成人生存者实现儿科中枢神经系统肿瘤的功能和社会独立:来自圣裘德终身队列研究的报告。

Attainment of Functional and Social Independence in Adult Survivors of Pediatric CNS Tumors: A Report From the St Jude Lifetime Cohort Study.

机构信息

Tara M. Brinkman, Kirsten K. Ness, Zhenghong Li, I-Chan Huang, Kevin R. Krull, Amar Gajjar, Thomas E. Merchant, James L. Klosky, Robyn E. Partin, Ingrid Tonning Olsson, Frederick Boop, Paul Klimo Jr, Wassim Chemaitilly, Raja Khan, Deokumar Srivastava, Leslie L. Robison, Melissa M. Hudson, and Gregory T. Armstrong, St Jude Children's Research Hospital; and Frederick Boop and Paul Klimo Jr, University of Tennessee Health Science Center, Memphis, TN.

出版信息

J Clin Oncol. 2018 Sep 20;36(27):2762-2769. doi: 10.1200/JCO.2018.77.9454. Epub 2018 Aug 9.

Abstract

Purpose Beyond survival, achieving independence is a primary goal for adult survivors of pediatric CNS tumors. However, the prevalence of and risk factors for failure to achieve independence, assessed with multiple concurrent indicators, have not been examined. Patients and Methods Functional and social independence was assessed in 306 survivors (astrocytoma [n = 130], medulloblastoma [n = 77], ependymoma [n = 36], and other [n = 63]; median current age, 25.3 years [range, 18.9 to 53.1 years]; time since diagnosis, 16.8 years [range, 10.6 to 41.8 years]). Six observed indicators were used to identify latent classes of independence, which included employment, living independently, assistance with personal care, assistance with routine needs, obtaining a driver's license, and marital status. Physical performance impairments were defined as scores < 10th percentile on measures of aerobic capacity, strength, flexibility, balance, mobility, and adaptive function. Multinomial logistic regression estimated odds ratios (ORs) and 95% CIs were calculated for associations of disease/treatment exposures and impairments in physical performance with nonindependence. Results Three classes of independence were identified as independent (40%), moderately independent (34%), and nonindependent (26%). In multivariable models, 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) were associated with risk of nonindependence versus 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 associated with nonindependence versus independence. Nonindependent survivors reported reduced physical but not mental health-related quality of life compared with independent survivors. Conclusion Sixty percent of survivors of pediatric CNS tumors do not achieve complete independence as adults. Reduction in intensity of primary therapies and interventions that target physical performance and adaptive deficits may help survivors to achieve greater independence.

摘要

目的

除生存之外,实现独立是儿科中枢神经系统肿瘤成年幸存者的主要目标。然而,尚未使用多个并发指标评估无法实现独立的患病率和危险因素。

方法

在 306 名幸存者(星形细胞瘤[130 例],髓母细胞瘤[77 例],室管膜瘤[36 例]和其他[63 例];中位当前年龄为 25.3 岁[范围,18.9 至 53.1 岁];诊断后时间为 16.8 年[范围,10.6 至 41.8 年])中评估了功能和社会独立性。使用六个观察指标来确定独立的潜在类别,其中包括就业,独立生活,个人护理协助,日常需求协助,获得驾驶执照和婚姻状况。身体机能障碍定义为有氧能力,力量,柔韧性,平衡,移动性和适应性功能测量得分<第 10 个百分位数。使用多项逻辑回归估计疾病/治疗暴露和身体机能障碍与非独立性之间的关联的优势比(OR)和 95%CI。

结果

确定了三个独立类别

独立(40%),中度独立(34%)和非独立(26%)。在多变量模型中,颅脊髓照射(OR,4.20;95%CI,1.69 至 10.44)和诊断时年龄较小(OR,1.24;95%CI,1.14 至 1.35)与非独立性与独立性的风险相关。除了智商受损之外,有氧能力受限(OR,5.47;95%CI,1.78 至 16.76),柔韧性受限(OR,3.66;95%CI,1.11 至 12.03)和适应性身体功能受限(OR,11.54;95%CI,3.57 至 37.27)与非独立性与独立性相关。与独立幸存者相比,非独立幸存者报告的身体健康相关生活质量降低,而心理健康相关生活质量却没有降低。

结论

儿科中枢神经系统肿瘤幸存者中有 60%未达到成年后完全独立。减少主要治疗和干预措施的强度,并针对身体机能和适应性缺陷进行干预,可能有助于幸存者实现更大的独立性。

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