Impact of vision loss among survivors of childhood central nervous system astroglial tumors

• Published in: Cancer 2016-03, Vol.122 (5), p.730-739
• Main Authors: de Blank, Peter M. K., Fisher, Michael J., Lu, Lu, Leisenring, Wendy M., Ness, Kirsten K., Sklar, Charles A., Stovall, Marilyn, Vukadinovich, Chris, Robison, Leslie L., Armstrong, Gregory T., Krull, Kevin R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antineoplastic Agents; Astrocytoma - complications; Astrocytoma - psychology; Astrocytoma - therapy; Blindness - etiology; Blindness - psychology; Central Nervous System Neoplasms - complications; Central Nervous System Neoplasms - psychology; Central Nervous System Neoplasms - therapy; Child; Child, Preschool; childhood cancer survivors; Cranial Irradiation; Employment - statistics & numerical data; Female; Humans; Income - statistics & numerical data; Independent Living - statistics & numerical data; Logistic Models; Male; Multivariate Analysis; Neurosurgical Procedures; optic pathway glioma; pediatric glioma late effects; Retrospective Studies; Social Class; Survivors - psychology; Survivors - statistics & numerical data; Vision Disorders - etiology; Vision Disorders - psychology; vision loss; Young Adult
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.29705

BACKGROUND The impact of impaired vision on cognitive and psychosocial outcomes among long‐term survivors of childhood low‐grade gliomas has not been investigated previously but could inform therapeutic decision making. METHODS Data from the Childhood Cancer Survivor Study were used to investigate psychological outcomes (measures of cognitive/emotional function) and socioeconomic outcomes (education, income, employment, marital status, and independent living) among astroglial tumor survivors grouped by 1) vision without impairment, 2) vision with impairment (including unilateral blindness, visual field deficits, and amblyopia), or 3) bilateral blindness. The effect of vision status on outcomes was examined with multivariate logistic regression with adjustments for age, sex, cranial radiation therapy, and medical comorbidities. RESULTS Among 1233 survivors of childhood astroglial tumors 5 or more years after their diagnosis, 277 (22.5%) had visual impairment. In a multivariate analysis, survivors with bilateral blindness were more likely to be unmarried (adjusted odds ratio (OR), 4.7; 95% confidence interval [CI], 1.5‐15.0), live with a caregiver (adjusted OR, 3.1; 95% CI, 1.3‐7.5), and be unemployed (adjusted OR, 2.2; 95% CI, 1.1‐4.5) in comparison with those without visual impairment. Bilateral blindness had no measurable effect on cognitive or emotional outcomes, and vision with impairment was not significantly associated with any psychological or socioeconomic outcomes. CONCLUSIONS Adult survivors of childhood astroglial tumors with bilateral blindness were more likely to live unmarried and dependently and to be unemployed. Survivors with visual impairment but some remaining vision did not differ significantly with respect to psychological function and socioeconomic status from those without visual impairment. Cancer 2016;122:730–739. © 2016 American Cancer Society. The impact of impaired vision on psychological and socioeconomic outcomes among long‐term survivors of childhood low‐grade gliomas has not been investigated, but it could inform therapeutic decision making. Among survivors of childhood astroglial tumors (n = 1233), only adult survivors with bilateral blindness are more likely to live unmarried (adjusted odds ratio, 4.7; 95% confidence interval, 1.5‐15.0), live with a caregiver (adjusted odds ratio, 3.1; 95% confidence interval, 1.3‐7.5), and be unemployed (adjusted odds ratio, 2.2; 95% confidence interval, 1.1‐4.5), whereas survivors with so