Good cognitive, social functioning seen decades after retinoblastoma treatment

By Will Boggs MD

NEW YORK (Reuters Health) - Cognitive function and social attainment reach normal levels for most adults who survived childhood retinoblastoma, according to the St. Jude Lifetime Cohort Study.

"Despite receiving intensive, multimodal therapies in very early childhood, few survivors demonstrate deficits in cognition or social attainment," Dr. Tara M. Brinkman from St. Jude Children's Research Hospital in Memphis, Tennessee, told Reuters Health by email. "Early intervention and rehabilitation remain important to optimize functional outcomes."

Adverse medical outcomes of retinoblastoma treatment have been well documented, but there are few reports on the cognitive function of childhood retinoblastoma survivors, Dr. Brinkman and colleagues note in Cancer, online November 24.

The team investigated cognitive outcomes and social attainment in 69 adult survivors of retinoblastoma (mean age, 33 years) an average of 31 years after their diagnosis.

Overall, these survivors performed within normative expectations on measures of verbal intelligence, attention, memory, processing speed, and executive functioning, the researchers say.

The participants performed above expectations in nonverbal reasoning abilities and the ability to learn new information over a series of trials and below expectations on a measure of fine motor dexterity, according to the report.

Compared with similar-aged adults, the study group reported more problems with working memory and task completion, although their self-ratings on cognition and behavior were otherwise in the average range.

In subgroup analyses, survivors with bilateral disease performed significantly better than survivors with unilateral disease on measures of verbal learning, short-term verbal memory, and long-term verbal memory.

Age at diagnosis correlated negatively with several performance measures, and total brain radiation exposure correlated negatively with performance on measures of verbal learning and verbal memory.

"We found that diagnosis less than one year of age was associated with better cognitive performance in a number of verbal domains, including intelligence, memory, and new learning," Dr. Brinkman said. "For other childhood cancer diagnoses such as leukemia and brain tumors, younger age at diagnosis is often associated with poorer cognitive outcomes."

"Our results highlight the potential for neuroplasticity such that the brain may adapt to an early insult to the visual system and reorganize to enhance processing of verbal information," she said.

Most survivors (70%) were living independently, 62% were married or living as married and 58% had completed college or a postgraduate education. Three-quarters worked full-time, but over half reported personal incomes below $20,000.

"While radiation therapy is less commonly used in contemporary treatment protocols, surgical and chemotherapeutic approaches to retinoblastoma changed very little until the end of the 20th century," the investigators explain. "Therefore, evaluation of functional outcomes of historic cohorts remains relevant for large numbers of patients and their providers."

"The majority of retinoblastoma survivors are doing well with respect to cognitive (e.g., attention, memory) and social functioning (e.g., independent living, educational attainment) in adulthood," Dr. Brinkman concluded. "These findings represent outcomes for adults nearly 30 years after diagnosis and treatment for retinoblastoma."

SOURCE: http://bit.ly/1AN4rlF

Cancer 2014.

(c) Copyright Thomson Reuters 2014. Click For Restrictions - http://about.reuters.com/fulllegal.asp