Life-Altering Consequences of Neurocognitive Impairment in Survivors of Pediatric Cancer

Limited research investigating the value of MRI in predicting future cognitive morbidity in survivors of paediatric brain tumours: A systematic-review and call to action for clinical neuroimaging researchers

Survivors of pediatric brain tumours are at a high risk of cognitive morbidity. Reliable individual-level predictions regarding the likelihood, degree, and affected domains of cognitive impairment would be clinically beneficial. While established risk factors exist, quantitative MRI analysis may enhance predictive value, above and beyond current clinical risk models. This systematic review addresses the question: "Do MRI markers predict future cognitive functioning in pediatric brain tumour survivors?" We conducted a comprehensive search for studies published up to March 2024 that assessed MRI variables as predictors of later neuropsychological outcomes in pediatric brain tumour patients. Only studies that acquired MRI scans at an earlier timepoint to predict subsequent cognitive test performance were included. Surprisingly, few studies met these criteria, with identified research focusing primarily on MRI measures of cerebellar and white matter damage as features in predicting cognitive outcomes. Ultimately, this review reveals a limited literature, characterized by small sample sizes and poor-quality studies, placing findings at high risk of bias. Consequently, the quality and conclusions drawn from the existing research are constrained, especially in the context of prediction studies. Given the significant implications for this clinical population, this review highlights the urgent need for further investigation and a 'call to action' for medical imaging researchers in pediatric neuro-oncology.

Improving quality and quantity of life for childhood cancer survivors globally in the twenty-first century

The contributions of cooperative groups to performing large-cohort clinical trials and long-term survivorship studies have facilitated advances in treatment, supportive care and, ultimately, survival for patients with paediatric cancers. As a result, the number of childhood cancer survivors in the USA alone is expected to reach almost 580,000 by 2040. Despite these substantial improvements, childhood cancer survivors continue to have an elevated burden of chronic disease and an excess risk of early death compared with the general population and therefore constitute a large, medically vulnerable population for which delivery of high-quality, personalized care is much needed. Data from large survivorship cohorts have enabled the identification of compelling associations between paediatric cancers, cancer therapy and long-term health conditions. Effectively translating these findings into clinical care that improves the quality and quantity of life for survivors remains an important focus of ongoing research. Continued development of well-designed clinical studies incorporating dissemination and implementation strategies with input from patient advocates and other key stakeholders is crucial to overcoming these gaps. This Review highlights the global progress made and future efforts that will be needed to further increase the quality and quantity of life-years gained for childhood cancer survivors.

Life-Saving Cancer Care

What, precisely, are we seeking to achieve in offering 'life-saving' treatment to patients with cancer? Research funding agencies and pharmaceutical industry media releases, and government cancer screening programs all promise that their cancer programs save lives. But everybody dies. The nature of life and death from cancer is explored philosophically in this essay, with particular reference to the quality of life, and its meaning, during the period of prolongation of survival by 'life-saving' cancer care.