Caregivers matter: Neurological vulnerability for pediatric brain tumor survivors

Emily L Moscato; Allison P Fisher; Natasha Pillay-Smiley; Ralph Salloum; Shari L Wade

doi:10.1093/nop/npad010

Caregivers matter: Neurological vulnerability for pediatric brain tumor survivors

Neurooncol Pract. 2023 Feb 24;10(5):418-428. doi: 10.1093/nop/npad010. eCollection 2023 Oct.

Authors

Emily L Moscato¹, Allison P Fisher¹, Natasha Pillay-Smiley^{2

3}, Ralph Salloum⁴, Shari L Wade^{1

3}

Affiliations

¹ Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center; Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.
² Cancer and Blood Diseases Institute, The Cure Starts Now Foundation Brain Tumor Center; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
³ Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
⁴ Division of Hematology and Oncology, Nationwide Children's Hospital; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.

Abstract

Background: Pediatric brain tumor survivors (PBTS) are at risk of worse quality of life (QOL) due to the impact of neurotoxic treatments on the developing nervous system. Parenting factors such as protectiveness have been linked to worse QOL in childhood cancer survivors generally, but have yet to be explored for PBTS. We examined whether parenting behaviors moderated the association between neurotoxic treatment and QOL for PBTS.

Methods: PBTS (n = 40; ages 10-25) and their caregivers (n = 47) completed measures of parenting behaviors including warmth (support/connectedness) and psychological control (protectiveness) and QOL. We divided the sample into moderate/high and low neurotoxicity groups based on chart review using the Pediatric Neuro-Oncology Rating of Treatment Intensity and examined moderator effects.

Results: Survivor-reported primary caregiver warmth moderated the relationship between neurotoxicity and caregiver-reported QOL. Moderate/high neurotoxicity was associated with lower caregiver-reported QOL only when survivor-reported primary caregiver warmth was low, P = .02. Similar results were found for survivor-reported QOL. Caregiver-reported psychological control moderated the association between neurotoxicity and caregiver-reported QOL such that neurotoxicity only affected QOL at high levels of psychological control, P = .01.

Conclusions: Heightened associations between parenting and QOL in the context of neurotoxic treatments underscore the need to better support PBTS. Findings are consistent with research suggesting that family factors may be particularly important for children with other neurological insults. Limitations include cross-sectional design and a small/heterogeneous clinical sample with low ethnic/racial diversity. Prospective studies are needed to refine evidence-based screening and develop psychosocial intervention strategies to optimize QOL for PBTS and their families.

Keywords: caregiver; central nervous system tumor; quality of life.

© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.