Risk factors for neurocognitive impairment, emotional distress, and poor quality of life in survivors of pediatric rhabdomyosarcoma: A report from the Childhood Cancer Survivor Study

Ellen van der Plas; Himani Darji; Deo K Srivastava; Melissa Schapiro; Donna Jeffe; Stephanie Perkins; Rebecca Howell; Wendy Leisenring; Gregory T Armstrong; Kevin Oeffinger; Kevin Krull; Kim Edelstein; Robert J Hayashi

doi:10.1002/cncr.35236

Risk factors for neurocognitive impairment, emotional distress, and poor quality of life in survivors of pediatric rhabdomyosarcoma: A report from the Childhood Cancer Survivor Study

Cancer. 2024 Feb 19. doi: 10.1002/cncr.35236. Online ahead of print.

Authors

Ellen van der Plas^{1

2}, Himani Darji^{3

4}, Deo K Srivastava⁴, Melissa Schapiro⁵, Donna Jeffe⁶, Stephanie Perkins⁷, Rebecca Howell⁸, Wendy Leisenring⁹, Gregory T Armstrong¹⁰, Kevin Oeffinger¹¹, Kevin Krull¹², Kim Edelstein¹³, Robert J Hayashi¹⁴

Affiliations

¹ Department of Hematology/Oncology, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
² Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
³ Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA.
⁴ Biostatistics Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
⁵ Department of Pediatrics, SSM Health Cardinal Glennon Children's Hospital-St. Louis University, St. Louis, Missouri, USA.
⁶ John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
⁷ Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA.
⁸ Department of Radiation Physics, The MD Anderson Cancer Center, Houston, Texas, USA.
⁹ Clinical Research Division, Fred Hutch Cancer Center, Seattle, Washington, USA.
¹⁰ Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
¹¹ Department of Medicine, Duke University, Durham, North Carolina, USA.
¹² Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
¹³ Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
¹⁴ Washington University School of Medicine in St. Louis, Department of Pediatrics, St. Louis Childrens Hospital, Siteman Cancer Center, St. Louis, Missouri, USA.

PMID: 38373075
DOI: 10.1002/cncr.35236

Abstract

Background: Prevalence and risk of poor psychological outcomes following rhabdomyosarcoma (RMS) are not well-established.

Methods: Participants in this cross-sectional, case-control study (n = 713 survivors, 42.5% female; mean [SD] age, 30.5 [6.6] years; n = 706 siblings, 57.2% female; mean age, 32.8,[7.9] years) completed measures of neurocognition, emotional distress, and health-related quality of life (HRQOL). Multivariable logistic regression models identified treatments, health behaviors, and chronic conditions associated with impairment.

Results: Relative to siblings, more survivors reported neurocognitive impairment (task efficiency: 21.1% vs. 13.7%, emotional regulation: 16.7% vs. 11.0%, memory: 19.3% vs. 15.1%), elevated emotional distress (somatic distress: 12.9% vs. 4.7%, anxiety: 11.7% vs. 5.9%, depression: 22.8% vs. 16.9%) and poorer HRQOL (physical functioning: 11.1% vs. 2.8%, role functioning due to physical problems: 16.8% vs. 8.2%, pain: 17.5% vs. 10.0%, vitality: 22.3% vs. 13.8%, social functioning: 14.4% vs. 6.8%, emotional functioning: 17.1% vs. 10.6%). Cranial radiation increased risk for impaired task efficiency (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.14-4.63), whereas chest and pelvic radiation predicted increased risk of physical functioning (OR, 2.68; 95% CI, 1.16-6.21 and OR, 3.44; 95% CI, 1.70-6.95, respectively). Smoking was associated with impaired task efficiency (OR, 2.06; 95% CI, 1.14-3.70), memory (OR, 2.23; 95% CI, 1.26-3.95), anxiety (OR, 2.71; 95% CI, 1.36-5.41) and depression (OR, 1.77; 95% CI, 1.01-3.11). Neurologic conditions increased risk of anxiety (OR, 2.30; 95% CI, 1.04-5.10), and hearing conditions increased risk of depression (OR, 1.79; 95% CI, 1.05-3.03). Neurologic and hearing conditions, respectively, were associated with impaired memory (OR, 2.44; 95% CI, 1.20-4.95 and OR, 1.87; 95% CI, 1.05-3.35) and poor health perception (OR, 2.62; 95% CI, 1.62-1.28 and OR, 2.33; 95% CI, 1.34-4.06).

Conclusions: RMS survivors are at significant risk for poor psychological outcomes. Advancing therapies for local control, smoking cessation, and managing chronic medical conditions may mitigate poor outcomes following RMS.

Keywords: cognition; psychological distress; quality of life; rhabdomyosarcoma; surveys and questionnaires; survivorship.

Abstract

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