Brain Tumor Treatment in Early Childhood Predicts Academic Readiness

Treatment for central nervous system (CNS) malignancies in early childhood has an adverse impact on academic readiness skills, according to the findings of a small study published in JNIC: Journal of the National Cancer Institute.

Although previous studies have shown an association between cancer treatment in childhood and brain development, the risk for academic difficulties in patients who received brain tumor treatment in early childhood remains unknown.

Using data from a phase 2 multi-institutional trial (ClincialTrials.gov Identifier: NCT00602667), researchers studied the association between academic readiness and outcomes in patients who received treatment for CNS tumors during early childhood.

Eligible participants had a newly diagnosed CNS tumor, were younger than 3 years at diagnosis or between 3 and 5 years at diagnosis with standard-risk medulloblastoma, did not receive prior radiation therapy or chemotherapy, were available for treatment within a month of surgery, and had an adequate performance status (Lansky score, ≥30).

Patients were classified into risk groups (low, intermediate, and high), which informed treatment course. All participants underwent surgical resection at diagnosis and received chemotherapy during the 16-week induction phase and 24-week maintenance phase. Specifically, the low-risk group received additional chemotherapy; the intermediate-risk group received focal radiation therapy; and the high-risk group received additional chemotherapy or deferred radiation therapy.

All participants also underwent neurocognitive testing for assessment of academic skills. Academic readiness and functioning were measured among children aged at least 3 years, with higher scores on assessment tools indicating better performance.

A total of 70 patients (boys, 67.1%; White, 78.6%; mean age at diagnosis, 1.8 years) had at least 2 academic readiness scores. The majority (62.9%) of these patients were classified into the intermediate-risk group having a diverse range of CNS tumors. Median age at first assessment of academic readiness was 3.6 years.

Read more about pediatric CNS tumors such as Ependymoma

After assessing several demographic and clinical variables, only socioeconomic status was observed to predict academic readiness, with lower socioeconomic status linked to reduced academic readiness at all timepoints (P <.0001).

Distal academic functioning in word reading and applied math were also found to be below the average range (as compared with the normative population) in 28.8% and 20.3% of participants, respectively; however, only word reading scores were significantly different and greater than the 16% below the average range as in the normative population (P =.007).

Analysis limitations included the small sample size; clinical representation in the cohort was limited by poor prognosis; and a broader assessment of academic skills was not conducted.

“Characterizing academic readiness and its predictors in this population is critical to informing caregiver education regarding risk for academic difficulties as well as monitoring and intervention efforts targeting early academic skills,” the researchers concluded.