Pediatric Neurology xxx (2013) 1e4
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Pediatric Neurology journal homepage: www.elsevier.com/locate/pnu
Original Article
Access to Neuropsychologic Services After Pediatric Brain Tumor Ingrid Tonning Olsson MA a, b, *, Sean Perrin PhD a, e, Johan Lundgren MD, PhD b, c, Lars Hjorth MD, PhD b, c, Aki Johanson PhD a, d a
Department of Psychology, Lund University, Lund, Sweden Department of Pediatrics, Skåne University Hospital, Lund, Sweden c Clinical Sciences, Lund University, Lund, Sweden d Department of Psychiatry, Lund University, Lund, Sweden e Department of Psychology, Institute of Psychiatry, King’s College, London, United Kingdom b
abstract BACKGROUND: Increasing survival rates for children with brain tumors creates a greater need for neuropsychologic
follow-up and intervention. The aim of this study was to evaluate rates of referral by medical doctors to neuropsychologic services and patient and treatment factors that differentiated referred and nonreferred patients. METHODS: Data were retrieved from medical records of all pediatric brain tumor patients in southern Sweden diagnosed between 1993 and 2004 who survived more than 1 year (n ¼ 132). Characteristics of the patients, the cancer, and treatment received were then compared for patients who were and were not referred for neuropsychologic examination during that period. RESULTS: Sixty-four (48%) of the pediatric brain tumor patients were referred for neuropsychologic evaluation. These patients had significantly larger tumors, more recurrences of cancer, and increased intracranial pressure at diagnosis when compared with the nonreferred group (n ¼ 68). However, most of the patients in the nonreferred group either had significant risk factors for cognitive impairment or were reporting impairments that would suggest a referral was warranted. CONCLUSIONS: Given the high rates of cognitive impairment in children with brain tumors, referral to neuropsychologic services should be considered in all survivors. In addition to improving long-term adjustment, systematic referral can provide data on cognitive impairments, making it possible to evaluate different cancer treatment protocols not only in terms of survival but also in terms of quality of survival. Greater efforts are needed to disseminate and raise awareness about published guidelines on the long-term care of pediatric brain tumor patients. Keywords: pediatric brain tumor, neuropsychology, cognition, rehabilitation, neuropsychological services
Pediatr Neurol 2013; -: 1-4 Ó 2013 Elsevier Inc. All rights reserved.
Introduction
The annual incidence of pediatric brain tumors in Sweden is 4.2 per 100,000 children (0-16 years of age) and the 10-year survival rate is approximately 72%.1 However, many pediatric brain tumor patients suffer from long-term physical and cognitive impairments,2e5 including deficits of attention, memory, tempo, and executive function.6e10 Two primary risk factors for cognitive impairments in children Article History: Received 30 April 2013; Accepted 6 July 2013 * Communications should be addressed to: Olsson; Department of Pediatrics; Skåne University Hospital; SE-22185 Lund, Sweden. E-mail address:
[email protected] 0887-8994/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pediatrneurol.2013.07.002
with pediatric brain tumors are age at diagnosis (
