Abstract
Purpose
Brain tumors are the leading cause of death from childhood cancer. Although overall survival has improved due to earlier detection, better therapies, and improved surveillance, visual dysfunction and impaired vision-related quality-of-life (VR-QOL) are often unrecognized in children. This project investigated VR-QOL in pediatric brain tumor patients.
Methods
We evaluated visual impairment and quality-of-life (QOL) in a quality improvement project at one tertiary care center. Patients ≤ 18, greater than 6 months from diagnosis of brain tumor, excluding intrinsic anterior visual pathway tumors, underwent standardized neuro-ophthalmologic examination. Health-related QOL (HR-QOL) (PedsQL Brain Tumor Module) and VR-QOL questionnaires [CVFQ (Children’s Visual Function Questionnaire) in children < 8, and EYE-Q in children 8–18] were obtained from patients and parents.
Results
Among 77 patients, craniopharyngiomas (n = 16, 21%) and astrocytomas (n = 15, 20%) were the most common tumors. Among 44/77 (57%) visually impaired children, 7 (16%) were legally blind. Eye-Q median score was 3.40 (interquartile range 3.00–3.75), worse than average scores for normal children. Eye-Q score decreased 0.12 with every 0.1 increase in logMAR visual acuity (p < 0.001). Patients who were legally blind had a significantly lower Eye-Q score than those who were not [0.70 vs. 3.44 (p < 0.001)]. Cognitive HR-QOL scores decreased 1.3 for every 0.1 increase in logMAR visual acuity (p = 0.02).
Conclusions
Pediatric brain tumor patients’ vision, HR-QOL, and VR-QOL were often severely affected even when tumors were considered cured. Visual acuity and legal blindness correlated with VR-QOL. Systematic neuro-ophthalmologic examinations in pediatric primary brain tumor patients are necessary to facilitate early preventative and corrective ophthalmologic interventions.
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Data availability
The datasets generated during and/or analysed during the current project are available from the corresponding author on reasonable request.
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Funding
This research was supported in part by a grant from the Knights Templar of the state of Georgia. Dr Bruce was a data and scientific monitoring committee member for VielaBio and a medicolegal consultant for Bayer and for individual litigants on the topic of idiopathic intracranial hypertension. Dr Biousse and Dr Newman are consultants for GenSight Biologics and Neurophoenix. Dr Newman is a consultant for Santhera Pharmaceuticals and Stealth BioTherapeutics. Dr Biousse and Dr Newman are supported by the National Institutes of Health’s National Institute of Neurological Diseases and Stroke (R01-NSO89694). Dr Peragallo, Dr Biousse and Dr Newman are supported in part by the National Institutes of Health’s National Eye Institute core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine).
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Experimental design: JP, BB, SJ, AJ, NN, VB. Design implementation: JP, BB, CV, SJ, NN, VB. Analysis or interpretations of data: JP, BB, CV, NN, VB. Involved in writing the draft of, revising, reading, and approving the final manuscript: All authors.
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Appendix 1: Additional questions asked of participants and their parents
Appendix 1: Additional questions asked of participants and their parents
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(1)
Do you require special assistance at school, such as an independent education plan (IEP) or 504 plan?
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(2)
Do you wear glasses? Do you require additional low vision assistance, such as brail, a cane, or magnifier? If so, please specify.
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Peragallo, J.H., Bruce, B.B., Vasseneix, C. et al. Vision-related quality-of-life in pediatric primary brain tumor patients. J Neurooncol 154, 365–373 (2021). https://doi.org/10.1007/s11060-021-03835-2
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DOI: https://doi.org/10.1007/s11060-021-03835-2