Quality of life and functional outcomes in pediatric brain tumor survivors in resource-limited settings: A retrospective cohort study

Background: Pediatric brain tumors represent the leading cause of cancer-related mortality in children, with survival outcomes in low-middle-income countries (LMICs) significantly inferior to those in high-income countries. While survival data from LMICs are emerging, health-related quality of life (HRQOL) and functional outcomes remain poorly characterized. This study aimed to evaluate HRQOL and identify predictors of functional outcomes in pediatric brain tumor survivors at a tertiary care center in India. Methods: A retrospective cohort study was conducted on pediatric brain tumor patients (age 2–18 years) treated between January 2019 and December 2023 at our tertiary care center. For the present analysis, we included 92 children who were alive and in active follow-up for at least 12 months after completion of primary treatment and were therefore considered survivors. The Pediatric Quality of Life Inventory (PedsQL) Brain Tumor Module and Lansky Performance Scale were administered at the time of the last follow-up visit (minimum 12 months post-treatment). Clinical variables, including tumor histology, location, treatment modality, complications, and late effects, were extracted, and univariate and multivariate regression were used to identify predictors of HRQOL. Results: Among these 92 survivors, the mean follow-up duration was 32.4 months (range 12–58 months). In the initial cohort of 134 children, 58.7% were alive at last follow-up. Mean total PedsQL score was 64.3 ± 18.2. Cognitive functioning (56.8 ± 21.4) and procedural anxiety (58.2 ± 19.6) subscales scored lowest. Multivariate analysis revealed that supratentorial tumor location (β = −12.4, p = 0.002), disease recurrence (β = −15.8, p < 0.001), craniospinal radiation (β = −11.2, p = 0.004), and postoperative complications (β = −9.6, p = 0.012) were independent predictors of poor HRQOL. Gross total resection predicted better outcomes (β = 8.7, p = 0.008). Conclusion: Pediatric brain tumor survivors in LMICs demonstrate impaired HRQOL, particularly in cognitive and emotional domains. Tumor location, treatment-related toxicity, and extent of resection significantly impact long-term outcomes. These findings emphasize the need for comprehensive survivorship programs and neurocognitive rehabilitation strategies in resource-limited settings.