Cognitive and behavioral outcomes of childhood brain tumor survivors: a longitudinal study

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Cognitive and behavioral outcomes of childhood brain tumor survivors: a longitudinal study

Thesis submitted by Sophie GENIN

in fulfilment of the requirements of the PhD Degree in Psychological Sciences (“Docteur en Sciences Psychologiques”)

Academic year 2018-2019

Supervisor: Professor Philippe PAQUIER

Co-supervisor: Professor Patrick VAN BOGAERT

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ACKNOWLEDGMENTS 5

TABLE OF CONTENTS 9

RESEARCH OBJECTIVES AND OUTLINE OF THE DISSERTATION 17

1 RESEARCH OBJECTIVES 18

2 OUTLINE OF THE DISSERTATION 19

CHAPTER 1: LITERATURE REVIEW 20

1 CHILDHOOD BRAIN TUMORS 22

1.1 T

UMOR CLASSIFICATION

22 1.2 I

NCIDENCE

23 1.3 P

ROGNOSIS

24 1.4 C

AUSES

25 1.5 C

LINICAL PRESENTATION

25 1.6 T

REATMENT MODALITIES

26 1.6.1 S

URGICAL RESECTION

27 1.6.2 C

HEMOTHERAPY

27 1.6.3 R

ADIOTHERAPY

28 2 OUTCOMES 29

2.1 C

OGNITIVE OUTCOMES

29 2.1.1 C

OGNITIVE LATE EFFECTS

30 2.1.1.1 Age at treatment 31

2.1.1.2 Time since treatment 32

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2.1.1.3 Age at assessment 33

2.1.2 C

OGNITIVE FUNCTIONS

34 2.1.3 F

ACTORS IMPACTING COGNITIVE OUTCOMES

37 2.1.3.1 Age at diagnosis 38

2.1.3.2 Hydrocephalus 38

2.1.3.3 Tumor location 40

2.1.3.4 Radiotherapy 41

2.2 B

EHAVIORAL OUTCOMES

43 2.3 A

FEW WORDS ON ACADEMIC OUTCOMES

45 CHAPTER 2: COGNITIVE OUTCOMES OF CHILDHOOD BRAIN TUMOR SURVIVORS 48

1 INTRODUCTION 50

2 METHODS 52

2.1 P

ARTICIPANTS

52 2.2 P

ROCEDURE

53 2.3 C

OGNITIVE DOMAINS

,

TASKS AND SCORES

53 2.3.1 I

NTELLECTUAL FUNCTIONS

56 2.3.2 W

ORKING MEMORY

57 2.3.3 E

PISODIC MEMORY

58 2.3.4 A

TTENTIONAL FUNCTIONS

61 2.3.5 E

XECUTIVE FUNCTIONS

61 2.3.6 L

ANGUAGE

64 2.3.7 V

ISUO

-

CONSTRUCTIVE PRAXIS

64 3 DATA ANALYSIS AND STATISTICS 65

4 RESULTS 67

4.1 C

OGNITIVE OUTCOMES OF OUR GROUP OF

CBTS 67

4.1.1 I

67

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4.1.2 W

ORKING MEMORY

68 4.1.3 E

PISODIC MEMORY

69 4.1.4 A

71 4.1.5 E

XECUTIVE FUNCTIONS

72 4.1.6 L

ANGUAGE

73 4.1.7 V

ISUO

-

CONSTRUCTIVE PRAXIS

74 4.1.8 A

CROSS COGNITIVE DOMAINS

75 4.1.9 S

UMMARY

75 4.2 C

OGNITIVE OUTCOMES OF

CBTS

AT AN INDIVIDUAL LEVEL

76 4.3 F

ACTORS IMPACTING COGNITIVE PERFORMANCE IN OUR GROUP OF

CBTS 79

4.3.1 A

GE AT THE TIME OF DIAGNOSIS

79 4.3.2 H

YDROCEPHALUS

,

LOCATION AND RADIOTHERAPY

80 4.3.3 S

UMMARY

80 5 DISCUSSION 82

5.1 C

OGNITIVE OUTCOMES OF OUR GROUP OF

CBTS 82

5.1.1 I

83 5.1.2 W

ORKING MEMORY

84 5.1.3 E

PISODIC MEMORY

85 5.1.4 A

88 5.1.5 E

XECUTIVE FUNCTIONS

89 5.1.6 L

ANGUAGE

90 5.1.7 V

ISUO

-

CONSTRUCTIVE PRAXIS

91 5.1.8 S

UMMARY

91 5.2 C

OGNITIVE OUTCOMES OF

CBTS

94 5.3 F

ACTORS IMPACTING COGNITIVE PERFORMANCE IN OUR GROUP OF

CBTS 95

5.3.1 A

GE AT THE TIME OF DIAGNOSIS

95 5.3.2 P

RESENCE OF HYDROCEPHALUS AT THE TIME OF DIAGNOSIS

96 5.3.3 L

OCATION OF THE TUMOR

96 5.3.4 U

SE OF RADIOTHERAPY AS A TREATMENT

98 5.3.5 S

UMMARY

101

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CHAPTER 3: COGNITIVE OUTCOMES OF CHILDHOOD BRAIN TUMOR SURVIVORS FOLLOW-UP STUDY 102

1 INTRODUCTION 104

2 METHODS 105

2.1 P

ARTICIPANTS

105 2.2 P

ROCEDURE

106 2.3 C

OGNITIVE DOMAINS

,

TASKS AND SCORES

106 3 DATA ANALYSIS AND STATISTICS 107

4 RESULTS 108

4.1 C

OMPARISONS OF PERFORMANCE BETWEEN EVALUATIONS

108 4.2 I

NDIVIDUAL VARIATIONS IN PERFORMANCE BETWEEN EVALUATIONS

111 5 DISCUSSION 115

5.1 S

UMMARY

119 CHAPTER 4: BEHAVIORAL OUTCOMES OF CHILDHOOD BRAIN TUMOR SURVIVORS 120

1 INTRODUCTION 122

2 METHODS 124

2.1 P

ARTICIPANTS

124 2.2 P

ROCEDURE

125 2.3 B

EHAVIORAL FORMS

,

SCALES AND SCORES

125 3 DATA ANALYSIS AND STATISTICS 126

4 RESULTS 128

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4.1 B

EHAVIORAL OUTCOMES OF OUR SUBGROUP OF

CBTS 128

4.2 B

EHAVIORAL OUTCOMES OF

CBTS

131 4.3 P

ARENTS AND TEACHERS

’

DEGREE OF AGREEMENT

133 4.4 A

SSOCIATIONS BETWEEN BEHAVIORAL AND COGNITIVE OUTCOMES

135 5 DISCUSSION 137

5.1 B

EHAVIORAL OUTCOMES OF OUR SUBGROUP OF

CBTS 137

5.2 P

ARENTS AND TEACHERS

’

DEGREE OF AGREEMENT

142 5.3 A

SSOCIATION BETWEEN BEHAVIORAL AND COGNITIVE OUTCOMES

143 5.4 C

ONCLUSIONS

145 CHAPTER 5: GENERAL DISCUSSION 146

1 SUMMARY OF THE FINDINGS AND REFLECTIONS 148

1.1 S

TUDY

1 148

1.2 S

TUDY

2 149

1.3 S

TUDY

3 150

1.4 O

BSERVATIONS AND CONSIDERATIONS

152 2 STRENGTHS AND LIMITATIONS 153

3 PROPOSAL FOR FUTURE RESEARCH 154

BIBLIOGRAPHY 158

APPENDIXES 178

A

PPENDIX

A. C

LINICAL CHARACTERISTICS OF OUR GROUP OF

CBTS

IN STUDY

1 (

CHAPTER

2) 180

A

PPENDIX

B. A

SSOCIATIONS OF IMPAIRED COGNITIVE FUNCTIONS IN STUDY

1 (

CHAPTER

2) 183

A

PPENDIX

C. C

LINICAL CHARACTERISTICS OF OUR GROUP OF

CBTS

IN STUDY

2 (

CHAPTER

3) 184

A

PPENDIX

D. A

CADEMIC CHARACTERISTICS OF GROUP OF

CBTS

IN STUDY

3 (

CHAPTER

4) 185

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A

PPENDIX

E. T

HE

C

HILD

B

EHAVIOR

C

HECKLIST FOR

A

GES

6-18 (CBCL) (

CHAPTER

4) 186

A

PPENDIX

F. T

HE

T

EACHER

’

^S

R

EPORT

F

ORM

(TRF) (

CHAPTER

4) 190

A

PPENDIX

G. P

ROBLEM ITEMS INCLUDED IN EACH SYNDROME SCALE

(CBCL

AND