Quality of life and mental health in pediatric patients with low-grade CNS tumors treated with surgery alone.
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OBJECTIVE: Pediatric patients with low-grade CNS tumors can experience an array of physical, cognitive, and psychosocial late effects, even in the absence of adjuvant therapy. It is unclear to what extent these late effects impact long-term quality of life (QOL). The aim of this study was to evaluate QOL and mental health in children with low-grade CNS tumors treated with surgery alone compared with healthy children and children with chronic illness. METHODS: Medical records were retrospectively reviewed to identify children (age ≤ 18 years) who underwent surgical treatment of a low-grade CNS tumor (WHO grades I or II) without adjuvant therapy. Caregivers of enrolled patients (1-8 years after resection) completed a demographic questionnaire, the PedsQL Generic Core Scales, and the BASC-3 Parent Rating Scales. Scores were compared with published levels of QOL and mental health in healthy children and children with chronic illness. RESULTS: Sixty-six patients and their caregivers enrolled in the study; the mean patient age at enrollment was 13.47 years, with a mean time from surgery to enrollment of 4.26 years. These patients demonstrated significantly lower patient-reported QOL scores compared with their healthy peers for all scales. The mean PedsQL scores showed that 58% of children experienced difficulty with school-related functioning, 49% fell at or below the age-appropriate cutoff for emotional QOL, 42% experienced decreased physical QOL, and 30% experienced social challenges. The proportion of patients with BASC-3 scores (n = 51) that met or exceeded the cutoff for at-risk or clinically relevant difficulties ranged from 8% (depression) to 14% (anxiety and attention, each). CONCLUSIONS: Children treated for low-grade CNS tumors with surgery alone can face challenges that impact their long-term QOL and mental health. Psychosocial functioning of these children should be routinely assessed at follow-up visits in neurosurgery clinics. Other providers and families should be made aware of the potential long-term consequences associated with low-grade CNS tumors treated with surgery alone. Similar to the psychosocial care recommendations for children with chronic illness, interventions should be developed for patients with low-grade CNS tumors to mitigate risk of impaired long-term QOL and mental health.