Physical Therapy And Length Of Inpatient Stay In Relation To Neuropsychological Functioning Among Childhood Cancer Survivors: A Retrospective Cohort Study From The Heros Registry

Author

• Jingyi ZhangFollow

Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Xiaomei Ma

Abstract

Background: As 5-year survival after childhood cancer exceeds 85%, neuropsychological late effects have emerged as a key issue. Despite this, the impact of modifiable risk factors during cancer treatment on subsequent neuropsychological outcomes remains obscure. This study aimed to evaluate whether physical therapy (PT) and length of inpatient stay are associated with later neurocognitive, emotional, and behavioral outcomes in childhood cancer survivors (CCS).Methods: This study included 92 CCS who had available electronic health records (EHR) for cancer treatment and completed a neuropsychological evaluation 0–5 years after their treatment end date. Information on PT and length of inpatient stay (i.e., the exposures) was abstracted from EHR. Outcomes were measured continuously and dichotomized (e.g., impaired/not impaired). Multivariable regression models evaluated possible associations between exposures and outcomes, adjusting for age at cancer diagnosis and type of cancer. Results: The 92 CCS had a median of 1 PT visit (IQR: 0–4.25; 51% with any PT visit) and a median of 26 inpatient days (IQR: 11.5–58.5). Receiving PT was associated with higher matrix reasoning scores (β = 1.61; 95% CI: 0.16, 3.06), while >30 inpatient days were associated with lower working memory (β = -16.18; 95% CI: -29.56, -2.80) and matrix reasoning (β = -3.40; 95% CI: -5.81, -0.98) when compared to 0 days. CCS who underwent PT were more likely to experience depressive symptoms (OR = 7.51; 95% CI: 1.26, 61.01), whereas those with longer inpatient stays had lower odds of depressive symptoms (OR = 0.08; 95% CI: 0.00, 0.94). Conclusions: In-treatment exposures may influence neuropsychological outcomes in CCS. While receipt of PT and fewer inpatient days were associated with better neurocognitive outcomes, they appear to increase the risk of depressive symptoms, warranting further study in larger samples.

Comments

This is an Open Access Thesis.

Recommended Citation

Zhang, Jingyi, "Physical Therapy And Length Of Inpatient Stay In Relation To Neuropsychological Functioning Among Childhood Cancer Survivors: A Retrospective Cohort Study From The Heros Registry" (2026). Public Health Theses. 2663.
https://elischolar.library.yale.edu/ysphtdl/2663