Neuroblastoma survivors face increased risk for psychological impairment

Children who survived neuroblastoma demonstrated an increased risk for psychological impairments, according to study results.

Developments of psychological impairments, in turn, appeared associated with lower education levels.

“Subsets of neuroblastoma survivors may be vulnerable to long-term health impairments because of their young age at diagnosis and the specific therapies they receive. However, late psychological effects of treatment are understudied in this population,” Nina S. Kadan-Lottick, MD, associate professor of pediatrics at Yale School of Medicine, and colleagues wrote.

“In the United States, children with neuroblastoma are diagnosed at a median age of 17.3 months,” Kadan-Lottick and colleagues added. “This young age may place them at increased risk for psychological impairment because of contributions from both the early biologic insult to the developing central nervous system and the disruption of normal psychosocial development by intensive cancer treatment.”

As part of the ongoing Childhood Cancer Survivor Study, researchers compared 859 patients who had survived neuroblastoma for at least 5 years with 872 siblings of childhood cancer survivors aged younger than 18 years.

Patients were aged a median 0.8 years at the time of diagnosis. Median follow-up was 13.3 years.

Kadan-Lottick and colleagues compared the two groups’ parent-reported Behavior Problem Index scores for psychological functioning. Investigators used age- and sex-adjusted models to identify factors associated with impairment.

Survivors demonstrated increased prevalence of impairment in the categories of anxiety and depression compared with siblings (19% vs. 14%; P = .003), as well as increased prevalence of headstrong behavior (19% vs. 13%; P < .001), attention deficits (21% vs. 13%; P < .001), peer conflicts or social withdrawal (26% vs. 17%; P < .001), and antisocial behavior (16% vs. 12% P = .01).

Specific treatments — including vincristine, cisplatin and retinoic acid — did not appear associated with any psychological impairments.

The presence of two or more chronic health problems was predictive of psychological impairment in four domains (P < .001).

Pulmonary disease appeared predictive of impairment in all five domains (P ≤ .004), whereas endocrine disease (P ≤ .004) and peripheral neuropathy (P ≤ .02) both predicted impairment in three domains.

Psychological impairments appeared associated with increased use of special education services and attaining education levels lower than college.

“This is the first large study that could look at how neuroblastoma patients are doing in terms of psychological and educational outcomes,” Kadan-Lottick said in a press release. “Before recent advances in treatment, this survivor population was much smaller, and we were not able to analyze these sorts of long-term outcomes.

“The goal is not simply to get our patients to be cancer free but also to optimize their mental, emotional and social functioning as they move into adolescence and adulthood,” she added. “Our hope is that these findings will help inform strategies for early screening and intervention to identify those survivors at highest risk for developing psychological and educational impairment later on in life.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.