Adult Glioma Survivors With Blindness Suffer Socioeconomic Impact

Adult survivors of childhood astroglial tumors with significant vision loss are more likely to suffer various psychological and socioeconomic impacts such as unemployment, according to results of a new study.

“Astroglial tumors are the most common brain tumors in children and can result in rapid vision loss with involvement of the visual pathways or compression of visual circuits,” wrote study authors led by Peter M. K. de Blank, MD, of Rainbow Babies and Children’s Hospital in Cleveland. Low-grade astroglial tumors often have prolonged patient survival, suggesting that preserving vision is a high priority in these patients.

“To better advise patients with progressive astroglial tumors that threaten their vision about the risks and benefits of therapy, we must first understand the long-term effect of vision loss,” the authors wrote. The new study included 1,233 adult survivors of these tumors included in the Childhood Cancer Survivor Study; results were published online ahead of print in Cancer.

From the initial cohort, 115 patients died before completing the baseline survey, and 128 died before completing a follow-up survey during 2007-2010. In total, 646 were excluded from final analysis for various reasons.

Of the full cohort, 227 patients (22.5%) had vision impairment of any kind, and 47 patients (3.8%) were bilaterally blind. Almost all impairment occurred within 5 years of diagnosis. Those survivors with visual impairment were diagnosed at a younger age and were less likely to have been treated with surgery.

On multivariate analysis with adjustments for age, sex, prior cranial radiation therapy, and chronic health conditions, survivors with bilateral blindness were significantly more likely to be unmarried than survivors without any visual impairment, with an odds ratio (OR) of 4.74 (95% CI, 1.49–15.00). They were also more likely to live dependently, with an OR of 3.12 (95% CI, 1.30–7.48), and to be unemployed, with an OR of 2.17 (95% CI, 1.06–4.46).

Those with bilateral blindness also may have been less likely to attend college, but this did not reach statistical significance, with an OR of 2.05 (95% CI, 0.99–4.23).

Those survivors with impaired vision other than bilateral blindness were not significantly more likely to suffer any of these negative impacts than those without any impairment.

The authors stressed that though blindness did appear to affect these certain outcomes, many other outcomes were not affected by vision loss. This included a lack of any effect on psychological distress, neurocognitive impairment, or income deficit compared with other survivors.

This is important given that the goal of determining vision loss’s effect on impact is to help guide treatment decisions in children. “Our data suggest that tumors threatening vision in a single eye, such as solitary optic nerve gliomas, may have limited impact on adult psychological and socioeconomic outcomes,” the authors wrote.