{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:52:26Z","timestamp":1789685546815,"version":"4.0.1"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T00:00:00Z","timestamp":1694217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CA55727"],"award-info":[{"award-number":["CA55727"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"name":"St Jude Children\u2019s Research Hospital"},{"DOI":"10.13039\/100007345","name":"Cancer Center","doi-asserted-by":"publisher","award":["CA21765"],"award-info":[{"award-number":["CA21765"]}],"id":[{"id":"10.13039\/100007345","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012524","name":"American Lebanese-Syrian Associated Charities","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012524","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Treatment of childhood glioma has evolved to reduce radiotherapy exposure with the goal of limiting late toxicity. However, the associations between treatment changes and neurocognition, and the contribution of neurocognition and chronic health conditions to attainment of adult independence, remain unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Adult survivors of childhood glioma diagnosed in 1970-1999 in the Childhood Cancer Survivor Study (n\u2009=\u20091284; median [minimum-maximum] 30 [18-51] years of age at assessment; 22 [15-34] years from diagnosis) self-reported neurocognitive impairment and chronic health conditions. Multivariable models evaluated associations between changes in treatment exposures (surgery only, chemotherapy [with or without surgery], cranial radiation [with or without chemotherapy and\/or surgery]), and neurocognitive impairment. Latent class analysis with 5 indicators (employment, independent living, assistance with routine and\/or personal care needs, driver\u2019s license, marital or partner status) identified classes of functional independence. Path analysis tested associations among treatment exposures, neurocognitive impairment, chronic health conditions, and functional independence. Statistical tests were 2-sided.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Cranial radiation exposure decreased over time (51%, 1970s; 46%, 1980s; 27%, 1990s]. However, compared with siblings, survivors with any treatment exposure were at elevated risk for neurocognitive impairment, including surgery only (eg, memory: relative risk = 2.22; task efficiency: relative risk\u2009=\u20091.88; both P\u2009&amp;lt;\u2009.001). Three classes of functional independence were identified: independent (58%), moderately independent (20%), and nonindependent (22%). Cranial radiation was associated with nonindependence through impaired task efficiency (\u03b2\u2009=\u20090.06), sensorimotor (\u03b2\u2009=\u20090.06), and endocrine (\u03b2\u2009=\u20090.10) chronic health conditions and through the associations between these conditions and task efficiency (each \u03b2\u2009=\u20090.04). Sensorimotor and endocrine chronic health conditions were associated with nonindependence through memory.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Most long-term glioma survivors achieve adult independence. However, functional nonindependence is associated with treatment-related neurocognitive impairment and chronic health conditions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jnci\/djad190","type":"journal-article","created":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T13:41:43Z","timestamp":1694266903000},"page":"288-298","source":"Crossref","is-referenced-by-count":4,"title":["Evolving therapies, neurocognitive outcomes, and functional independence in adult survivors of childhood glioma"],"prefix":"10.1093","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5338-4154","authenticated-orcid":false,"given":"Chiara","family":"Papini","sequence":"first","affiliation":[{"name":"Department of Psychology and Biobehavioral Sciences, St. Jude Children\u2019s Research Hospital , Memphis, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sedigheh","family":"Mirzaei S.","sequence":"additional","affiliation":[{"name":"Department of 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine R","family":"Lange","sequence":"additional","affiliation":[{"name":"Divison of Pediatric Oncology, Hackensack Meridian Children\u2019s Health , Hackensack, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Salloum","sequence":"additional","affiliation":[{"name":"Pediatric Brain Tumor Program, Division of Hematology, Oncology & Bone Marrow Transplant, Nationwide Children\u2019s Hospital , Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deokumar","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, St. Jude Children\u2019s Research Hospital , Memphis, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy M","family":"Leisenring","sequence":"additional","affiliation":[{"name":"Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M","family":"Howell","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Radiation Physics, The University of Texas at MD Anderson Cancer Center , Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C","family":"Oeffinger","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University , Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie L","family":"Robison","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control, St. Jude Children\u2019s Research Hospital , Memphis, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory T","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control, St. Jude Children\u2019s Research Hospital , Memphis, TN, 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