Lea M. Ventura.

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Ventura, L.M., Grieco, J.A., Evans, C.L. et al. Executive functioning, academic skills, and quality of life in pediatric patients with brain tumors post-proton radiation therapy. J Neurooncol 137, 119–126 (2018). https://doi.org/10.1007/s11060-017-2703-6

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