{"doi":"10.1002/acn3.51951","title":"Neurologic morbidity and functional independence in adult survivors of childhood cancer","abstract":"OBJECTIVE: To examine associations between neurologic late effects and attainment of independence in adult survivors of childhood cancer treated with central nervous system (CNS)-directed therapies. METHODS: A total of 7881 survivors treated with cranial radiation therapy (n = 4051; CRT) and/or intrathecal methotrexate (n = 4193; IT MTX) ([CNS-treated]; median age [range] = 25.5 years [18-48]; time since diagnosis = 17.7 years [6.8-30.2]) and 8039 without CNS-directed therapy reported neurologic conditions including stroke, seizure, neurosensory deficits, focal neurologic dysfunction, and migraines/severe headaches. Functional independence was assessed using latent class analysis with multiple indicators (independent living, assistance with routine and personal care needs, ability to work/attend school, attainment of driver's license, marital/partner status). Multivariable regression models, adjusted for age, sex, race/ethnicity, and chronic health conditions, estimated odds ratios (OR) or relative risks (RR) for associations between neurologic morbidity, functional independence, and emotional distress. RESULTS: Among CNS-treated survivors, three classes of independence were identified: (1) moderately independent, never married, and non-independent living (78.7%); (2) moderately independent, unable to drive (15.6%); and (3) non-independent (5.7%). In contrast to 50% of non-CNS-treated survivors and 60% of siblings, a fourth fully independent class of CNS-treated survivors was not identified. History of stroke (OR = 2.50, 95% CI: 1.70-3.68), seizure (OR = 9.70, 95% CI: 7.37-12.8), neurosensory deficits (OR = 2.67, 95% CI: 2.16-3.31), and focal neurologic dysfunction (OR = 3.05, 95% CI: 2.40-3.88) were associated with non-independence among CNS-treated survivors. Non-independence was associated with emotional distress symptoms. INTERPRETATION: CNS-treated survivors do not attain full independence comparable to non-CNS-treated survivors or siblings. Interventions to promote independence may be beneficial for survivors with treatment-related neurological sequalae.","journal":"Annals of Clinical and Translational Neurology","year":2023,"id":380030,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.857,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":379986,"name":"Mingjuan Wang","orcid":null,"position":1,"is_corresponding":false},{"id":771409,"name":"M. Fatih Okcu","orcid":"0000-0001-9492-8675","position":2,"is_corresponding":false},{"id":647522,"name":"Daniel C. Bowers","orcid":"0000-0002-3947-2481","position":3,"is_corresponding":false},{"id":295593,"name":"Nicole J. Ullrich","orcid":"0000-0001-5623-3362","position":4,"is_corresponding":false},{"id":255612,"name":"Kirsten K. Ness","orcid":"0000-0002-2084-1507","position":5,"is_corresponding":false},{"id":499221,"name":"Chenghong Li","orcid":"0009-0004-0604-7421","position":6,"is_corresponding":false},{"id":255625,"name":"Deo Kumar Srivastava","orcid":"0000-0001-6693-8120","position":7,"is_corresponding":false},{"id":310246,"name":"Rebecca M. Howell","orcid":"0000-0002-0803-071X","position":8,"is_corresponding":false},{"id":310245,"name":"Todd M. Gibson","orcid":"0000-0002-8718-699X","position":9,"is_corresponding":false},{"id":230926,"name":"Wendy M. Leisenring","orcid":"0000-0001-7405-0906","position":10,"is_corresponding":false},{"id":107382,"name":"Kevin C. Oeffinger","orcid":"0000-0003-0806-7894","position":11,"is_corresponding":false},{"id":230935,"name":"Leslie L. Robison","orcid":"0000-0001-7460-8578","position":12,"is_corresponding":false},{"id":230934,"name":"Gregory T. Armstrong","orcid":"0000-0001-8722-4207","position":13,"is_corresponding":false},{"id":230931,"name":"Kevin R. Krull","orcid":"0000-0002-0476-7001","position":14,"is_corresponding":false},{"id":255615,"name":"Tara M. Brinkman","orcid":"0000-0002-4250-6160","position":15,"is_corresponding":false},{"id":1145145,"name":"Stefanie C. Vuotto","orcid":"0000-0003-2461-1060","position":0,"is_corresponding":true}],"reference_count":34,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:17:00.789848Z","pmid":"38013658","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}