A team of researchers from Emory and Georgia State Universities has been awarded a four-year, nearly $850,000 grant from the American Cancer Society to study risk factors for long-term social and cognitive problems in adult survivors of pediatric brain tumors. The study will focus on more than 100 adults, currently in their 20s, who have survived at least ten years beyond their initial diagnosis.
The research team will use cutting-edge neuroimaging technology and neuropsychological evaluations to look for neurological, cognitive and psychosocial predictors of adaptive functioning--the skills needed to live independently. The hypothesized predictive markers include memory, decision-making skills, socioeconomic status as well as the structure and integrity of the brain's white matter.
"Identifying these predictors will allow for early recognition of individuals at risk for adverse long-term outcomes, leading to the development of interventions that lessen the severity of late effects of the treatment of brain tumors and optimizing the adaptive functioning across the patient's lifespan," says Hui Mao, PhD, assistant professor of radiology in Emory University School of Medicine and the lead investigator of the study at Emory.
The research team includes a neurologist, neuro-oncologist, neuropsychologists and radiologists. The researchers will use functional magnetic resonance imaging (fMRI) to map the brain regions where executive function abilities such as working memory are processed and how they may be altered by the presence of a tumor and subsequent radiation or chemotherapy treatments.
Diffusion tensor imaging (DTI) will allow the researchers a look at the integrity and arrangement of the brain's white matter, the complex network of neuronal fibers that connect different areas of the brain and that are often affected by tumors themselves as well as treatments.
Brain tumors are the second most common type of pediatric cancer, exceeded only by childhood leukemia. Because long-term survival rates of pediatric brain-tumor patients have risen by more than one-third over the last 20 years, researchers say new studies on the long-term effect and outcomes of individuals following treatment of brain tumors are needed to help recognize markers of later adaptive functioning and develop therapeutic interventions to reduce overall levels of disability and improve the quality of life in this growing population. Studies have shown lower rates of employment, academic achievement and marriage in brain tumor survivors relative to the comparison groups, and higher rates of depression and alcoholism. Likewise, neurological and cognitive difficulties may include hearing and vision loss, motor impairment and learning difficulties.
"This new study aims to gain insights into brain structural and functional changes caused by the tumor and their links to those outcomes, and we hope that the new information and understanding will also help us to improve the current strategy of brain tumor treatment," says Dr. Mao.
Other Emory researchers involved in this study include Nicolas Krawiecki, MD, associate professor of pediatrics and Anna Janns, MD, associate professor of pediatrics, a Georgia Cancer Coalition Scholar and a member of Emory's Winship Cancer Institute and the Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta; and Chad Holder, MD, assistant professor of radiology. Researchers from Georgia State University include Tricia King, PhD, assistant professor of psychology and principal investigator of this American Cancer Society funded project; and Robin Morris, PhD, professor of psychology and vice president for research.