Brinkman TM, et al. - As beyond survival, achieving independence is a primary goal for adult survivors of pediatric CNS tumors, researchers sought the prevalence of and risk factors for failure to achieve independence. Findings suggest that complete independence as adults was not achieved in 60 percent of survivors of pediatric CNS tumors. Survivors may achieve greater independence via a reduction in intensity of primary therapies and interventions that target physical performance and adaptive deficits.

Methods

• Researchers assessed functional and social independence in 306 survivors (astrocytoma [n = 130], medulloblastoma [n = 77], ependymoma [n = 36], and other [n = 63]).
• Median current age was 25.3 years [range, 18.9 to 53.1 years]; time since diagnosis was 16.8 years [range, 10.6 to 41.8 years].
• To identify latent classes of independence, they used 6 observed indicators including employment, living independently, assistance with personal care, assistance with routine needs, obtaining a driver’s license, and marital status.
• Scores < 10th percentile on measures of aerobic capacity, strength, flexibility, balance, mobility, and adaptive function defined the physical performance impairments.
• For associations of disease/treatment exposures and impairments in physical performance with nonindependence, they calculated multinomial logistic regression estimated odds ratios (ORs) and 95% CIs.

Results

• Researchers identified 3 classes of independence: independent (40%), moderately independent (34%), and nonindependent (26%).
• Multivariable models suggested an association of craniospinal irradiation (OR, 4.20; 95% CI, 1.69 to 10.44) and younger age at diagnosis (OR, 1.24; 95% CI, 1.14 to 1.35) with risk of nonindependence vs independence.
• Beyond impaired IQ, limitations in aerobic capacity (OR, 5.47; 95% CI, 1.78 to 16.76), flexibility (OR, 3.66; 95% CI, 1.11 to 12.03), and adaptive physical function (OR, 11.54; 95% CI, 3.57 to 37.27) were noted to be correlated with nonindependence vs independence.
• Reduced physical but not mental health-related quality of life was reported among nonindependent survivors compared with independent survivors.