QOS-30FUNCTIONAL INDEPENDENCE IN ADULT SURVIVORS OF PEDIATRIC CNS TUMORS: A REPORT FROM THE ST. JUDE LIFETIME COHORT STUDY

Abstract

Background: Beyond survival, attainment of functional independence is the primary goal for adult survivors of pediatric CNS tumors. However, the prevalence of and risk factors for non-independence have not been examined. Methods: Functional independence was assessed in 306 survivors (95 astrocytoma, 77 medulloblastoma/PNET, 35 ependymoma, 99 other) with mean[SD] current age = 26.3 years[5.1] and years since diagnosis = 17.6[5.0]. Six indicators were used to identify classes of independence using latentclass analysis:employment,independentliving,assistancewithpersonal care and routine needs, driving ability and marital status. Physical performance impairments were defined as scores,10th percentile of normative data. Multinomial logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations with functional independence. Covariates for adjustment included age, sex, age at diagnosis, tumor location, surgical resection, IQ, and chronic health conditions (cardiac, pulmonary, endocrine, neurologic). Results: Three classes of functional independence were identified: 1) independent (40%), 2) moderately independent (34%), and non-independent (26%). In multivariable treatment models, craniospinal irradiation (OR = 4.9, 95%, 2.0-11.9) and younger age at diagnosis (OR = 0.81, 95% CI, 0.74-0.88) were associated with risk of non-independence. After relevant covariate adjustment, limitations in aerobic capacity (OR = 6.2; 95% CI, 2.1-18.5), balance (OR = 3.1; 95% CI, 1.2-7.7), strength (OR = 4.6; 95% CI, 1.2-18.2), and adaptive abilities (OR = 13.3; 95% CI, 4.2-42.4) were associated with increased odds of non-independence. Non-independent survivors reported worse physical, social, and emotional quality of life. Conclusions: A substantial proportion of pediatric CNS tumor survivors are unable to function independently as adults. Interventions targeting physical performance deficits are needed.