Nicholas S Phillips1, Raja B Khan2, Chenghong Li3, Sedigheh Mirzaei Salehabadi3, Tara M Brinkman1,4, Deokumar Srivastava3, Leslie L Robison1, Melissa M Hudson1,5, Kevin R Krull1,4, Zsila S Sadighi2. 1. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee. 2. Division of Neurology, St. Jude Children's Research Hospital, Memphis, Tennessee. 3. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee. 4. Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee. 5. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Abstract
BACKGROUND: The objective of this study was to determine the impact of seizure-related factors on neurocognitive, health-related quality of life (HRQOL), and social outcomes in survivors of childhood cancer. METHODS: Survivors of childhood cancer treated at St. Jude Children's Hospital (n = 2022; 48.3% female; median age, 31.5 years; median time since diagnosis, 23.6 years) completed neurocognitive testing and questionnaires. The presence, severity, resolution, and treatment history of seizures were abstracted from medical records. Adjusting for the age at diagnosis, sex, and prior cancer therapy, multivariable models examined the impact of seizures on neurocognitive and HRQOL outcomes. Mediation analyses were conducted for social outcomes. RESULTS: Seizures were identified in 232 survivors (11.5%; 29.9% of survivors with central nervous system [CNS] tumors and 9.0% of those without CNS tumors). In CNS tumor survivors, seizures were associated with poorer executive function and processing speed (P < .02); in non-CNS tumor survivors, seizures were associated with worse function in every domain (P < .05). Among non-CNS survivors, seizure severity was associated with worse processing speed (P = .023), and resolution was associated with better executive function (P = .028) and attention (P = .044). In CNS survivors, seizure resolution was associated with improved attention (P = .047) and memory (P < .02). Mediation analysis revealed that the impact of seizures on social outcomes was mediated by neurocognitive function. CONCLUSIONS: Seizures in cancer survivors adversely affect long-term functional and psychosocial outcomes independently of cancer therapy. The resolution of seizure occurrence is associated with better outcomes. Seizure severity is associated with poorer outcomes and should be a focus of clinical management and patient education.
BACKGROUND: The objective of this study was to determine the impact of seizure-related factors on neurocognitive, health-related quality of life (HRQOL), and social outcomes in survivors of childhood cancer. METHODS: Survivors of childhood cancer treated at St. Jude Children's Hospital (n = 2022; 48.3% female; median age, 31.5 years; median time since diagnosis, 23.6 years) completed neurocognitive testing and questionnaires. The presence, severity, resolution, and treatment history of seizures were abstracted from medical records. Adjusting for the age at diagnosis, sex, and prior cancer therapy, multivariable models examined the impact of seizures on neurocognitive and HRQOL outcomes. Mediation analyses were conducted for social outcomes. RESULTS: Seizures were identified in 232 survivors (11.5%; 29.9% of survivors with central nervous system [CNS] tumors and 9.0% of those without CNS tumors). In CNS tumor survivors, seizures were associated with poorer executive function and processing speed (P < .02); in non-CNS tumor survivors, seizures were associated with worse function in every domain (P < .05). Among non-CNS survivors, seizure severity was associated with worse processing speed (P = .023), and resolution was associated with better executive function (P = .028) and attention (P = .044). In CNS survivors, seizure resolution was associated with improved attention (P = .047) and memory (P < .02). Mediation analysis revealed that the impact of seizures on social outcomes was mediated by neurocognitive function. CONCLUSIONS: Seizures in cancer survivors adversely affect long-term functional and psychosocial outcomes independently of cancer therapy. The resolution of seizure occurrence is associated with better outcomes. Seizure severity is associated with poorer outcomes and should be a focus of clinical management and patient education.
Authors: Siobhan M Phillips; Lynne S Padgett; Wendy M Leisenring; Kayla K Stratton; Ken Bishop; Kevin R Krull; Catherine M Alfano; Todd M Gibson; Janet S de Moor; Danielle Blanch Hartigan; Gregory T Armstrong; Leslie L Robison; Julia H Rowland; Kevin C Oeffinger; Angela B Mariotto Journal: Cancer Epidemiol Biomarkers Prev Date: 2015-04 Impact factor: 4.254
Authors: Brandon Korman; Pavel Krsek; Michael Duchowny; Bruno Maton; Esperanza Pacheco-Jacome; Gustavo Rey Journal: Neurology Date: 2013-07-19 Impact factor: 9.910
Authors: Tara M Brinkman; Matthew J Krasin; Wei Liu; Gregory T Armstrong; Rohit P Ojha; Zsila S Sadighi; Pankaj Gupta; Cara Kimberg; Deokumar Srivastava; Thomas E Merchant; Amar Gajjar; Leslie L Robison; Melissa M Hudson; Kevin R Krull Journal: J Clin Oncol Date: 2016-02-01 Impact factor: 44.544
Authors: Kirsten K Ness; James G Gurney; Lonnie K Zeltzer; Wendy Leisenring; Daniel A Mulrooney; Paul C Nathan; Leslie L Robison; Ann C Mertens Journal: Arch Phys Med Rehabil Date: 2008-01 Impact factor: 4.060
Authors: Nicholas S Phillips; Carrie R Howell; Jennifer Q Lanctot; Robyn E Partin; Ching-Hon Pui; Melissa M Hudson; Leslie L Robison; Kevin R Krull; Kirsten K Ness Journal: Cancer Date: 2019-10-21 Impact factor: 6.921
Authors: Nina S Kadan-Lottick; Daniel J Zheng; Mingjuan Wang; Michael W Bishop; Deo Kumar Srivastava; Wilhelmenia L Ross; Rozalyn L Rodwin; Kirsten K Ness; Todd M Gibson; Sheri L Spunt; Mehmet Fatih Okcu; Wendy M Leisenring; Leslie L Robison; Gregory T Armstrong; Kevin R Krull Journal: J Cancer Surviv Date: 2022-01-21 Impact factor: 4.062