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Neurological predictor scale is associated with academic achievement outcomes in long-term survivors of childhood brain tumors

  • Clinical Study
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Abstract

Introduction

Survivors of childhood brain tumors exhibit impairments in academic performance and have lower rates of educational attainment compared to healthy same-aged peers. Prior research has demonstrated the concurrent validity of the Neurological Predictor Scale (NPS), a measure that incorporates tumor-related treatments and complications into one cumulative score, in predicting IQ, adaptive functioning, and core neurocognitive skills. The purpose of this study is to determine whether the NPS predicts academic achievement outcomes over and above the effects of individual treatment factors alone.

Methods

Sixty-two adult survivors completed four untimed measures of academic achievement from the Woodcock–Johnson III.

Results

NPS scores significantly predicted performance on all four academic measures: Letter Word ID (R2 = − 0.454, p < .01), Calculation (R2 = − 0.494, p < .01), Spelling (R2 = − 0.428, p < .01) and Passage Comprehension (R2 = − 0.447, p < .01). 16% of survivors were impaired on the Letter Word ID, 23% on Calculation, 19% on Spelling, and 11% on Passage Comprehension subtests with impairment defined as z ≤ − 1.5. The NPS predicted academic outcomes over and above chemotherapy, surgery, seizure medication, endocrine dysfunction, hydrocephalus, and radiation on all measures.

Conclusion

This study extends prior research by demonstrating that the NPS is significantly associated with academic achievement in survivors on average 15.9 years after diagnosis. The NPS may be especially helpful in clinical research when studies lack the statistical power to investigate how treatments and neurological conditions individually contribute to outcomes.

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References

  1. Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67(1):7–30. https://doi.org/10.3322/caac.21387

    Article  PubMed  Google Scholar 

  2. Ward E, DeSantis C, Robbins A, Kohler B, Jemal A (2014) Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 64(2):83–103

    Article  PubMed  Google Scholar 

  3. Ris MD, Noll RB (1994) Long-term neurobehavioral outcome in pediatric brain-tumor patients: review and methodological critique. J Clin Exp Neuropsychol 16(1):21–42. https://doi.org/10.1080/01688639408402615

    Article  PubMed  CAS  Google Scholar 

  4. Palmer SL, Goloubeva O, Reddick WE, Glass JO, Gajjar A, Kun L, Merchant TE, Mulhern RK (2001) Patterns of intellectual development among survivors of pediatric medulloblastoma: a longitudinal analysis. J Clin Oncol 19(8):2302–2308

    Article  PubMed  CAS  Google Scholar 

  5. Hoppe-Hirsch E, Brunet L, Laroussinie F, Cinalli G, Pierre-Kahn A, Renier D, Sainte-Rose C, Hirsch J (1995) Intellectual outcome in children with malignant tumors of the posterior fossa: influence of the field of irradiation and quality of surgery. Child’s Nerv Syst 11(6):340–345

    Article  CAS  Google Scholar 

  6. Deary IJ, Strand S, Smith P, Fernandes C (2007) Intelligence and educational achievement. Intelligence 35(1):13–21

    Article  Google Scholar 

  7. Mabbott DJ, Spiegler BJ, Greenberg ML, Rutka JT, Hyder DJ, Bouffet E (2005) Serial evaluation of academic and behavioral outcome after treatment with cranial radiation in childhood. J Clin Oncol 23(10):2256–2263

    Article  PubMed  Google Scholar 

  8. Koch S, Kejs A, Engholm G, Johansen C, Schmiegelow K (2004) Educational attainment among survivors of childhood cancer: a population-based cohort study in Denmark. Br J Cancer 91(5):923

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Mitby PA, Robison LL, Whitton JA, Zevon MA, Gibbs IC, Tersak JM, Meadows AT, Stovall M, Zeltzer LK, Mertens AC (2003) Utilization of special education services and educational attainment among long-term survivors of childhood cancer. Cancer 97(4):1115–1126

    Article  PubMed  Google Scholar 

  10. Buono LA, Morris MK, Morris RD, Krawiecki N, Norris FH, Foster MA, Copeland DR (1998) Evidence for the syndrome of nonverbal learning disabilities in children with brain tumors. Child Neuropsychol 4(2):144–157. https://doi.org/10.1076/chin.4.2.144.3184

    Article  Google Scholar 

  11. Briere ME, Scott JG, McNall-Knapp RY, Adams RL (2008) Cognitive outcome in pediatric brain tumor survivors: delayed attention deficit at long-term follow-up. Pediatr Blood Cancer 50(2):337–340. https://doi.org/10.1002/pbc.21223

    Article  PubMed  Google Scholar 

  12. Robinson KE, Kuttesch JF, Champion JE, Andreotti CF, Hipp DW, Bettis A, Barnwell A, Compas BE (2010) A quantitative meta-analysis of neurocognitive sequelae in survivors of pediatric brain tumors. Pediatr Blood Cancer 55(3):525–531

    Article  PubMed  Google Scholar 

  13. Mulhern RK, Palmer SL, Merchant TE, Wallace D, Kocak M, Brouwers P, Krull K, Chintagumpala M, Stargatt R, Ashley DM (2005) Neurocognitive consequences of risk-adapted therapy for childhood medulloblastoma. J Clin Oncol 23(24):5511–5519

    Article  PubMed  Google Scholar 

  14. Ris MD, Walsh K, Wallace D, Armstrong FD, Holmes E, Gajjar A, Zhou T, Packer RJ (2013) Intellectual and academic outcome following two chemotherapy regimens and radiotherapy for average-risk medulloblastoma: COG A9961. Pediatr Blood Cancer 60(8):1350–1357. https://doi.org/10.1002/pbc.24496

    Article  PubMed  PubMed Central  Google Scholar 

  15. Silber JH, Radcliffe J, Peckham V, Perilongo G, Kishnani P, Fridman M, Goldwein JW, Meadows AT (1992) Whole-brain irradiation and decline in intelligence: the influence of dose and age on IQ score. J Clin Oncol 10(9):1390–1396. https://doi.org/10.1200/JCO.1992.10.9.1390

    Article  PubMed  CAS  Google Scholar 

  16. Micklewright JL, King TZ, Morris RD, Krawiecki N (2008) Quantifying pediatric neuro-oncology risk factors: development of the neurological predictor scale. J Child Neurol 23(4):455–458

    Article  PubMed  Google Scholar 

  17. Hardy KK, Bonner MJ, Willard VW, Watral MA, Gururangan S (2008) Hydrocephalus as a possible additional contributor to cognitive outcome in survivors of pediatric medulloblastoma. Psychooncology 17(11):1157–1161. https://doi.org/10.1002/pon.1349

    Article  PubMed  Google Scholar 

  18. Taiwo Z, Na S, King TZ (2017) The Neurological Predictor Scale: a predictive tool for long-term core cognitive outcomes in survivors of childhood brain tumors. Pediatr Blood Cancer 64(1):172–179. https://doi.org/10.1002/pbc.26203

    Article  PubMed  CAS  Google Scholar 

  19. McCurdy MD, Rane S, Daly BP, Jacobson LA (2016) Associations among treatment-related neurological risk factors and neuropsychological functioning in survivors of childhood brain tumor. J Neurooncol 127(1):137–144

    Article  PubMed  CAS  Google Scholar 

  20. King TZ, Na S (2016) Cumulative neurological factors associated with long-term outcomes in adult survivors of childhood brain tumors. Child Neuropsychol 22(6):748–760

    Article  PubMed  Google Scholar 

  21. Woodcock RW, McGrew KS, Mather N, Schrank F (2001) Woodcock-Johnson R III NU tests of achievement. Riverside, Itasca

    Google Scholar 

  22. Mather N, Wendling BJ (2015) Essentials of WJ IV tests of achievement. Wiley, New York

    Google Scholar 

  23. Cor IS (2016) Ibm spss statistics for windows, version 24.0. IBM Corp, Armonk (NY)

    Google Scholar 

  24. Holland AA, Hughes CW, Stavinoha PL (2015) School competence and fluent academic performance: informing assessment of educational outcomes in survivors of pediatric medulloblastoma. Appl Neuropsychol Child 4(4):249–256

    Article  PubMed  Google Scholar 

  25. Ach E, Gerhardt CA, Barrera M, Kupst MJ, Meyer EA, Patenaude AF, Vannatta K (2013) Family factors associated with academic achievement deficits in pediatric brain tumor survivors. Psychooncology 22(8):1731–1737. https://doi.org/10.1002/pon.3202

    Article  PubMed  Google Scholar 

  26. Mulhern RK, Merchant TE, Gajjar A, Reddick WE, Kun LE (2004) Late neurocognitive sequelae in survivors of brain tumours in childhood. Lancet Oncol 5(7):399–408

    Article  PubMed  Google Scholar 

  27. Mulhern RK, Palmer SL, Reddick WE, Glass JO, Kun LE, Taylor J, Langston J, Gajjar A (2001) Risks of young age for selected neurocognitive deficits in medulloblastoma are associated with white matter loss. J Clin Oncol 19(2):472–479

    Article  PubMed  CAS  Google Scholar 

  28. Jayakar R, King TZ, Morris R, Na S (2015) Hippocampal volume and auditory attention on a verbal memory task with adult survivors of pediatric brain tumor. Neuropsychology 29(2):303

    Article  PubMed  Google Scholar 

  29. King T, Wang L, Mao H (2015) White matter integrity disruption in normal appearing white matter: Correlates with long term intellectual outcomes of childhood brain tumor survivors. PLoS ONE 10(7):1–17

    Google Scholar 

  30. Na S, Li L, Crosson B, Dotson V, MacDonald TJ, Mao H, King TZ (2018) White matter network topology relates to cognitive flexibility and cumulative neurological risk in adult survivors of pediatric brain tumors. NeuroImage Clin 20:485–497

    Article  PubMed  PubMed Central  Google Scholar 

  31. Organization WH (2001) International classification of functioning, disability and health: ICF. World Health Organization, Geneva

    Google Scholar 

  32. Gragert MN, Ris MD (2011) Neuropsychological late effects and rehabilitation following pediatric brain tumor. J Pediatr Rehabil Med 4(1):47–58

    PubMed  Google Scholar 

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Acknowledgements

We are grateful to all the individuals and families who participated in this study, as this research would not be possible without their time and effort. We would like to acknowledge the Brain Tumor Foundation for helping share information about this clinical research opportunity with long-term brain tumor survivors. Additionally, we thank the Developmental Neuropsychology Across the Lifespan Research Team for assistance with data acquisition and management. This research was supported by a Research Scholar Grant from the American Cancer Society to TZK (#RSGPB-CPPB-114044). RK was supported by a doctoral fellowship provided by the Georgia State University Second Century Neurogenomics Initiative.

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Correspondence to Tricia Z. King.

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Kautiainen, R.J., Na, S.D. & King, T.Z. Neurological predictor scale is associated with academic achievement outcomes in long-term survivors of childhood brain tumors. J Neurooncol 142, 193–201 (2019). https://doi.org/10.1007/s11060-018-03084-w

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  • DOI: https://doi.org/10.1007/s11060-018-03084-w

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