Journal Article

Motor and sensory impairment in survivors of childhood central nervous system (CNS) tumors in the St. Jude Lifetime Cohort (SJLIFE)

Robison, Leslie L., Srivastava, Deo Kumar, Phillips, Nicholas S., Gajjar, Amar, Hudson, Melissa M., Ness, Kirsten K., Wang, Fang, Rodwin, Rozalyn L., Li, Zhenghong, Lu, Lu, Krull, Kevin R., Merchant, Thomas E., Brinkman, Tara M., Boop, Frederick A., Khan, Raja B., Kadan‐Lottick, Nina S., Armstrong, Gregory T.

2024

Overview

Background Survivors of childhood central nervous system (CNS) tumors can develop motor and sensory impairment from their cancer and treatment history. We estimated the prevalence of motor and sensory impairment in survivors compared with controls through clinical assessment and identified associated treatment exposures and functional, quality of life (QOL), and social outcomes. Methods Survivors of childhood CNS tumors from the St. Jude Lifetime Cohort (n = 378, median [range] age 24.0 [18.0–53.0] years, 43.4% female) ≥5 years from diagnosis and controls (n = 445, median [range] age 34.0 [18.0–70.0] years, 55.7% female) completed in‐person evaluation for motor and sensory impairment using the modified Total Neuropathy Score. Impairment was graded by modified Common Terminology Criteria for Adverse Events. Multivariable models estimated associations between grade ≥2 motor/sensory impairment, individual/treatment characteristics, and secondary outcomes (function by Physical Performance Test, fitness by physiologic cost index, QOL by Medical Outcomes Survey Short Form‐36 physical/mental summary scores, social attainment). Results Grade ≥2 motor or sensory impairment was more prevalent in survivors (24.1%, 95% Confidence Interval [CI] 19.8%–29.4%) than controls (2.9%, CI 1.4–4.5%). Among survivors, in multivariable models, motor impairment was associated with vinca exposure <15 mg/m2 versus none (OR 4.38, CI 1.06–18.08) and etoposide exposure >2036 mg/m2 versus none (OR 12.61, CI 2.19–72.72). Sensory impairment was associated with older age at diagnosis (OR 1.09, CI 1.01–1.16) and craniospinal irradiation versus none (OR 4.39, CI 1.68–11.50). There were lower odds of motor/sensory impairment in survivors treated in the year 2000 or later versus before 1990 (Motor: OR 0.29, CI 0.10–0.84, Sensory: OR 0.35, CI 0.13–0.96). Motor impairment was associated with impaired physical QOL (OR 2.64, CI 1.22–5.72). Conclusions In survivors of childhood CNS tumors, motor and sensory impairment is prevalent by clinical assessment, especially after exposure to etoposide, vinca, or craniospinal radiation. Treating motor impairment may improve survivors' QOL.

• Publisher: John Wiley & Sons, Inc,Wiley
• Subject: Achievement tests / Adolescent / Adult / Aged / Cancer Survivors - statistics & numerical data / Cancer therapies / Central nervous system / Central Nervous System Neoplasms - epidemiology / central nervous system tumor / Chemotherapy / Child / Childhood / childhood cancer / Children / Chronic illnesses / Cohort Studies / cranial radiation / Diagnosis / Drug dosages / Etoposide / Female / Heart rate / Humans / Male / Medical diagnosis / Middle Aged / motor impairment / Neuropathy / Neurotoxicity / peripheral neuropathy / Physical therapists / platinum / Prevalence / Quality of Life / Radiation / Sensation Disorders - epidemiology / Sensation Disorders - etiology / sensory impairment / Sensory properties / Surgery / survivorship / Terminology / Tumors / vinca alkaloid / Writing / Young Adult