Cognitive predictors of social adjustment in pediatric brain tumor survivors treated with photon versus proton radiation therapy

Emily A.H. Warren, Kimberly P. Raghubar, Paul T. Cirino, Amanda E. Child, Philip J. Lupo, David R. Grosshans, Arnold C. Paulino, M. Fatih Okcu, Charles G. Minard, M. Douglas Ris, Anita Mahajan, Andres Viana, Murali Chintagumpala, Lisa S. Kahalley

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: Pediatric brain tumor survivors are at risk for poor social outcomes. It remains unknown whether cognitive sparing with proton radiotherapy (PRT) supports better social outcomes relative to photon radiotherapy (XRT). We hypothesized that survivors treated with PRT would outperform those treated with XRT on measures of cognitive and social outcomes. Further, we hypothesized that cognitive performance would predict survivor social outcomes.

PROCEDURE: Survivors who underwent PRT (n = 38) or XRT (n = 20) participated in a neurocognitive evaluation >1 year post radiotherapy. Group differences in cognitive and social functioning were assessed using analysis of covariance (ANCOVA). Regression analyses examined predictors of peer relations and social skills.

RESULTS: Age at evaluation, radiation dose, tumor diameter, and sex did not differ between groups (all p > .05). XRT participants were younger at diagnosis (XRT M = 5.0 years, PRT M = 7.6 years) and further out from radiotherapy (XRT M = 8.7 years, PRT M = 4.6 years). The XRT group performed worse than the PRT group on measures of processing speed (p = .01) and verbal memory (p < .01); however, social outcomes did not differ by radiation type. The proportion of survivors with impairment in peer relations and social skills exceeded expectation; χ 2 (1) = 38.67, p < .001; χ 2 (1) = 5.63, p < .05. Household poverty predicted peer relation difficulties (t = 2.18, p < .05), and verbal memory approached significance (t = -1.99, p = .05). Tumor diameter predicted social skills (t = -2.07, p < .05).

CONCLUSIONS: Regardless of radiation modality, survivors are at risk for social challenges. Deficits in verbal memory may place survivors at particular risk. Results support monitoring of cognitive and social functioning throughout survivorship, as well as consideration of sociodemographic risk factors.

Original languageEnglish (US)
Article numbere29645
Pages (from-to)e29645
JournalPediatric Blood and Cancer
Issue number6
StatePublished - Jun 2022


  • brain tumor
  • cognition
  • proton radiation
  • social adjustment
  • Protons
  • Humans
  • Survivors/psychology
  • Cognition
  • Social Adjustment
  • Child
  • Proton Therapy/adverse effects
  • Brain Neoplasms/pathology

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Pediatrics, Perinatology, and Child Health


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