{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T21:23:16Z","timestamp":1793740996934,"version":"4.6.1"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:00:00Z","timestamp":1720051200000},"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":["U24 CA055727"],"award-info":[{"award-number":["U24 CA055727"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"name":"St. Jude Cancer Center Support","award":["P30 CA21765"],"award-info":[{"award-number":["P30 CA21765"]}]},{"DOI":"10.13039\/100012524","name":"American Lebanese Syrian Associated Charities","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012524","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Treatment of childhood medulloblastoma has evolved to reduce neurotoxicity while improving survival. However, the impact of evolving therapies on late neurocognitive outcomes and adult functional independence remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult survivors of childhood medulloblastoma (n\u2005=\u2005505; median [minimum\u2013maximum] age, 29 [18\u201346] years) and sibling controls (n\u2005=\u2005727; 32 [18\u201358] years) from the Childhood Cancer Survivor Study completed surveys assessing neurocognitive problems and chronic health conditions (CHCs). Treatment exposures were categorized as historical (craniospinal irradiation [CSI]\u2005\u2265\u200530 Gy, no chemotherapy), standard-risk (CSI\u2005&amp;gt;\u20050 to &amp;lt;30 Gy\u2005+\u2005chemotherapy) and high-risk (CSI\u2005\u2265\u200530 Gy\u2005+\u2005chemotherapy) therapy. Latent class analysis identified patterns of functional independence using employment, independent living, assistance with routine\/personal care needs, driver\u2019s license, and marital\/partner status. Multivariable models estimated the risk of neurocognitive impairment in survivors versus siblings and by treatment exposure group, and associations between neurocognitive impairment, CHCs, and functional independence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Survivors in each treatment exposure group had a 4- to 5-fold elevated risk of impaired memory and task efficiency compared to siblings. Contemporary risk-based therapies did not confer lower risk compared to historical therapy. Survivors treated in the 1990s had a higher risk of memory impairment (relative risk [RR] 2.24, 95% confidence interval 1.39\u20133.60) compared to survivors treated in the 1970s. Sensorimotor, hearing problems, and seizures were associated with 33\u201334%, 25\u201326%, and 21\u201342% elevated risk of task efficiency and memory impairment, respectively. Treatment-related CHCs and neurocognitive impairment were associated with nonindependence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite treatment changes, long-term survivors of childhood medulloblastoma remain at risk for neurocognitive impairment, which was associated with CHCs. Neurocognitive surveillance after contemporary regimens is imperative.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuonc\/noae119","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T16:24:30Z","timestamp":1720023870000},"page":"254-266","source":"Crossref","is-referenced-by-count":14,"title":["Neurocognitive outcomes and functional independence in adult survivors of childhood medulloblastoma diagnosed over 3 decades"],"prefix":"10.1093","volume":"27","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, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sedigheh","family":"Mirzaei","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, St. Jude 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,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M K","family":"de Blank","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, The Cure Starts Now Brain Tumor Center , Cincinnati, Ohio ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine R","family":"Lange","sequence":"additional","affiliation":[{"name":"Division of Pediatric Oncology, Hackensack Meridian Children\u2019s Health , Hackensack, New Jersey ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tricia Z","family":"King","sequence":"additional","affiliation":[{"name":"Department of Psychology, Georgia State University , Atlanta, Georgia ,\u00a0","place":["USA"]},{"name":"Neuroscience Institute, Georgia State University , Atlanta, Georgia 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