Longitudinal associations between exposure to anesthesia and neurocognitive functioning in pediatric medulloblastoma

M Partanen, D L Anghelescu, L Hall, J E Schreiber, M Rossi, A Gajjar, L M Jacola

Research output: Contribution to journalArticlepeer-review

Abstract

AIM: To examine whether anesthesia exposure is associated with neurocognitive decline in pediatric medulloblastoma.

METHODS: Patients were treated at St. Jude Children's Research Hospital and completed ≥2 protocol-directed neurocognitive assessments (n = 107) as part of a multisite clinical trial for pediatric medulloblastoma (NCT00085202). Patients received risk-adapted craniospinal photon irradiation, followed by four cycles of high-dose chemotherapy and stem cell rescue. Neurocognitive testing was completed at study baseline (after surgery and <2 weeks of starting radiation therapy) and annually for 5 years. Data on anesthesia exposure during treatment was abstracted from medical records.

RESULTS: Patients were 10.2 years at diagnosis on average (SD = 4.5; 37% female, 73% average-risk). Mean cumulative anesthesia duration was 20.4 h (SD = 15.2; range 0.7-55.6 h). In the overall group, longer anesthesia duration was associated with greater declines in IQ (Estimate = -0.08, P < 0.001), attention (Estimate = -0.10, P < .001) and processing speed (Estimate = -0.13, P < 0.001). Similar results were shown in subgroups of patients who were <7 years at diagnosis (IQ = -0.14, P = 0.027; Attention = -0.25: P = 0.011), ≥7 years at diagnosis (Attention = -0.07, P = 0.039; Processing Speed = -0.08, P = 0.022), treated for high-risk disease (IQ = -0.09, P = 0.024; Attention = -0.11, P = 0.034; Processing Speed = -0.13, P = 0.001), or treated for average-risk disease (IQ = -0.05, P = .022; Attention = -0.08, P = 0.011; Processing Speed = -0.10, P < 0.001).

CONCLUSION: Greater anesthesia exposure is a risk factor for clinically significant neurocognitive decline, in addition to factors of age at diagnosis and treatment risk arm. This result is notable as there are evidence-based strategies that can limit the need for anesthesia. Limiting anesthesia exposure, as feasible, may mitigate neurocognitive late effects, and thus, improve quality of life for survivors.

Original languageEnglish
Pages (from-to)103-111
Number of pages9
JournalEuropean Journal of Cancer
Volume148
DOIs
Publication statusPublished - May 2021

Keywords

  • Adolescent
  • Adult
  • Anesthesia/adverse effects
  • Cerebellar Neoplasms/pathology
  • Child
  • Child, Preschool
  • Cognition Disorders/etiology
  • Cranial Irradiation/adverse effects
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Male
  • Medulloblastoma/pathology
  • Mental Status and Dementia Tests
  • Prognosis
  • Quality of Life
  • Risk Factors
  • Young Adult

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