Cognition, psychosocial functioning, and health-related quality of life among childhood cancer survivors

Figures & data

Table 1. Demographic and clinical data.

	Controls (n = 56)	CC survivors (n = 78)			CC subgroups (n = 78)
					without CNS involvement  (n = 61)	with CNS involvement (n = 17)
	Mean (SD) range	Mean (SD) range	t/${\chi }^2$	p	Mean (SD) range	Mean (SD) range	t/${\chi }^2$	p
Age	11.49 (2.75) 7.0 – 16.2	11.23 (2.49) 7.3 – 16.7	0.58	.565	10.90 (2.32) 7.28 – 15.56	12.42 (2.80) 7.98 – 16.70	−2.29	.025*
Sex (female/male)	27/29	32/46	0.68	.408	25/36	7/10	< 0.01	.989
SES	6.84 (1.49) 4 – 9	6.6 (1.43) 2 – 9	0.77	.446	6.58 (1.60) 2 – 9	6.68 (1.77) 2 – 9	−0.2	.843
Age at diagnosis	N/A	5.38 (3.13) 0.6 – 12.7	N/A	N/A	4.94 (3.04) 0.67 – 12.74	6.95 (3.05) 0.57 – 12.13	2.4	.019*
Treatment duration	N/A	1.34 (0.92) 0.0 – 3.6	N/A	N/A	1.45 (0.84) 0.15 – 3.18	0.93 (1.09) 0.00 – 3.63	−2.13	.036*
Years since cancer treatment	N/A	4.51 (2.04) 1.1 – 9.2	N/A	N/A	4.50 (2.05) 1.13 – 9.15	4.55 (2.08) 1.11 – 7.48	0.08	.939

Note. Units of age, age at diagnosis, and treatment duration = years; N/A = not applicable; SD = standard deviation;

n = sample size; CC = childhood cancer; SES = socio-economic status: ranging from 1 to 9, with higher scores representing higher SES; t = t-value;

${\chi }^2$ = chi-square; p = level of statistical significance, * < .05.

Figure 1. Percentage of childhood cancer (CC) survivors and controls with performance below the normative range in cognitive domains. The dotted line indicates the cut-off of the percentage of survivors expected to perform below the normative range according to the Gaussian distribution.

Table 2. Cognitive functions.

		Controls (n = 56)	CC survivors (n = 78)
		Mean (SD) range	Mean (SD) range	t	p	Effect size^c
Fluid intelligence^a		107.36 (12.22)	105.99 (11.69)	0.66	.291	0.10
		85 – 132	82 – 136
Working memory	verbal^a	101.8 (13.09)	96.47 (11.63)	2.48	.007*	0.44
		78 –146	73 – 128
	visuospatial^a	108.28 (16.84)	100.48 (18.85)	2.45	.007*	0.43
		73 – 140	56 – 145
Inhibition	completion time^b	11.07 (2.44)	9.92 (2.86)	2.42	.008*	0.43
		4 –15	1 – 15
errors^b		11.00 (2.19)	10.96 (2.21)	0.10	.460	0.02
		3 – 14	3 – 14
Cognitive flexibility	completion time^b	10.95 (2.61)	9.98 (2.83)	1.96	.025*	0.35
		2 – 16	1 – 14
errors^b		10.83 (2.38)	10.56 (2.30)	0.65	.259	0.12
		4 – 15	4 – 14
Planning^b		12.57 (2.43)	11.99 (2.70)	1.29	.101	0.22
		5 – 17	5 – 18
Verbal memory^b		12.55 (2.34)	11.72 (2.59)	1.92	.028*	0.33
		8.5 – 17.5	5.0 – 17.5
Selective attention^b		10.81 (2.79)	9.67 (3.42)	2.04	.021*	0.36
		5 – 16	1 – 18
Processing speed^a		105.5 (12.37)	101.42 (16.10)	1.66	.007*	0.28
		79 – 134	53 – 131

Note. CC = childhood cancer; N/A = not applicable; SD = standard deviation; n = sample size; t = t-value,

p = level of statistical significance, * < .05.

^a Standard score (mean 100, SD 15)

^b Scaled score (mean 10, SD 3)

^c g Hedges for continuous variables with unequal sample sizes

Table 3. Psychosocial functions and health-related quality of life.

	Controls (n = 56)	CC survivors (n = 78)				CC subgroups
						without CNS involvement (n = 61)	with CNS involvement (n = 17)
	Mean (SD)	Mean (SD)	t	p	Effect size^c	Mean (SD)	Mean (SD)	t	p	Effect size^c
Psychosocial behavior^a
Total difficulty score	4.06 (0.30)	4.34 (0.71)	−2.62	.005*	0.49	4.26 (0.76)	4.61 (0.91)	−1.43	.078	0.44
Emotional problems	4.21 (0.49)	4.31 (0.63)	−0.93	.178	0.17	4.26 (0.73)	4.48 (0.77)	−1.05	.149	0.30
Conduct problems	4.20 (0.50)	4.40 (0.71)	−1.75	.041*	0.32	4.37 (0.85)	4.48 (0.75)	−0.54	.300	0.13
Hyperactivity/Inattention	4.10 (0.33)	4.31 (0.55)	−1.88	.034*	0.45	4.24 (0.61)	4.54 (0.83)	−1.32	.093	0.45
Peer problems	4.20 (0.49)	4.50 (0.79)	−2.61	.005*	0.44	4.34 (0.66)	5.05 (1.20)	−2.73	.003*	0.88
Prosocial behavior	4.18 (0.51)	4.16 (0.48)	0.13	.449	0.04	4.12 (0.42)	4.33 (0.62)	−1.22	.113	0.45
Health-related quality of life^b
Parent-reports	53.10 (9.95)	50.89 (10.84)	1.15	.246	0.21	51.80 (9.58)	47.61 (13.59)	1.3	.198	0.39
Self-reports	51.42 (12.35)	51.05 (12.48)	0.17	.87	0.03	52.41 (12.17)	46.18 (12.50)	1.57	.124	0.51

Note. CC = childhood cancer; SD = standard deviation; n = sample size; t= t-test; p = level of statistical significance, *< .05.

^a range of entire scale: 1–7; 4 = average, > 5 = slightly raised, ≥ 6 raised

^b T-values (mean 50, SD 10): higher values indicate higher quality of life

^c g Hedges for variables with unequal sample sizes

Figure 2. Percentage of childhood cancer (CC) subgroups with performance below the normative range in cognitive domains. The dotted line indicates the cut-off of the percentage of survivors expected to perform below the normative range according to the Gaussian distribution.

Table 4. Cognitive functions of childhood cancer subgroups.

		CC survivors
		without CNS involvement (n = 61)	with CNS involvement (n = 17)
		Mean (SD) range	Mean (SD) range	t/ F	p	Effect size^c
Fluid intelligence^a		106.82 (11.98)	103.00 (10.37)	1.2	.118	0.33
		82 – 136	83 – 121
Working memory	verbal^a	96.69 (11.80)	95.71 (11.31)	0.31	.380	0.08
		75 – 128	73 – 111
	visuospatial^a	102.23 (17.94)	94.22 (21.19)	1.56	.059	0.43
		56 – 145	56 – 131
Inhibition	completion time^b	10.20 (2.74)	8.92 (3.13)	1.61	.054	0.45
		1 – 15	1 – 15
	errors^b	11.16 (2.07)	10.21 (2.61)	1.57	.058	0.43
		6 – 14	3 – 14
Cognitive flexibility	completion time^b	10.71 (2.07)	7.36 (3.61)	3.62	< .0005* .001***	1.35
		5 – 14	1 – 13
	errors^b	10.92 (1.83)	9.28 (3.25)	1.95	.026*	0.74
		6 – 14	4 – 15
Planning^b		12.20 (2.52)	11.24 (3.25)	1.13	.136	0.36
		5 – 18	5 – 15
Verbal memory^b		12.13 (2.49)	10.22 (2.43)	1.91	.003*	0.77
		5 – 17.5	7 – 15.5
Selective attention^b		10.07 (2.96)	8.24 (4.56)	1.99	.024*	0.55
		4 – 17	1 – 18
Processing speed^a		103.97 (14.20)	92.29 (19.44)	2.75	.003*	0.76
		65 – 131	53 – 126

Note. CC = Childhood cancer; SD = standard deviation; n = sample size; t = t-value

p = level of statistical significance, *< .05.

^a Standard score (mean 100, SD 15)

^b Scaled score (mean 10, SD 3)

^c g Hedges for continuous variables with unequal sample sizes

Data availability statement

All data of this study are available upon reasonable request after signing a confidentiality statement and a data sharing agreement.