Limitations
Readers should note several study limitations. Given the practical and
ethical barriers preventing a randomized controlled trial in this
sample, patients were not randomized to RT groups. It should also be
noted that RT groups differed with respect to the follow-up interval, as
PRT patients were treated more recently than XRT patients. We attempted
to minimize this difference by examining the last available cohort of
XRT patients and the first available cohort of PRT patients. Further,
the cross-sectional study design precludes direct analysis of changes in
cognitive and social functioning over time. It should also be noted that
families with greater concerns regarding their child’s outcomes may be
more likely to remain engaged in follow-up through pediatric oncology
centers, which may result in a sample with more cognitive or functional
difficulties. The small sample size is another limitation for the
present study, potentially affecting our ability to detect significant
differences and significant predictors in some instances. Regarding
measurement, it is notable that the present study incorporated only
parent report measures for the assessment of social outcomes. Although
parent report measures provide meaningful information and are commonly
used as screening measures in clinical settings, other studies have
noted the benefits of sociometric approaches (e.g., peer nominations),
computer-based measures of social information processing, and interviews
for the evaluation of survivor social outcomes.3,4,42,43