Pediatric Brain Tumors: A Clinicopathological Study and Assessment of Caregiver Quality of Life at a Tertiary Neurosurgical Referral Center in Northern India.
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BACKGROUND: Pediatric brain tumors are the leading cause of cancer-related death in children, yet in low- and middle-income countries (LMICs) their outcomes are shaped as much by socio-environmental factors as by tumor biology. The child and caregiver form a single therapeutic unit whose combined trajectory is rarely studied together. We analyzed the clinicopathological profile and short-term surgical outcomes of pediatric brain tumor patients alongside the quality of life (QoL) of their caregivers. MATERIALS AND METHODS: In this prospective observational study, 56 consecutively admitted children (≤18 years) with histologically confirmed primary brain tumors and their principal caregivers were recruited over six months at a tertiary neurosurgical center. Clinical, operative, histopathological, and outcome data were recorded, and morbidity was graded as improved, same, or deteriorated at discharge and at three months. Caregiver QoL was measured using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire preoperatively and at three months. Categorical associations were tested with the chi-square/Fisher exact test and continuous scores with the t-test/ANOVA using SPSS Statistics version 16.0 (SPSS Inc., Chicago, IL); p < 0.05 was significant. RESULTS: The mean age was 10.9 ± 4.9 years, with a male predominance (60.7%, n = 34). Headache (87.5%, n = 49) and vomiting (82.1%, n = 46) were the commonest symptoms, and 53.6% (n = 30) of tumors were infratentorial. Medulloblastoma (19.6%, n = 11) was the commonest tumor, and half of all tumors were malignant. Gross- or near-total excision was achieved in 69.6% (n = 39). Three-month mortality was 30.4% (n = 17), and 58.9% (n = 33) improved overall at third-month follow-up. Benign histology, age >10 years, and full preoperative consciousness predicted successful outcome. Caregiver QoL declined significantly when the child deteriorated or died and improved when the child improved; a decline in caregiver total QoL was strongly associated with treatment failure (p < 0.001). Only 15.2% (n = 5) of children needing radiotherapy started it by three months, chiefly for financial and transport reasons. CONCLUSIONS: Outcomes of pediatric brain tumors in this setting are governed by a web of clinical and family-level determinants. Caregiver QoL mirrors the child's course, arguing for a holistic, family-centered model of neuro-oncological care.