Symptom burden trajectories experienced by patients with brain tumors

Cancer. 2020 Jul 15;126(14):3341-3351. doi: 10.1002/cncr.32879. Epub 2020 May 6.


Background: Survivors of childhood brain tumors experience persistent health concerns across their lifespan. In the current study, the authors evaluated changes in symptom burden over the course of 12 months using pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) measures.

Methods: Data from 202 survivors aged 8 to 21 years and 262 parents of survivors who were aged 5 to 21 years were analyzed. All completed a PROMIS Cognition short form and computerized adaptive tests of pediatric Anxiety, Depressive Symptoms, Fatigue, Mobility, Upper Extremity Function, and Peer Relationships. Approximately one-half of participants (223 participants: 97 survivors of childhood brain tumors and 126 parents) completed the 12-month follow-up. Linear mixed-effects models evaluated group-level symptoms over time. Cox proportional hazard models explored whether symptoms predicted survival, and latent class growth analysis investigated patterns of individual-level symptom changes over time.

Results: Linear mixed-effects models demonstrated that patient-reported Cognition and parent-reported Anxiety worsened over time. Latent class growth analysis results indicated that patient and parent reports diverged, both with regard to the number of classes identified and in the trends of these classes. Parents and patients reported similar patterns of depression over time. For the other areas, parents either were more likely to observe different patterns (Peer Relationships and Mobility) or less likely to observe different patterns (Upper Extremity Function, Cognition, Anxiety, and Fatigue). Baseline patient-reported Mobility and Upper Extremity Function were found to be associated with survival.

Conclusions: Survivors of childhood brain tumors demonstrated different trajectory patterns of symptom burden. Along with baseline functioning status and days since treatment, patient-reported Mobility and Upper Extremity Function were associated with survival, suggesting a possible role for patient-reported outcomes in clinical care, especially individualized, tailored assessments such as PROMIS.

Keywords: brain tumor; children; computerized adaptive test (CAT); patient-reported outcomes; symptom burden.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Anxiety / complications*
  • Brain Neoplasms / complications*
  • Brain Neoplasms / epidemiology
  • Cancer Survivors*
  • Child
  • Child Health*
  • Child, Preschool
  • Cognitive Dysfunction / complications*
  • Depression / complications*
  • Fatigue / complications*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Mobility Limitation*
  • Parents
  • Patient Reported Outcome Measures
  • Quality of Life
  • Self Report
  • United States / epidemiology
  • Upper Extremity / physiopathology*
  • Young Adult