Opinion: Economic Hardship May Be a Harbinger of Neurocognitive Outcomes in Pediatric Patients Undergoing Radiation Therapy
A recent study found that pediatric patients with cancer undergoing radiation therapy may experience greater baseline and long-term neurocognitive outcomes when they have supportive environments compared with those who live in neighborhoods with economic hardship. The study makes a compelling case that policies and resources providing support at a neighborhood level may help protect high-risk pediatric patients with brain tumors from neurocognitive decline.
The study used a framework called the economic hardship index that allowed researchers to account for the environment surrounding the patients. The data collected from the index includes factors such as unemployment, dependency, education, income, crowded housing, and poverty presented at the Census block level, comprising groups of 250 and 550 housing units for almost every neighborhood in the United States.
The researchers found that economic hardship at the neighborhood level predicted how these patients performed cognitively at baseline and then also based on what economic hardship index quartile they were in, how much they declined or stayed stable over time. Even though patients received similar care at no expense, the researchers deduced that at least some of the differences in outcomes were likely due to nontreatment-related factors such as living in a high poverty area. Within the overall economic hardship index score components, the factor that most correlated with poor outcomes was neighborhood-level poverty.
The new study followed a growing body of research showing that lower socioeconomic status can predict worse neurocognitive outcomes in pediatric patients with brain tumors who are undergoing radiation therapy. The researchers suggested that environmental conditions in high poverty areas may have a strong effect on long-term neurocognitive outcomes. As a result, patients may benefit if physicians and policymakers offer solutions that address these factors for current and future pediatric patients with brain tumors.
– The study is the first to examine neurocognitive outcomes in relation to neighborhood-wide economic hardship, rather than individual measures of family income or education.
– A similar study by the same researchers found that neighborhood-level hardship was associated with worse health-related quality of life in pediatric patients with cancer.
The study highlights the importance of considering environmental factors when caring for pediatric patients with brain tumors undergoing radiation therapy. It underscores that neurocognitive outcomes in pediatric patients with cancer are not solely determined by clinical factors but are also dependent on a patient’s neighborhood and support system. The study thus highlights the need for a multidisciplinary approach to address the long-term effects of cancer and its treatment.
Economic hardship may be predictive of neurocognitive outcomes in pediatric patients with cancer undergoing radiation therapy. Physicians and policymakers must therefore consider the environmental factors and support systems surrounding pediatric patients with brain tumors to mitigate the adverse effects on neurocognitive functions. It is high time that we recognize that addressing health disparities also means addressing social determinants of health, including poverty, that impact access to care and health outcomes.