Victoria A Torres1,2, Jason M Ashford2, Evelyn Wright2, Jiahui Xu3, Hui Zhang3, Thomas E Merchant4, Heather M Conklin2. 1. Department of Psychology, University of Mississippi, University, Mississippi, USA. 2. Department of Psychology, Memphis, Tennessee, USA. 3. Department of Biostatistics, Memphis, Tennessee, USA. 4. Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Abstract
BACKGROUND: Socioeconomic status (SES) is a determinant of cognitive and academic functioning among healthy and ill children; however, few pediatric oncology studies examine SES and long-term cognitive functioning. The current study systematically investigated SES as a predictor of cognitive outcomes among children treated for localized brain tumors (BT) with photon radiation therapy (RT). METHODS: 248 children treated on a prospective, longitudinal, phase II trial of conformal RT (54-59.4 Gy) for ependymoma, low-grade glioma, or craniopharyngioma were monitored serially with cognitive assessments (intelligence quotient [IQ], reading, math, attention, adaptive function) for 10 years (2209 observations, median age at RT = 6.6 years, 48% male, 80% Caucasian). SES was derived from the Barratt Simplified Measure of Social Status, which incorporates parental occupation, education, and marital status. RESULTS: Overall, SES scores fell in the low range (Barratt median = 37). At pre-RT baseline, linear mixed models revealed significant associations between SES and IQ, reading, math, attention, and adaptive function, with higher SES associated with better performance (P < .005). SES predicted change over time in IQ, reading, and math; higher SES was associated with less decline (P < .001). Accounting for sex and age at RT, SES remained predictive of IQ, reading, and math. Analysis of variance revealed a greater relative contribution of SES than sex or age at RT to reading and math. CONCLUSIONS: SES represents a novel predictor of cognitive performance before and after RT for pediatric BT. These findings have broad implications as high SES represents a protective factor. Developing interventions to mitigate the effects of low SES is warranted.
BACKGROUND: Socioeconomic status (SES) is a determinant of cognitive and academic functioning among healthy and ill children; however, few pediatric oncology studies examine SES and long-term cognitive functioning. The current study systematically investigated SES as a predictor of cognitive outcomes among children treated for localized brain tumors (BT) with photon radiation therapy (RT). METHODS: 248 children treated on a prospective, longitudinal, phase II trial of conformal RT (54-59.4 Gy) for ependymoma, low-grade glioma, or craniopharyngioma were monitored serially with cognitive assessments (intelligence quotient [IQ], reading, math, attention, adaptive function) for 10 years (2209 observations, median age at RT = 6.6 years, 48% male, 80% Caucasian). SES was derived from the Barratt Simplified Measure of Social Status, which incorporates parental occupation, education, and marital status. RESULTS: Overall, SES scores fell in the low range (Barratt median = 37). At pre-RT baseline, linear mixed models revealed significant associations between SES and IQ, reading, math, attention, and adaptive function, with higher SES associated with better performance (P < .005). SES predicted change over time in IQ, reading, and math; higher SES was associated with less decline (P < .001). Accounting for sex and age at RT, SES remained predictive of IQ, reading, and math. Analysis of variance revealed a greater relative contribution of SES than sex or age at RT to reading and math. CONCLUSIONS: SES represents a novel predictor of cognitive performance before and after RT for pediatric BT. These findings have broad implications as high SES represents a protective factor. Developing interventions to mitigate the effects of low SES is warranted.
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