Nida Zahid: Risk factors and late effects of primary brain tumor in children and young people treated at tertiary care hospitals of Karachi, Pakistan

Abstract

Background: Despite significant advancements, primary brain tumors (PBTs) sadly remains a major cause of morbidity and mortality, especially among children and young people (CYP) worldwide.

Aims: This study aimed to evaluate the risk factors and late effects of PBTs among CYP and their primary caregivers at tertiary care hospitals in Karachi, Pakistan.

Method: Study 1 was a matched case-control study at a private tertiary care hospital. Telephonic interviews were conducted with mothers of 122 cases (CYP with PBTs, ages 5-21) and 122 controls (CYP without tumors, ages 5-21) treated between 2017 and 2022. Conditional logistic regression was used for data analysis with STATA software version 12. Studies II to IV were prospective cohort studies conducted at private and public tertiary care hospitals. Forty-eight CYP with PBTs and their primary caregivers were recruited. CYP were assessed pre-treatment and at 12 months post-treatment for neurocognitive outcomes using validated tools such as the Slosson Intelligence Tool, Raven's Progressive Matrices, and Wechsler Intelligence Scale. Quality of life (QoL) of CYP and their caregivers were evaluated using the Pediatric Quality of Life Inventory. Generalized estimating equations were used for data analysis with STATA software version 12. Study V was a pilot exploratory study. The microRNA expression was assessed using quantitative polymerase chain reaction (qPCR). Data was analyzed by R software.

Results: The risk factors of PBTs among CYP were maternal analgesic use, paternal addictive substance use (specially smoking), higher household income, and lower paternal education. Predictors of neurocognitive outcomes in CYP were tumor type, surgical resection, post-treatment seizures, lower socioeconomic status, and low maternal education. Predictors of QoL in CYP were hydrocephalous managed with shunt and/or EVD and surgical resection. Factors affecting the QoL and family functioning of primary caregivers (mothers) included CYPs having post-treatment seizures, CYP's cognition and QoL scores, and financial burden of the disease. A significant correlation was found between pre-treatment miRNA-210 and miRNA-10b with non-verbal neurocognition at 12 months post-treatment. 

Conclusions: The study identified sociodemographic and antenatal risk factors associated with PBTs in CYP. It also highlighted the factors impacting the neurocognitive outcomes in CYP and QoL outcomes in CYP and their mothers. Understanding these predictors can guide the development of cost-effective treatments aimed at reducing the neurocognitive and psychological burdens faced by CYP and their primary caregivers. Future research should focus on larger-scale, multi-country studies to ensure broader applicability and generalizability of the findings.