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Cancer. 2018 Aug 1;124(15):3220-3230. doi: 10.1002/cncr.31379. Epub 2018 Jun 11.

Long-term psychological and educational outcomes for survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study.

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Yale University School of Medicine, New Haven, Connecticut.
Boston Children's Hospital, Boston, Massachusetts.
Boston Medical Center, Boston, Massachusetts.
St. Jude Children's Research Hospital, Memphis, Tennessee.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Fred Hutchinson Cancer Research Center, Seattle, Washington.
National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
The University of Texas MD Anderson Cancer Center, Houston, Texas.
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Yale Comprehensive Cancer Center, New Haven, Connecticut.
Duke Cancer Institute, Durham, North Carolina.



Neuroblastoma survivors may be at elevated risk for psychological impairments because of their young age at diagnosis and neurotoxic treatment, but this is not well described.


A total of 859 ≥5-year survivors of neuroblastoma younger than 18 years (diagnosed in 1970-1999), who had a median age at diagnosis of 0.8 years (range: 0.0-7.3 years) and a median follow-up of 13.3 years (range: 8.0-17.9 years), were compared with 872 siblings of childhood cancer survivors who were younger than 18 years with the parent-reported Behavior Problem Index (BPI) for psychological functioning. Age- and sex-adjusted multivariate log-binomial models were used to identify factors associated with impairment in BPI domains (scores worse than the sibling 10th percentile). The impact of psychological impairment on educational outcomes was examined among survivors.


Compared with siblings, neuroblastoma survivors had an increased prevalence of impairment in the domains of anxiety/depression (19% vs 14%; P = .003), headstrong behavior (19% vs 13%; P < .001), attention deficits (21% vs 13%; P < .001), peer conflict/social withdrawal (26% vs 17%; P < .001), and antisocial behavior (16% vs 12%; P = .01). Common treatment exposures (vincristine, cisplatin, and retinoic acid) were not associated with impairment. Having 2 or more chronic health conditions predicted impairment in 4 domains (P < .001). Specifically, pulmonary disease predicted impairment in all 5 domains (P ≤ .004). Endocrine disease (P ≤ .004) and peripheral neuropathy (P ≤ .02) each predicted impairment in 3 domains. Psychological impairment was associated with special education service usage and educational attainment less than college.


Neuroblastoma survivors are at elevated risk for psychological impairment, which is associated with special education service usage and lower adult educational attainment. Those with chronic health conditions may represent a high-risk group for targeted screening and intervention. Cancer 2018. © 2018 American Cancer Society.


cancer survivorship; chronic health; educational outcomes; neuroblastoma; psychological outcomes

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