Neurobehavioral outcomes and associated risk factors in pediatric brain tumor survivors

PURPOSE: Survival rates for children with brain tumors improve, highlighting the importance of understanding the long-term neurobehavioral outcomes because of its impact on children's well-being and quality of life. This study investigated the prevalence of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and emotional/behavioral difficulties in pediatric brain tumor survivors (PBTS), and identified the risks and protective factors on mental well-being. METHODS: A territory-wide retrospective cohort included 274 PBTS registered in the Hong Kong Paediatric Haematology and Oncology Study Group Registry. In addition, a cross-sectional follow-up survey on mental well-being was completed by 107 PBTS during survivorship follow-up. Emotional/behavioral difficulties, health-related quality of life, parental stress, and sleep variables were assessed by the survey and benchmarked against previously published Hong Kong-based reference/community cohorts. RESULTS: Among 274 PBTS, 10.6% had ADHD and 6.9% had ASD, which are significantly higher than the general pediatric population prevalence. They had more emotional/behavioral symptoms, higher parental stress, and poorer quality of life. Younger age at diagnosis, seizure history, and supratentorial tumors were linked to more difficulties. Radiotherapy was associated with reduced quality of life. Better sleep correlated with fewer ADHD and emotional symptoms. CONCLUSION: PBTS had increased risk of ADHD and ASD, and are more vulnerable to peer-relationship difficulties, poorer mental health, and quality of life. Improving sleep could be key to reducing neurobehavioral challenges. Implementing routine neurobehavioral monitoring, including sleep assessments, is crucial for enhancing survivorship care and overall well-being.