Executive Function and Psychosocial Adjustment in Adolescent Survivors of Pediatric Brain Tumor

Figures & data

Table 1. Clinical characteristics

		N survey group (n= 48)	%	N retested subgroup (n= 26)	%
Tumor diagnosis
	Ependymomas and choroid plexus tumors	6	12.5	4	15.4
	Astrocytomas	23	47.9	13	50.0
	Embryonal tumors	16	33.3	6	23.1
	Other gliomas	1	2.1	-	-
	Other CNS-tumors	2	4.2	3	11.5
Tumor location
	Supratentorial	14	29.2	7	26.9
	Infratentorial	32	66.7	18	69.2
	Both	2	4.2	1	3.8
Treatment
	Surgery only	28	58.3	17	65.4
	Surgery and chemotherapy	9	18.8	5	19.2
	Surgery and CRT^a	1	2.1	-	-
	Surgery, chemotherapy and CRT^a	10	20.8	4	15.4
Number of surgeries
	One surgery	40	83.3	20	76.9
	Two or more surgeries	8	16.7	6	23.1
Postoperative hydrocephalus treatment^b
	Yes	7	14.6	3	11.5
	No	41	85.4	23	88.5
Postoperative seizures
	Yes	6	12.5	3	11.5
	No	42	87.5	23	88.5
Hormone replacement treatment^c
	Yes	12	25.0	6	23.1
	No	36	75.0	20	76.9
Psychiatric comorbidity
	Yes	8	15.7	3	11.5
	No	43	84.3	23	88.5

^aCRT = cranial radiation therapy ^b Ventriculoatrial shunt (VA), ventriculperitoneal shunt (VP) or third ventriculostomy (3CVS), ^c Hormone replacement treatment, e.g., growth hormone, cortisol, thyroid stimulating hormone, testosterone and estrogen, and antidiuretic hormone.

Table 2. Self- and parent-reported executive functioning, psychological symptoms, and fatigue at ≥2 years after PBT-treatment completion compared to healthy controls

	PBT survivors (n= 48)	Controls (n= 73)	Mann-Whitney test	Effect size	Parents of PBT survivors	Parents of controls	Mann-Whitney test	Effect size
	Mean (SD)	Mean (SD)	p	r	Mean (SD)	Mean (SD)	p	r
BRIEF scales (T-scores)
Inhibit	-	-	-	-	45.6 (8.01)	45.6 (7.51)	.726	.03
Shift	-	-	-	-	48.2 (11.01)	43.4 (6.99)	.017^2	−.22
Emotional Control	-	-	-	-	48.3 (9.56)	43.9 (8.23)	.012^2	−.23
Initiate	-	-	-	-	49.1 (13.44)	45.6 (8.91)	.049	−.18
Working Memory	-	-	-	-	54.1 (14.06)	47.0 (9.34)	.004^1,2	−.26
Plan/Organize	-	-	-	-	51.2 (11.61)	46.3 (9.22)	.012^2	−.23
Organization of Materials	-	-	-	-	44.6 (10.95)	44.9 (10.73)	.798	.02
Monitor	-	-	-	-	47.9 (10.49)	44.2 (9.18)	.035^2	−.19
BRI	-	-	-	-	47.0 (9.19)	43.5 (7.52)	.045^2	−.18
MI	-	-	-	-	49.1 (13.81)	45.2 (9.59)	.026	−.20
GEC	-	-	-	-	47.9 (12.98)	44.2 (9.07)	.017	−.22
YSR, CBCL subscales (T-scores)
Total Competence	38.5 (11.09)	47.1 (10.97)	<.001^1,2	.36	38.3 (10.45)	47.5 (9.81)	<.001^1,2	.40
Anxious/Depressed	55.8 (6.53)	53.9 (7.52)	.120	−.14	56.4 (9.99)	52.0 (3.47)	.095^2	−.15
Withdrawn/Depressed	55.1 (5.58)	54.4 (7.00)	.301	−.09	57.3 (8.24)	53.5 (4.75)	.008^2	−.24
Somatic Complaints	54.8 (5.86)	53.6 (6.08)	.088	−.16	60.4 (9.99)	55.0 (5.56)	.005^2	−.25
Social Problems	55.9 (8.11)	52.7 (4.81)	.019^2	−.21	56.4 (8.45)	51.4 (3.36)	<.001^1,2	−.37
Thought Problems	54.1 (5.29)	53.3 (5.95)	.459	−.07	54.6 (7.03)	51.9 (4.03)	.094^2	−.15
Attention Problems	55.1 (7.64)	52.3 (5.32)	.074^2	−.16	55.9 (6.22)	52.5 (4.40)	<.001^1,2	−.35
Rule-Breaking Behavior	52.5 (3.29)	52.7 (4.57)	.321	−.09	52.0 (3.46)	51.4 (2.92)	.149	−.13
Aggressive Behavior	52.7 (4.59)	51.5 (3.92)	.141	−.14	52.3 (4.64)	51.5 (3.92)	.432	−.07
Internalizing Problems	52.4 (9.46)	49.9 (9.76)	.066	−.17	55.2 (12.31)	48.0 (8.91)	.002^1,2	−.28
Externalizing Problems	47.3 (8.43)	45.0 (8.90)	.088	−.16	45.0 (9.37)	42.5 (8.51)	.117	−.14
Total Problems	49.7 (9.67)	46.5 (9.36)	.079	−.16	50.9 (11.36)	43.5 (9.10)	<.001^1,2	−.32
PedsQL scales (Likert-scores)
Physical Functioning	82.8 (19.95)	91.4 (10.07)	.023^2	.21	79.2 (22.17)	92.7 (11.06)	<.001^1,2	.34
Emotional Functioning	72.3 (19.68)	82.0 (16.49)	.005^1,2	.25	74.2 (21.91)	82.9 (14.18)	.044^2	.18
Social Functioning	81.3 (21.09)	93.0 (10.89)	.001^1,2	.30	76.4 (24.30)	91.7 (11.58)	.001^1,2	.29
School Functioning	66.6 (20.81)	82.6 (15.98)	<.001^1,2	.40	65.6 (22.40)	82.9 (15.52)	<.001^1,2	.39
Total score	75.7 (17.23)	87.2 (11.25)	<.001^1,2	.39	73.8 (18.35)	87.6 (8.83)	<.001^1,2	.39
PedsQL-MFS scales (Likert-scores)
General Fatigue	71.2 (18.97)	81.7 (16.34)	.001^1,2	.30	-	-	-	-
Sleep/Rest Fatigue	65.1 (16.77)	67.8 (20.36)	.280	.10	-	-	-	-
Cognitive Fatigue	62.6 (25.43)	80.9 (17.01)	<.001^1,2	.36	-	-	-	-
Total score	66.2 (17.07)	76.7 (14.78)	.001^1,2	.31	-	-	-	-

¹indicate between-group differences that remained significant after Bonferroni corrections for multiple comparisons.

²indicate between-group differences that were significant after adjustment for age.

Table 3. Neuropsychological test scores for a subsample of the PBT survivors

				ES* d	% < 1.5 SD
	Mean	SD	Range
Estimated current IQ	48.3	10.26	30.0–71.0	.17	7.7
Processing speed	43.5	9.79	25.8–65.0	.66	26.9
Auditory attention span	47.8	11.34	23.5–76.7	.21	19.2
Sustained attention	49.0	7.08	35.0–64.0	.12	3.8
Verbal learning	47.3	16.42	20.0–74.7	.20	19.2
Verbal recall	46.7	17.15	20.0–70.7	.24	34.6
Verbal fluency	48.6	11.15	28.3–80.0	.13	7.7
EF: shift	41.7	12.44	20.0–65.0	.74	38.5
EF: updating	49.2	9.30	30.0–73.3	.08	3.8
EF: inhibition	46.1	8.75	31.0–66.5	.42	7.7

Numbers in bold indicate p < .05. SD = standard deviation.

* Effect size (ES): Cohen’s d calculated with reference to the normative mean (T = 50, SD = 10)

Table 4. Self- and parent-reported executive functioning, psychological symptoms, and fatigue in ICCC-3 tumor type subgroups

	Ependymomas and choroid plexus tumors (ECPT) (n= 6)		Astrocytomas (A) (n= 23)		Embryonal tumors (ET) (n= 16)		Post hoc tests	Effect size
	Mean	SD	Mean	SD	Mean	SD	p	r
BRIEF BRI	40.2	7.28	46.6	6.98	51.6	11.15	ECPT < ET; p= .006* ECPT < A; p= .042	−.59 -.38
BRIEF MI	38.0	2.37	49.6	9.56	53.3	19.64	ECPT < ET; p= .001* ECPT < A; p= .007*	−.68 -.50
BRIEF GEC	38.3	4.37	48.1	8.01	52.1	19.06	ECPT < ET; p= .002* ECPT < A; p= .016*	−.66 -.45
CBCL Internalizing Problems	46.5	13.68	57.0	13.51	57.4	9.59	-	-
CBCL Externalizing Problems	37.7	5.72	47.0	7.66	46.4	11.50	-	-
CBCL Total Problems	39.5	14.68	52.2	10.06	54.4	10.27	-	-
YSR Internalizing Problems	47.2	9.30	54.3	8.91	53.1	9.34	-	-
YSR Externalizing Problems	39.8	6.01	50.0	8.05	48.0	7.83	ECPT < ET; p= .040 ECPT < A; p= .008*	−.44 -.49
YSR Total Problems	41.0	6.29	51.7	9.54	51.7	8.24	ECPT < ET; p= .016* ECPT < A; p= .016*	−.51 -.45
PedsQL Total – parent report	88.7	11.36	75.0	18.11	65.1	17.67	ECPT > ET; p= .005*	.60
PedsQL Total – self-report	93.2	4.75	78.0	11.84	64.3	20.69	ECPT > ET; p< .001* ECPT > A; p= .012* A > ET, p= .037	.82 .47 .33
MFS Total	83.6	11.93	66.4	15.53	58.4	16.81	ECPT > ET; p= .004* ECPT > A; p= .040	.61 .38

Note: – indicates between subgroup differences that did not reach statistical significance, and for which p-values and effect size r therefore could not be obtained.

*indicates between subgroup differences that remained significant after Bonferroni corrections for multiple comparisons.

Table 5. Self- and parent-reported executive functioning, psychological symptoms, and fatigue in treatment type subgroups

	Surgery only (SO) (n= 28)		Surgery and chemotherapy (SC) (n= 9)		Surgery, CRT^1 and chemotherapy (SCC) (n= 10)		Post Hoc Tests	Effect size
	Mean	SD	Mean	SD	Mean	SD	p	r
BRIEF BRI	44.0	6.83	49.2	8.42	52.1	12.56	-	-
BRIEF MI	44.3	12.44	53.8	12.23	57.7	14.70	SO < SCC, p= .012*	−.41
BRIEF GEC	43.1	11.19	52.3	10.48	56.1	15.08	SO < SCC, p= .015* SO < SC, p= .034	−.39 -.35
CBCL Internalizing Problems	54.1	14.30	55.7	9.47	58.4	8.90	-	-
CBCL Externalizing Problems	45.0	8.29	45.1	11.08	44.8	11.92	-	-
CBCL Total Problems	49.2	12.11	52.2	11.30	54.5	9.71	-	-
YSR Internalizing Problems	51.9	9.94	53.9	6.31	52.0	11.25	-	-
YSR Externalizing Problems	48.0	8.44	47.8	9.56	45.2	8.74	-	-
YSR Total Problems	48.9	9.81	51.1	10.82	50.4	9.13	-	-
PEDSQL Total – parent report	78.9	17.70	74.2	17.78	58.7	14.13	SO > SCC, p= .002*	.49
PEDSQL Total – self-report	81.8	11.96	73.2	15.51	59.9	23.47	SO > SCC, p= .002*	.49
MFS Total	70.4	16.68	64.9	17.46	54.8	16.03	-	-

Note: – indicates those between subgroup differences that did not reach statistical significance, and for which p-values and effect size r therefore could not be obtained.

¹CRT = cranial radiation therapy

*indicates between subgroup differences that remained significant after Bonferroni corrections for multiple comparisons.