Young children treated for brain tumors less ready for school than their peers
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Key takeaways:
- Young children who underwent treatment for brain tumors had lower academic readiness scores than their peers.
- Lower socioeconomic status correlated with poorer results.
Young children who underwent treatment for brain tumors had lower academic readiness scores than their peers, according to results of a prospective longitudinal trial.
Gaps widened with age, results showed.
Researchers identified socioeconomic status as the only demographic or medical factor predictive of academic readiness, with higher socioeconomic status associated with better outcomes.
“I want us to be monitoring academic building blocks early on,” researcher Heather M. Conklin, PhD, chief of the neuropsychology division at St. Jude Children’s Research Hospital, told Healio. “Sometimes parents and clinicians feel like children will catch up. They think, ‘They’re not feeling well, they need a nap, let’s not bother them, let’s just get through treatment.’ It’s really important we don’t do that. We should be monitoring their academic readiness so that we can intervene early with those kids given we know it’s going to predict long-term outcomes.”
Background
Prior studies showed school-aged and older children treated for brain tumors had greater academic difficulty, needed special education services more often and had reduced scholastic success than their peers, according to study background.
Factors associated with those outcomes included younger age at time of treatment, increased treatment intensity, treatment complications and socioeconomic status.
However, data on young children is lacking.
“This group is probably at the greatest risk for cognitive problems, including downstream academic issues, because their brain is the most rapidly developing,” Conklin said. “There’s more to disrupt by the tumor and necessary treatment, and their treatment is long. Often they’re here for several months, if not a year. They miss important typical developmental experiences while they’re here, such as going to daycare, playing at the park, having playdates, or even more formalized early intervention services like speech, language or occupational therapy.”
Methods and results
Conklin and colleagues assessed 70 children (67.1% boys; 78.6% white) aged 3 years or younger with a newly diagnosed central nervous system tumor, or aged 3 to 5 years with standard-risk medulloblastoma (mean age at diagnosis, 1.8 years).
Comparable percentages of patients had received chemotherapy only (34.3%), chemotherapy plus photon radiation (30%), or chemotherapy plus proton radiation (35.7%).
Researchers evaluated participants’ academic readiness at baseline, 6 months after baseline, at the conclusion of treatment and annually after for up to 5 years. Median age at first assessment was 3.6 years.
Academic readiness and academic achievement for reading and math served as primary endpoints.
Participants had an average baseline academic readiness score of 9.35, with a decrease of 0.33 points per year thereafter.
“We usually say 7 to 13 is average, but 10 is spot-on average. Losing a third of a point a year is meaningful because, in 3 or 4 years, by the time we’re looking more at math and reading, they’re starting to fall in the below-average range,” Conklin said. “Typically their skills do improve over time. They are, year after year, learning new skills. It’s just the rate at which they’re doing that is slower, so the gap gets bigger between them and their same-age peers.”
Lower socioeconomic status appeared associated with lower academic readiness scores. However, researchers did not identify associations between academic readiness scores and age at diagnosis, risk group, tumor location, resection extent, shunt placement, PFS status or treatment type.
“How aggressively we treat them, their tumor location and shunt management for hydrocephalus [are] predictive [among] older kids with brain tumors,” Conklin said. “We were surprised [we didn’t see that with] these younger kids. It needs replication in a larger sample, but our thought is that [for] these very young kids, missing these early typical developmental opportunities has more salience for academic outcomes. Therefore, relative to older kids with brain tumors, it’s overshadowing some of these other clinical factors we usually see as predictive.”
‘Good for all’
Some cancer centers have implemented strategies to mitigate these academic shortcomings. These include reserving aggressive treatment for specific cases, having children around their parents and siblings as much as possible, and offering school programming in hospitals.
St. Jude has had a school program for the 2 decades Conklin has worked there, and they have implemented a preschool program, as well.
“Continuing to create those opportunities for families will be really important in addition to monitoring and getting the formal interventions in place, like speech, language and occupational therapy when you see the child needs those things,” Conklin said.
St. Jude also is conducting the SJiMB21 study, designed to evaluate risk-based medulloblastoma treatment for infants and young children. The study includes randomization to a 50-minute education session with parents about brain development.
Researchers paired that education session with a developmental app, which provides ideas for activities children can do at the hospital with everyday objects, such as crayons and straws.
“When we developed this intervention, we used focus groups with parents who already had a child treated for a brain tumor under 3 years of age,” Conklin said. “[We wanted] to make sure they wouldn’t feel this was overly burdensome, or they wouldn’t have additional guilt now that not only are they caring for a very sick child and worried about that outcome, but they’re not giving them opportunities they should be doing. Over and over, the parents said, ‘This would have really felt empowering, particularly if the team could support us.’”
More research is necessary though, particularly regarding the impact of socioeconomic status.
“What is driving it?” Conklin asked. “Can we harness what’s protective about higher socioeconomic status for families of lower socioeconomic status?”
Conklin and colleagues are investigating aspects such as home literacy — which includes how many books are in the home and how often children are read to — as well as school quality, parental vocabulary levels, parenting stress and nutrition.
“A lot of these are modifiable,” Conklin said. “I talk to the families that I know are struggling in these areas and we try to troubleshoot things. Is there an older sibling who can read with the child while you’re cooking dinner or working on homework with someone else? Is there a free library hour you could be going to once a week and getting that reading exposure and interaction with other kids? Can we advocate more for services in your school? We’re trying to do what seems most obvious but, at the same time, get that research validation of which factors are driving the benefit of higher socioeconomic status.”
For more information:
Heather M. Conklin, PhD, can be reached at heather.conklin@stjude.org.
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