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Clinical Therapy Trials—Quality of Life |
Departments of Psychiatry (S.A.S.) and Pediatrics (S.A.S., H.L.W., J.L.F.), New York University School of Medicine, New York, NY 10016; The Children's Hospital at Westmead and the University of Sydney, Sydney, Australia 2156 (S.J.K.); Department of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School, Newark, NJ 07103 (A.L.D.); Gutierrez Children's Hospital, Buenos Aries, Argentina 1425 (B.D.); Children's Hospital of Los Angeles, Los Angeles, CA 90027 (J.V.); State University of New York, Brooklyn, NY 11203 (C.B.); and Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY 10032 (M.C.P.)
1 Address correspondence and reprint requests to Stephen A. Sands, New York University, Hassenfeld Cancer Center, 317 E. 34th St., New York, NY 10016.
Abstract
This study evaluated the quality of life and neuropsychologic functioning among patients enrolled between 1989 and 1993 in the First International CNS Germ-Cell Tumor Study. Quality-of-life questionnaires (Short Form-36 or Child Health Questionnaire) were completed on 43 patients at median follow-up of 6.1 years after diagnosis (range, 4.5-8.8 years), and intellectual and academic testing was performed on 22 patients. Psychosocial and physical functioning of patients aged 19 years and older at follow-up was within the average range, whereas the same functioning for patients aged 18 years and younger, as reported by their parents at follow-up, was low average and borderline, respectively. Overall psychosocial and physical health summary scores were positively correlated with age at diagnosis for both groups combined. Those who received CNS radiation therapy (n = 29) reported significantly worse physical health, but similar psychosocial health, compared with those treated without radiation. Neuropsychologic testing indicated full-scale and verbal IQ, reading, spelling, and math skills in the average range, and performance IQ in the low average range. Intelligence and math skills were positively correlated with age at diagnosis. Those with germinomas significantly outperformed those with nongerminomatous/mixed tumors on all neuropsychological measures administered. Younger patients diagnosed with CNS germ-cell tumors are at increased risk for psychosocial and physical problems as well as neuropsychologic deficits. Exposure to irradiation adversely affects overall physical functioning, whereas tumor pathology appears to be a salient neurocognitive risk factor. Collaborative and randomized studies are required to further elucidate the late effects arising from factors such as age at diagnosis, tumor histology, level of irradiation therapy, and chemotherapy toxicity among these young and potentially curable patients.
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