The long-term outcome of childhood brain tumours: impact of radiotherapy<br />Dr Sally Davis<br />Registered Clinical Psyc...
        Background<br /><ul><li>Second most common form of childhood cancer
Increase in incidence
NZ amongst highest (3.42/100,000 children)
Increased survival rates & quality of survival?
Identified cognitive deficits
Beyond 5 years post-treatment???</li></li></ul><li>Aims <br /><ul><li>Long-term (> 5 years) effects of radiotherapy (RT)
Specific areas of neuropsychological functioning
Adaptive functioning (QOL, Coping)
Relationships between treatment factors, late effects, and performance</li></li></ul><li>Information gathered<br /><ul><li...
Age at diagnosis
Time since surgery
Duration of symptoms
Hydrocephalus
Shunt
Meningitis
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The long term outcome of childhood brain tumours; impact of radiotherapy, Sally Davis

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The long term outcome of childhood brain tumours; impact of radiotherapy, Sally Davis

  1. 1. The long-term outcome of childhood brain tumours: impact of radiotherapy<br />Dr Sally Davis<br />Registered Clinical Psychologist<br />
  2. 2. Background<br /><ul><li>Second most common form of childhood cancer
  3. 3. Increase in incidence
  4. 4. NZ amongst highest (3.42/100,000 children)
  5. 5. Increased survival rates & quality of survival?
  6. 6. Identified cognitive deficits
  7. 7. Beyond 5 years post-treatment???</li></li></ul><li>Aims <br /><ul><li>Long-term (> 5 years) effects of radiotherapy (RT)
  8. 8. Specific areas of neuropsychological functioning
  9. 9. Adaptive functioning (QOL, Coping)
  10. 10. Relationships between treatment factors, late effects, and performance</li></li></ul><li>Information gathered<br /><ul><li>Treatment factors
  11. 11. Age at diagnosis
  12. 12. Time since surgery
  13. 13. Duration of symptoms
  14. 14. Hydrocephalus
  15. 15. Shunt
  16. 16. Meningitis
  17. 17. Cerebellar mutism syndrome
  18. 18. Amount of tumour removed
  19. 19. Length of hospital stay
  20. 20. Late effects
  21. 21. Balance problems
  22. 22. Hearing loss
  23. 23. Left/right sided weakness
  24. 24. Ataxia
  25. 25. Alopecia
  26. 26. Growth hormone deficiency
  27. 27. Vision loss/blurry vision
  28. 28. Speech problems
  29. 29. Gait disturbance</li></li></ul><li>Posterior fossa<br />
  30. 30. Benign versus malignant<br /><ul><li>Benign (PA)
  31. 31. low-grade (Grade I and II)
  32. 32. slow growing
  33. 33. small with distinct borders
  34. 34. don’t spread to distant sites
  35. 35. easily removed surgically
  36. 36. surgery alone is often effective as little risk of further growth
  37. 37. Malignant (MB)
  38. 38. aggressive (Grade IV)
  39. 39. grow rapidly
  40. 40. large, lacking distinct borders
  41. 41. infiltrate surrounding tissue
  42. 42. difficult to surgically remove completely
  43. 43. remaining tissue following surgery continues to grow</li></li></ul><li>Participants<br /><ul><li>20 Medulloblastoma (MB)
  44. 44. Mean age at dx = 10 yrs
  45. 45. Mean no. of yrs post-dx = 17 yrs
  46. 46. 19 Pilocytic astrocytoma (PA)
  47. 47. Mean age at dx = 12 yrs
  48. 48. Mean no. of yrs post-dx = 14 yrs
  49. 49. 20 control subjects</li></li></ul><li>Methodology<br /><ul><li>Measures
  50. 50. Numerous (15) neuropsychological tests
  51. 51. Coping Response Inventory (Moos, 1993)
  52. 52. Quality of Life Inventory (Frisch, 1994)
  53. 53. Data Analysis
  54. 54. T-tests
  55. 55. ANOVA (one-way between groups)
  56. 56. MANOVA
  57. 57. Chi-square tests
  58. 58. Bivariate correlations (two-tailed)</li></li></ul><li>Data analysis<br />
  59. 59. Data analysis contd.<br />
  60. 60. Main findings<br /><ul><li>RT has a profound long-term negative impact on neuropsychological functioning
  61. 61. Deficits in MB and PA groups found in:
  62. 62. Information Processing Speed
  63. 63. Attention
  64. 64. Executive functioning
  65. 65. Memory
  66. 66. Fine motor speed</li></li></ul><li>Main findings contd.<br /><ul><li>Younger at diagnosis = greater risk of neuropsychological deficits
  67. 67. Hydrocephalus and shunt ↓ performance
  68. 68. No significant relationship between neuropsychological performance and total RT dose or amount of tumour removed</li></li></ul><li>Main findings contd.<br /><ul><li>↑ total number of pre- and post-surgical complications was related to ↓ performance
  69. 69. ↑ duration of symptoms prior to diagnosis had a negative impact on Learning
  70. 70. Increased time since surgery was related to an increased satisfaction in QOL</li></li></ul><li>Limitations<br />These include:<br /><ul><li>Small sample sizes
  71. 71. Self-selection
  72. 72. Participants treated between 1980 and 2003</li></li></ul><li>Implications<br /><ul><li>Are families being fully informed of the long-term impact of treatment required?
  73. 73. LEAP began July 2006 (Akld, Chch, Wgtn)
  74. 74. National paediatric oncology initiative
  75. 75. Clinical psychologist and paediatric oncologist
  76. 76. Long-term follow-up for survivors of childhood cancer (20 years post-treatment)</li></li></ul><li>“Ultimately, cure is about controlling the disease, but is also about preserving dreams and maximising potential.” (Eiser, 2004)<br />Thank you to: <br />Dr Suzanne Barker-Collo <br /> Dr Lynette Tippett<br />
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