Survivors of childhood neuroblastoma have neurocognitive impairments that affect their ability to reach adult milestones, according to research published in Cancer.

These survivors are less likely than their siblings to graduate college, live independently, or be employed full-time, researchers found.

The researchers compared neurocognitive impairments in neuroblastoma survivors and sibling control individuals enrolled in the Childhood Cancer Survivor Study (CCSS) using the CCSS Neurocognitive Questionnaire. A total of 837 neuroblastoma survivors were matched to 728 siblings.

The neuroblastoma survivors reported impairment in organization (25.3%), task efficiency (21.98%), emotional regulation (19.7%), and memory (19.4%).

Compared with their siblings, the neuroblastoma survivors had a greater risk of impaired task efficiency (survivors aged ≤1 year at diagnosis, relative risk [RR], 1.48, 95% CI, 1.08-2.03; >1 year RR, 1.58; 95% CI, 1.22-2.06) and impaired emotional regulation (≤1 year RR, 1.51; 95% CI, 1.07-2.12; >1 year RR, 1.44; 95% CI, 1.06-1.95).

The risk of impairment was higher with exposure to certain treatments. For example, neuroblastoma survivors who were diagnosed at age 1 year or younger had an increased risk of impaired task efficiency associated with exposure to platinum chemotherapy (RR, 1.74; 95% CI, 1.01-2.97). 

For survivors diagnosed when they were older than 1 year, receipt of brain irradiation was associated with impaired emotional regulation (RR, 1.96; 95% CI, 1.05-3.65) and impaired memory (RR, 2.02; 95% CI, 1.14-3.58). Survivors treated with chest, neck, or total body irradiation were less likely to have emotional regulation impairment (RR, 0.41; 95% CI, 0.23-0.76).

Neuroblastoma survivors were more likely than their siblings to have chronic health conditions, including hearing loss, cardiovascular conditions, and neurologic conditions. Survivors who had chronic health conditions were more likely to have neurocognitive impairment.

Neurocognitive impairment had a “striking” impact on neuroblastoma survivors’ ability to attain adult milestones, the researchers noted. Survivors who were 25 years of age or older were less likely than their siblings to graduate from college (P =.035), be employed full-time (P <.001), and be living independently (P <.001).

“The high prevalence of neurocognitive impairment found in this study suggests all survivors of neuroblastoma should be carefully screened, and there should be a low threshold for formal neuropsychological testing,” the researchers concluded. “Moreover, as research identifies survivors at risk for neurocognitive impairment, intervention studies aimed at preventing and mitigating these outcomes are needed.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Hesko C, Liu W, Srivastava DK, et al. Neurocognitive outcomes in adult survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study. Cancer. Published online May 18, 2023. doi:10.1002/cncr.34847

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