A phase 2 prospective longitudinal study found that family socioeconomic status (SES) is a strong predictor of neurocognitive outcomes in survivors after treatment for childhood brain tumors. Acute and chronic neurocognitive sequelae have been well described in these patients, but it has been suggested that the risk of cognitive problems depends primarily on what treatments the patient received and other factors such as tumor type and age at diagnosis.
This research was led by researchers at St. Jude Children’s Hospital in Memphis, Tennessee, and published in Neuro-Oncology.1 It suggests that family SES is a significant predictor of whether childhood brain tumor survivors have up to a decade of long-term neurocognitive sequelae will have after their treatment.
Investigation of cognitive problems
Children treated for brain cancer typically have a variety of risk factors for cognitive problems. The tumor itself can cause symptoms such as language or vision problems that may have led to the initial diagnosis. Surgical resection of tumors carries the risk of damage to cognitive function, and skull irradiation and certain types of chemotherapy are also associated with neurocognitive consequences.
“The risk of cognitive problems is multifactorial as many previous studies have described, and treatment at a younger age was previously the most reliable risk factor for cognitive problems,” said Heather Conklin, PhD, of the Department of Psychology at St. Jude and lead author of the Job.
“What was most surprising about our study was that, for some interventions, the contribution of socio-economic status was even greater than the age at treatment, which was normally the case [considered] the biggest risk factor, “added Dr. Conklin added.
The researchers followed the progress of 248 children treated for ependymoma, low-grade glioma, or craniopharyngioma. The research team frequently performed cognitive assessments of study participants during the 10-year follow-up period. A variety of metrics were assessed, including IQ, reading and math performance, attention, and adaptive function.
Each participant’s SES was assessed using the Barratt Simplified Measure of Social Status, which takes into account parenting occupation, education, and marital status.
The role of socio-economic factors
It is known that a high SES correlates with better cognitive performance in healthy children, and similarly, a low SES predicts poorer cognitive performance. The study found significant associations between SES and IQ, academic performance in reading and math, and adaptive function, with higher SES predicting better pre-radiotherapy performance in pediatric brain tumor survivors.
However, the study found that SES after radiation therapy (IQ and reading and math performance) predicted a change over time in three of these metrics, with higher SES associated with less cognitive decline in these areas.
“Most excitingly, what is driving this SES impact is changeable – whether it’s reading books at home or growing advocacy for school services. We can’t change age at diagnosis or gender, but we can potentially take advantage of the good and protective of high SES and change things for it [low SES] Children, “said Dr. Conklin.
Researchers plan further analysis to determine exactly which factors associated with high SES are associated with better cognitive outcomes for childhood brain tumor survivors, with the hope that this will lead to interventions to improve cognitive outcomes for childhood brain tumor survivors from families with low SES.
“We have been trying some of these things clinically for years, but it becomes much easier and more effective when we know what to aim for. We have to dismantle what protects the high SES. For example, is it parental style, vocabulary, literacy, advocacy for the child’s school? We believe these things correlate with high SES and therefore better outcomes for childhood brain tumor survivors, but we need to find out what contributes the most, ”said Dr. Conklin.
SES-based improvement interventions are not the only strategies for improving cognitive outcomes in this patient population. Dr. Conklin is also conducting an ongoing clinical trial (ClinicalTrials.gov identifier NCT03194906) of the dementia drug memantine to see if it can be used to modify cognitive outcomes in childhood brain cancer survivors.
Other measures currently being investigated to prevent cognitive changes in this group of patients concern the diabetes drug metformin, which showed promising results in a clinical pilot study last year
- Torres VA, Ashford JM, Wright E. et al. The influence of socioeconomic status (SES) on cognitive outcomes after radiation therapy for brain tumors in children: a prospective longitudinal study. Neuro Oncol. Published online February 5, 2021. doi: 10.1093 / neuonc / noab018
- Ayoub R., Ruddy RM, Cox E. et al. Evaluation of cognitive and neural recovery in childhood brain tumor survivors in a pilot clinical study using metformin. Nat Med. 2020; 26 (8): 1285- 1294. doi: 10.1038 / s41591-020-0985-2
This article originally appeared on Cancer Therapy Advisor