Somekh Melanie R, Ashford Jason M, Swain Michelle A, Harder Lana L, Carlson-Green Bonnie L, Wallace Joanna, Kaner Ryan J, Billups Catherine A, Onar-Thomas Arzu, Ali Jeanelle S, Harman Jennifer L, Merchant Thomas E, Gajjar Amar, Conklin Heather M
Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN, USA.
Oncology Services Group, Queensland Children's Hospital, Brisbane, QLD, Australia.
J Natl Cancer Inst. 2024 Dec 1;116(12):1952-1960. doi: 10.1093/jnci/djae194.
Young children treated for central nervous system (CNS) malignancies are at high risk for difficulties with academic functioning due to increased vulnerability of the developing brain and missed early developmental opportunities. Extant literature examining academics in this population is limited. We investigated academic readiness, its clinical and demographic predictors, and its relationship with distal academic outcomes among patients treated for CNS tumors during early childhood.
Seventy patients with newly diagnosed CNS tumors were treated on a prospective, longitudinal, multisite study with chemotherapy, with or without photon or proton irradiation. Patients underwent assessments of academic skills at baseline, 6 months, 1 year, and then annually for 5 years. Assessments measured academic readiness and academic achievement in reading and math.
Mixed linear models revealed slowed development of academic readiness skills over time. Socioeconomic status (SES) was predictive of academic readiness at all time points. Other demographic (eg, age at treatment) and clinical (eg, shunt status, treatment exposure) variables were not predictive of academic readiness. Distal reading difficulties were proportionally greater than normative expectations while math difficulties did not differ. Academic readiness was predictive of distal academic outcomes in reading and math.
Treatment for CNS malignancies in early childhood appears to slow development of academic readiness skills, with SES predictive of risk. Academic readiness skills were predictive of subsequent academic achievement. A disproportionate number of long-term survivors performed below age-based expectations in reading. These findings suggest the need for monitoring and interventions targeting early academic skills in this population.
由于发育中的大脑易受伤害以及早期发育机会缺失，接受中枢神经系统（CNS）恶性肿瘤治疗的幼儿出现学业功能障碍的风险很高。现有的关于该人群学业情况的文献有限。我们调查了幼儿期接受CNS肿瘤治疗的患者的学业准备情况、其临床和人口统计学预测因素，以及它与远期学业成果的关系。
70例新诊断的CNS肿瘤患者参与了一项前瞻性、纵向、多中心研究，接受化疗，可选择是否接受光子或质子照射。患者在基线、6个月、1年时接受学业技能评估，之后每年评估一次，持续5年。评估测量了学业准备情况以及阅读和数学方面的学业成绩。
混合线性模型显示，随着时间推移，学业准备技能的发展放缓。社会经济地位（SES）在所有时间点都可预测学业准备情况。其他人口统计学（如治疗时的年龄）和临床（如分流状态、治疗暴露情况）变量无法预测学业准备情况。远期阅读困难比正常预期比例更高，而数学困难没有差异。学业准备情况可预测阅读和数学方面的远期学业成果。
幼儿期CNS恶性肿瘤的治疗似乎会减缓学业准备技能的发展，SES可预测风险。学业准备技能可预测随后的学业成绩。相当数量的长期幸存者在阅读方面的表现低于基于年龄的预期。这些发现表明需要对该人群的早期学业技能进行监测和干预。
