Abstract B070: Longitudinal patterns of executive functioning and adherence in an ethnically diverse sample of pediatric patients with cancer
Authors: Ko Clara , Jewell Andrea , Isaac Evrosina , Verma Tanvi , Rohan Jennifer M. 
Published: January 2023

Introduction: Executive functioning (EF) is a set of cognitive abilities that includes working memory, flexible thinking, and self-control. EF has been linked to medication adherence in different pediatric populations (e.g., asthma, diabetes, transplant recipients), with greater EF associated with better adherence. The purpose of this study was to examine ethnic and racial differences in EF and medication adherence in a sample of pediatric patients with cancer. Methods: Participants were 39 pediatric cancer patients ages 2-18 years who were in active treatment (Mage = 11.03). Twenty patients (51.3%) identified as non-Hispanic, White; while the remaining 19 (48.7%) identified as other minority status (e.g., non-Hispanic, Black; Hispanic). Parents completed the Behavior Rating of Executive Functioning (BRIEF) at baseline, 6 months, and 12 months. The BRIEF yields an overall Global Executive Composite score (GEC) composed of two indexes: the Behavioral Regulation Index (BRI) and the Metacognition Index (MI). The BRI is composed of the Inhibit, Shift, and Emotional Control scales. The MI is composed of the Initiate, Working Memory, Plan/Organize, Organization of Materials, and Monitor scales. Adherence was measured across the same timepoints using the Medication Event Monitoring System (MEMS), which is an objective measure of daily adherence to medication. Results: When identifying ethnic and racial differences in EF over time, there were no significant effects of time or minority status on MI and GEC scores. For the BRI overall, there was no significant main effect of time (p=0.5), or minority status (p=0.66). However, there was a significant interaction between time and minority status on BRI, F(2,56)=5.26, p=0.01, ηp 2=0.16), with parents of non-minoritized patients observing more executive functioning deficits over time, and parents of minoritized patients observing improvements in executive functioning across 1-year. Finally, when examining EF and adherence, MI at Month 6 was significantly correlated with cumulative adherence at Month 6, even when controlling for minority status and age, r(27) = -0.45, p=0.01. Conclusions: Parents of minoritized patients observed improvements in behavioral regulation over time; whereas parents of non-Hispanic White patients reported worsening behavioral regulation. Additionally, MI was significantly correlated with medication adherence at 6 months, even when controlling for minority status and age. This suggests that deficits in a child’s ability to initiate, plan, organize, self-monitor, and sustain working memory can result in lower adherence regardless of minority status and age. Culturally-sensitive psychological interventions targeting meta-cognition domains may ameliorate nonadherence for pediatric patients with cancer, ultimately improving health outcomes.

Citation Format: Clara Ko, Andrea Jewell, Evrosina Isaac, Tanvi Verma, Jennifer M. Rohan. Longitudinal patterns of executive functioning and adherence in an ethnically diverse sample of pediatric patients with cancer [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B070.