FUNCTIONAL OUTCOME AFTER LOW-GRADE ASTROCYTOMA TREATMENT IN CHILDHOOD

Objectives: The relatively high survival rate of a low-grade astrocytoma necessitates increasing attention to physical and psychosocial outcome. We aimed to study functional outcome in children treated for low-grade or pilocytic astrocytoma in different areas of the brain. Methods: Functional outcome was evaluated in the following domains: impairments, disabilities, handicaps, and Quality Of Life (QOL). In a consecutive series 38 children were included. Follow-up ranged from three years and seven months to eleven years and four months after diagnosis. Results: Sixty–one percent of children had impairments and ten percent a severe disability. Handicaps were found in the domains of relationships, school, and behavior. Children treated for supratentorial tumors needed significantly more special education and children treated for an infratentorial tumor had significantly more behavioral and social problems. QOL was significantly decreased in all domains except for emotions. Children with a diagnosis in adolescence reported a lower QOL in social functioning than younger children. Data analysis revealed that some deficits suddenly become apparent years after diagnosis. Conclusion: At long-term follow-up children with a low-grade or pilocytic astrocytoma have an invalidating functional outcome depending on tumor site and age. Children without deficits may develop severe cognitive, social, and behavioral deficits years after diagnosis, because of the phenomenon of 'growing into deficit'. Therefore we advise a long-term follow-up of children who are treated for a low-grade or pilocytic astrocytoma at a young age, to detect and subsequently offer support focused on the medical and cognitive impairments as well as on the behavioral and social consequences of their disease.