BACKGROUND: Pediatric survivors of posterior fossa tumors (SPFTs) report poor cognitive functioning and increased psychoneurological symptoms (PNSs), including anxiety, depressive symptoms, and sleep disturbance. Although cognitive function and PNSs are associated with health-related quality of life (HRQOL), the interplay among these variables remains poorly understood. OBJECTIVE: To (1) describe how sociodemographic, clinical, cognitive, and PNS factors differ between survivors with high versus low HRQOL; and (2) examine whether PNSs mediate the relationship between perceived cognitive function and HRQOL. INTERVENTIONS/METHODS: A cross-sectional study recruited 40 SPFTs from a pediatric oncology institution. Validated instruments measured perceived cognitive function, anxiety, depressive symptoms, sleep disturbance, and HRQOL. RESULTS: Survivors with high HRQOL reported significantly better cognitive functioning and lower anxiety and depressive symptoms compared with those with low HRQOL. Perceived cognitive functioning was positively associated with HRQOL (P < .004). Counterfactual mediation analyses demonstrated that anxiety and depressive symptoms significantly mediated 53.11% (P = .008) and 40% (P = .016) of this relationship, respectively. A significant exposure-mediator interaction was observed between anxiety and perceived cognitive function (P = .026). Sleep disturbance was not a significant mediator. CONCLUSIONS: Improving cognitive function may enhance HRQOL by reducing anxiety and depressive symptoms, key mediators in this relationship. The interaction between anxiety and cognitive function highlights that anxiety may have a stronger influence on HRQOL in survivors with lower cognitive functioning. IMPLICATIONS FOR PRACTICE: Routine screening tools and self-directed interventions targeting cognitive function and PNSs may improve HRQOL in SPFTs.
Webster et al. (Mon,) studied this question.