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