Friendship Quality Among Survivors of Pediatric Brain Tumors and Survivors of Non-Central Nervous System Solid Tumors

Friendship Quality Among Survivors of Pediatric Brain Tumors and Survivors of Non-Central Nervous System Solid Tumors | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 11 June 2025 V1 Latest version Share on Friendship Quality Among Survivors of Pediatric Brain Tumors and Survivors of Non-Central Nervous System Solid Tumors Authors : Matthew C. Hocking [email protected] , Peter M. Fantozzi , Amanda P. Swartz , and Manali Zope Authors Info & Affiliations https://doi.org/10.22541/au.174962433.36003352/v1 Published Children's Health Care Version of record Peer review timeline 197 views 161 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background/Objectives : Survivors of pediatric brain tumors (SPBT) experience difficulties with social connectedness. However, little is known about the friendship quality among survivors who have friends despite its importance to critical outcomes. This study evaluated friendship quality with an identified friend among SPBT and survivors of non-central nervous system solid tumors (SNCNST) and factors associated with friendship quality. Methods : Survivors, ages 7-14, completed study visits within 6 months of finishing tumor-directed treatment. Participants identified a friend and completed measures of cognitive function, social cognition, and family functioning. Caregivers reported on survivor physical function. Survivors and identified friends completed the friendship quality measure. Analyses compared survivor- and friend-reported Closeness between SPBT and SNCNST and identified factors associated with friendship quality. Results : In univariate analyses, SPBT reported lower Closeness with their identified friend compared to SNCNST. In general linear model analysis controlling for sex and age at diagnosis, SPBT and SNCNST no longer differed on Closeness. SPBT and SNCNST did not differ on friend-reported Closeness. Level of agreement between survivor- and friend-reported closeness was low. Regression analysis indicated that survivor sex, survivor-reported family function, and parent-reported survivor physical function were significantly associated with survivor-reported Closeness. Conclusions : Findings suggest factors outside of diagnosis (brain v. non-brain) are important to friendship quality in the early stages of survivorship. Longitudinal research is needed to evaluate friendship quality when late effects emerge. Efforts to improve survivor physical and family function may promote enhanced connections with friends, particularly soon after completing cancer therapy. Friendship Quality Among Survivors of Pediatric Brain Tumors and Survivors of Non-Central Nervous System Solid Tumors Matthew C. Hocking, Ph.D. Children’s Hospital of Philadelphia and The University of Pennsylvania Peter M. Fantozzi Children’s Hospital of Philadelphia and The University of Kansas Amanda P. Swartz and Manali Zope Children’s Hospital of Philadelphia All correspondence regarding this article should be addressed to Matthew C. Hocking, Ph.D., Division of Oncology, The Children’s Hospital of Philadelphia, 3500 Civic Center Blvd., The Hub for Clinical Collaboration, Office 3568, Philadelphia, PA 19104. Email: [email protected] . Abstract Word Count: 245 Manuscript Word Count: 2736 3 Tables, 0 Figures Key Words: Brain Tumor, Solid Tumor, Friendship Quality Running Title: Friendship Quality Among Survivors Abbreviation Key SNCNST Survivors of Non-Central Nervous System Tumors SIP Social Information Processing CNS Central Nervous System WASI-II Wechsler Abbreviated Scale of Intelligence, Second Edition DANVA-2 Diagnostic Analysis of Nonverbal Accuracy – Revised ACQ Attributions and Coping Questionnaire – Friend PedsQL Pediatric Quality of Life Inventory 4.0 FAD-GFS Family Assessment Device - General Functioning Scale NRI-RQV Network of Relationships Inventory- Relationship Qualities Version ICC Intraclass Correlation Coefficient Abstract Background/Objectives: Survivors of pediatric brain tumors (SPBT) experience difficulties with social connectedness. However, little is known about the friendship quality among survivors who have friends despite its importance to critical outcomes. This study evaluated friendship quality with an identified friend among SPBT and survivors of non-central nervous system solid tumors (SNCNST) and factors associated with friendship quality. Methods: Survivors, ages 7-14, completed study visits within 6 months of finishing tumor-directed treatment. Participants identified a friend and completed measures of cognitive function, social cognition, and family functioning. Caregivers reported on survivor physical function. Survivors and identified friends completed the friendship quality measure. Analyses compared survivor- and friend-reported Closeness between SPBT and SNCNST and identified factors associated with friendship quality. Results: In univariate analyses, SPBT reported lower Closeness with their identified friend compared to SNCNST. In general linear model analysis controlling for sex and age at diagnosis, SPBT and SNCNST no longer differed on Closeness. SPBT and SNCNST did not differ on friend-reported Closeness. Level of agreement between survivor- and friend-reported closeness was low. Regression analysis indicated that survivor sex, survivor-reported family function, and parent-reported survivor physical function were significantly associated with survivor-reported Closeness. Conclusions: Findings suggest factors outside of diagnosis (brain v. non-brain) are important to friendship quality in the early stages of survivorship. Longitudinal research is needed to evaluate friendship quality when late effects emerge. Efforts to improve survivor physical and family function may promote enhanced connections with friends, particularly soon after completing cancer therapy. Developing and maintaining friendships is an important developmental process for youth [1]. Beyond the benefits of friendship on well-being [2], the quality of a child’s friendships is associated with critical outcomes in adulthood, including physical and mental health, and occupational success [3-6]. Further, having a friendship with positive qualities can mitigate the effects of other difficult relationships [7] or medical stressors [8]. Diagnosis and treatment for a brain tumor in childhood can alter the developmental process of making and fostering high quality friendships [9]. In addition to reduced time with peers and friends secondary to brain tumor therapies and their side effects, survivors of pediatric brain tumors (SPBT) may experience disruptions in social information processing (SIP) abilities that are essential to interacting with peers and friends [9, 10]. Emerging evidence suggests that SPBT have fewer friends, fewer interactions with friends, and a reduced number of positive interactions with peers compared to siblings and other survivors of childhood cancer [11-13]. Notably, difficulties with friendships persist into adulthood [14, 15] and are evident at early stages of survivorship. In a study of SPBT and survivors of non-central nervous system solid tumors (SNCNST) who had completed tumor-directed therapy within the prior 6 months, SPBT (61.7%) were significantly less likely to name a friend compared to SNCNST (85.3%) [16]. Biopsychosocial models of social functioning that are grounded in cognitive neuroscience [10, 17], and applicable to SPBT [9], implicate variability in intrinsic and extrinsic factors in the social outcomes of youth affected by central nervous system (CNS) injury. Intrinsic factors include things such as child age and sex, physical functioning, and cognitive and SIP abilities, while extrinsic factors include variables like family functioning and socio-economic status. There are critical knowledge gaps in how these factors are related to friendship quality in SPBT. While prior research has evaluated peer acceptance and the presence of friendships among SPBT, little is known about the friendship quality of survivors who do report having friends. Increased understanding of friendship quality and the factors affecting it in SPBT is needed to guide efforts to promote better friendships among this at-risk group of survivors. The objectives of this study were to extend our earlier work on the friendships of SPBT and SNCNST [16] and evaluate the quality of friendship identified by these survivors within 6 months of the completion of tumor-directed treatment. We aimed to 1) determine whether SPBT and SNCNST differ in terms of their self-reported friendship quality with an identified friend; 2) evaluate the level and directionality of agreement on ratings of friendship quality between survivors and their friend; and 3) identify pertinent factors associated with friendship quality. We hypothesized that 1) SPBT would have lower self-reported friendship quality compared to SNCNST; 2) the level of agreement on ratings of friendship quality between survivors and their friends would be lowest for SPBT with survivors reporting better friendship quality; and 3) older survivor age, female sex, and higher levels of survivor physical, cognitive, social cognitive, and family functioning would be associated with better friendship quality. Methods Participants Children who were English-speaking, between the ages of 7 and 14 at the time of the study, were able to name a friend, and had finished tumor-directed treatment within the past 6 months ( M = 3.39 months, SD = 1.78 months, range 2 weeks – 6.9 months) for either a brain tumor (n = 40) or a non-CNS solid tumor (n = 32) were included in this analysis. Tumor-directed treatment included any combination of surgery, radiation, or chemotherapy. SNCNST were included as a comparison group because they complete similar treatments and experience similar disruptions to peer relationships from treatment. SNCNST who received treatment that affected the CNS, such as total body irradiation, were excluded. Exclusion criteria for survivors included 1) genetic conditions affecting development; or 2) developmental delays prior to tumor diagnosis. Participants also included a friend identified by enrolled survivors (n = 46). Analyses indicated no differences between consenting and non-consenting survivors on demographic or medical characteristics. Of the 72 friends contacted, 46 (63.9%) completed study procedures. Procedures The current study represents baseline data from a prospective study conducted at the Children’s Hospital of Philadelphia that has been reported previously [16, 18, 19]. All procedures were approved by our institutional review board, and written informed consent and child assent were obtained. Study staff identified potentially eligible participants through medical records and medical teams, and contacted them through letter, phone, and during clinic visits. During study visits, each participant was asked to “name one of your closest friends”. These friends were contacted by study staff and invited to complete study measures (described below). Measures Cognitive Function. The two-subtest Wechsler Abbreviated Scale of Intelligence, Second Edition [WASI-II; 20] was used to estimate survivor IQ and control for any potential IQ differences between groups. IQ estimates from the two-subtest version (\(\mu\) = 100, \(\sigma\) = 15) correlate strongly with the full version (r = 0.83) [20]. Additionally, the Coding, Symbol Search, and Digit Span subtests from Wechsler Intelligence Scale for Children, Fourth Edition [21] measured processing speed and working memory, respectively. Social Cognition. Survivor-completed measures of social cognition mirror those used in a prior publication [16]. The Diagnostic Analysis of Nonverbal Accuracy – Revised [DANVA-2; 22] assessed facial expression recognition accuracy of child faces depicting four emotions – happy, sad, angry, or fearful. Analyses included z-scores for the number of overall errors. Survivor attributions of a friend’s behavior during hypothetical, ambiguous situations was measured using the Attributions and Coping Questionnaire – Friend [ACQ; 23]. After each hypothetical situation, the survivors gave a reason for their friend’s behavior by choosing between one of four responses. The response types include prosocial, external blame, internal blame, and neutral. The proportion of neutral attributions were included in analyses given their associations with friendship in a prior study [16]. Participant theory of mind, or understanding of others’ intentions or thoughts, was assessed through two measures: the Jack and Jill task [24] and the Literal Truth, Ironic Criticism, and Empathic Praise Task [25]. Descriptions of both tasks can be found here [16]. For the Jack and Jill task, the switched/unwitnessed score was used in analyses. For the Literal Truth, Ironic Criticism, and Empathic Praise Task, separate scores for items assessing the speaker’s beliefs and the speaker’s intentions were included in the analyses. Physical Function. Caregivers completed the Pediatric Quality of Life Inventory 4.0 (PedsQL) Generic Version [26] during the study visit. The PedsQL is a widely used measure of a child’s functioning across several domains: physical, emotional, social, and school. Scores from the Physical domain were used in analyses. Scores range from 0-100 with higher scores indicating better physical quality of life. Family Function. Survivors age 8 and older (n = 65) reported on their family functioning using the 12-item Family Assessment Device - General Functioning Scale [FAD-GFS; 27]. The FAD-GFS produces scores that range from 1 to 4. Higher scores indicate more family dysfunction and scores above 2.0 indicate poor family functioning. Friendship Quality. Participants completed the Network of Relationships Inventory- Relationship Qualities Version (NRI-RQV) [28] to assess friendship quality. The NRI-RQV consists of 25 statements about the relationship that are rated on a 5-point Likert scale evaluating positive (companionship, disclosure, emotional support, approval, satisfaction) and negative (conflict, criticism, pressure, exclusion, dominance) factors. The 5 positive domains are averaged to create the Closeness score, which was used in all analyses. Data Analyses Participant demographic and medical variables were summarized using descriptive statistics. Chi-square and t -tests compared these variables across diagnostic groups. Pearson bivariate correlations and t -tests also evaluated associations between some demographic variables and Closeness. Independent t -tests compared Closeness between the two diagnostic groups. Paired samples t -tests compared ratings of Closeness between survivors and their respective friends to assess agreement directionality. The level of agreement on the ratings of Closeness between survivors and their respective friends was evaluated using a two-way, mixed, absolute agreement model of the Intraclass Correlation Coefficient (ICC). Values of ICC range from 0 to 1, with higher values indicating better agreement. Agreement levels below 0.5 are considered poor, values between 0.5 and 0.75 are considered moderate, between 0.75 and 0.90 are considered good, and values above 0.90 are considered excellent [29]. Pearson bivariate correlations evaluated associations between Closeness and cognitive function, social cognition, physical function, and family function. Variables significantly related to Closeness were included in general linear models to evaluate their respective associations with Closeness while accounting for covariates. Results Descriptive and Preliminary Analyses Table 1 presents relevant demographic and study variables. The SPBT group had fewer females (22.5% v. 65.6.%, \(\chi^{2}\) [1, N = 72] = 13.60, p < .01) and was younger at the time of diagnosis ( m = 8.85, SD = 3.26 v. m = 10.78, SD = 2.52, t (70) = -2.75, p < .01). The groups were similar in terms of age at study visit, ethnicity, time since treatment completion, and estimated IQ. Additionally, there were no group differences on any of the measures of cognitive function or social cognition. Compared to male survivors, female survivors reported higher levels of Closeness with their identified friends ( m = 3.31, SD = 0.80 v. m = 4.14, SD = 1.07, t (69) = -3.72, p < .01). Additionally, older age at cancer diagnosis was related to better survivor-reported Closeness ( r = 0.24, p < .05). Survivor age was unrelated to survivor-reported Closeness. No demographic variables were related to friend-reported Closeness. Friendship Quality by Diagnosis In univariate analyses, SPBT reported significantly lower levels of Closeness with their friend compared to SNCNST ( m = 3.41, SD = 0.88 v. m = 3.94, SD = 1.07, t (68) = -2.29, p .73). There were no differences between SPBT and SNCNST on friend-reported Closeness ( m = 3.43, SD = 0.55 v. m = 3.62, SD = 0.68, t (44) = -1.05, p > .30). Agreement Between Survivor- and Friend-Reported Closeness ICC analyses indicated poor agreement between survivors and identified friends on Closeness for the full sample (ICC = 0.11, 95% CI = -0.17, 0.39). Agreement between SPBT and their identified friends (ICC = 0.03, 95% CI = -0.37, 0.42) appeared lower than for SNCNST and their identified friends (ICC = 0.12, 95% CI = -0.29, 0.51). Paired-samples t -tests comparing Closeness between survivors and friends showed no significant differences ( m = 3.81, SD = 1.02 v. m = 3.51, SD = 0.62, t (44) = 1.80, p > .07). Factors Associated with Friendship Quality In Pearson correlation analyses (Table 2), worse survivor-reported family function, lower survivor processing speed, and lower parent-reported survivor physical function were associated with lower survivor-rated Closeness. Parent-reported survivor physical function also was significantly associated with friend-reported Closeness. In regression analysis ( F = 5.43, p < .01, R 2 = 0.38; see Table 3), survivor sex, survivor-reported family function, and parent-reported survivor physical function were significantly associated with survivor-reported Closeness. Discussion Maintaining healthy friendships is essential for youth during and following cancer therapy. Positive friendship quality can serve as a buffer to the tolls of cancer-related stressors and promote better survivor well-being, particularly as survivors age and late effects emerge. Given that SPBT are at risk for poor social connectedness and loneliness [11, 14], this study evaluated friendship quality among SPBT and SNCNST and the factors affecting it. Among survivors with an identified friendship who recently completed cancer therapy, factors outside of diagnosis type (CNS v. non-CNS), including survivor sex, family function, and physical function, were important to friendship quality. Notably, agreement between survivors and their identified friends on the level of friendship quality was low. Findings offer insights into potential directions for promoting better friendship quality among survivors and for future investigation. While there were differences in univariate analyses on survivor-reported friendship quality between SPBT and SNCNST, these differences were no longer significant when accounting for the relevant covariates of survivor sex and age at diagnosis. This is likely due to imbalances in these demographic characteristics between the SPBT and SNCNST groups. There were fewer females in the SPBT group and female survivors reported better friendship quality than male survivors. Such sex differences in friendship quality have been noted in other studies of youth [e.g., 30]. Future work comparing friendship quality among SPBT to other groups of survivors should strive for sex-matched groups to effectively evaluate this question. Survivors and their identified friends had very poor levels of agreement in terms of their ratings of their friendship quality (ICC = 0.11). This level of agreement is lower than observed in other studies of friendships in childhood and adolescence among children with typical development where ICC values ranged from .20 to .82 across different measures of friendship quality [31-33]. While the level of agreement between survivors and friends was lower for SPBT than for SNCNST, the agreement for both groups was very low indicating high levels of variability on the perspectives of closeness within the survivor-friend dyads. Although survivors and their friends were found to have distinct perspectives of friendship quality, the paired sample t-test indicates no overall directionality to this variability. This variability raises questions related to the strength and stability of the friendships. Future work employing qualitative interviews could explore this variability in agreement on the friendships of survivors and the factors affecting agreement. Consistent with theoretical models of social function [10, 17], a combination of intrinsic (sex, physical function) and extrinsic (family functioning) factors were related to survivor-rated friendship quality. Our findings of associations between better survivor-rated family functioning and better survivor-rated friendship quality align with similar evidence across typically developing youth [34, 35] and youth with cancer [36]. Family functioning factors are known to be important to various aspects of survivor functioning, including health-related quality of life [37] and psychological function [36]. Longitudinal research is needed to evaluate how families can promote enhanced friendship quality among survivors. Additionally, better caregiver-reported survivor physical quality of life was associated with better survivor- and friend-reported friendship quality, highlighting the interconnectedness of physical and psychosocial outcomes [38]. Survivors with a better ability to engage in activities with and spend time with their friends are more likely to have higher levels of closeness. Interestingly, SIP abilities were unrelated to friendship quality. Prior studies of SPBT peer relationships have highlighted the importance of face processing [16, 39], social attention [40], and other cognitive domains [41]. This study included only survivors who identified having a close friend while prior work included those with and without friends [16]. SIP abilities may be more relevant to making friends and less relevant to existing friendships. Clinical Implications Findings from this study offer implications for clinical care and future intervention research. First, our prior report demonstrated the importance of asking SPBT about the presence of friends when evaluating social function [16]. This current work suggests it is important to further assess survivor social function by asking about the nature and quality of their friendships. Second, results highlight the importance of demographics when considering the quality of survivor friendships. Female survivor and those who were diagnosed at an older age reported better friendship quality suggesting that increased attention should be paid to promoting friendships in those who are male and younger at the time of diagnosis. Third, routinely evaluating aspects of family functioning and survivor physical health may have ramifications for friendship quality, in addition to other important outcomes. Assessments could identify those who are experiencing challenges with family functioning and physical health and may be at risk for poor engagement with friends and reduced levels of closeness. Additionally, interventions promoting better family functioning or better physical health may also benefit survivor social friendship quality [42]. Study strengths include assessing friendship quality from both survivor and friend perspectives and evaluating multiple domains that may be associated with it. However, its cross-sectional design limits generalization to long-term survivorship. Prospective work should study friendship quality and its correlates over time. Further, the diagnosis groups differed in terms of sex and age at diagnosis. Future research should use matching when assessing by diagnosis. In summary, factors outside of diagnosis and treatment, including survivor sex, family functioning, and survivor physical quality of life, appear important to friendship quality in the months following treatment. Given the potential for friendship to mitigate long-term morbidities, prospective research should evaluate friendship quality and modifiable factors over time to promote better friendship quality. CoI Statement The authors have no conflicts of interest to report. ACKNOWLEDGEMENTS This research was supported by a grant from the National Cancer Institute of the National Institutes of Health (K07CA178100). The authors have no conflicts of interest to disclose. MCH conceptualized and designed the methodology for the original study and was responsible for obtaining the study funding. All authors contributed to the conceptualization of the current study question and data analyses in this paper. MCH wrote the original draft of the manuscript and all authors reviewed and edited the manuscript. References 1. Rubin, K.H., W.M. Bukowski, and J. Parker, Peer interactions, relationships, and groups , in Handbook of Child Psychology: Social, Emotional, and Personality Development (6th Edition) , N. 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Variables Brain Tumor (n = 40), n (%) or M ± SD Non-CNS (n = 32), n (%) or M ± SD Test Statistic t or χ2 Survivor age in years 10.5 ± 2.14 11.4 ± 2.30 0.098 Female survivors 9 (22.5%) 21 (65.6%) <.001 Survivor Race 0.324 African American 3 (7.5%) 6 (18.8%) Native American 1 (2.5%) 1 (3.1%) Pacific Islander 4 (10%) 3 (9.4%) White 30 (75%) 20 (62.5%) Unknown 2 (5%) 2 (6.25%) Tumor-related characteristics Brain tumor type Low-grade glioma 16 (22.2%) Medulloblastoma 6 (8.3%) Craniopharyngioma 4 (5.6%) Ependymoma 2 (2.8%) Germinoma 3 (4.2%) Other* 9 (12.6%) Brain tumor location Infratentorial 15 (37.5%) Supratentorial 24 (60%) Unknown 1 (2.5%) Non-CNS solid tumor type Rhabdomyosarcoma 6 (8.3%) Wilms Tumor 4 (5.6%) Soft tissue sarcoma 5 (6.9%) Ewing’s Sarcoma 5 (6.9%) Other** 12 (16.8%) Treatment Surgical resection only 11 (27.5%) 12 (37.5%) 0.548 Chemotherapy only 5 (12.5%) 5 (15.6%) Radiation therapy only 1 (2.5%) 1 (3.1%) Surgery and chemotherapy 4 (10%) 6 (18.8%) Surgery and radiation therapy 2 (5.0%) 2 (6.3%) Radiation and chemotherapy 7 (17.5%) 2 (6.3%) All three 10 (25%) 4 (12.5%) Age at diagnosis 8.85 ± 3.26 10.8 ± 2.52 0.008 Cognitive and Social Functioning Mean IQ 102.4 ± 9.50 103.5 ± 15.2 0.694 Closeness (Self Report) 3.41 ± 0.88 3.95 ± 1.07 0.025 Closeness (Peer Report) 3.43 ± 0.55 3.62 ± 0.68 0.302 Caregiver education 0.741 High school degree or less 5 (12.5%) 8 (25%) Some college/vocational school 10 (25%) 9 (28.2%) At least college graduate 24 (60%) 15 (46.9%) Unknown 1 (2.5%) Total household income 0.107 $100,000 19 (47.5%) 9 (28.1%) Unknown 2 (5%) 5 (15.6%) *Other brain tumor types include: dysembryoplastic neuroepithelial tumor (n = 1), primitive neuroectodermal tumor (n = 2), germ cell tumor (n = 2), pineoblastoma (n = 1), anaplastic pilocytic astrocytoma (n = 1), anaplastic oligodendroglioma (n = 1), malignant hemangiopericytoma (n = 1) **Other non-CNS solid tumor types include: ovarian tumor (n = 3), osteosarcoma (n = 1), germ cell tumor (n = 1), mucoepidermoid tumor (n = 2), carcinoma (n = 1), myofibroblastic tumor (n = 1), desmoid tumor (n = 1), melanoma (n = 1), neuroblastoma (n = 1) M SD 1 2 3 4 5 6 7 8 9 10 11 12 13 1. Survivor Age 10.88 2.24 - 2. Survivor Age at Diagnosis 9.71 3.09 .648** - 3. Survivor IQ 102.9 12.33 .039 .213 - 4. Survivor Processing Speed 95.67 16.89 .168 .148 .588** - 5. Survivor Working Memory 51.55 10.66 .038 -.111 -.187 -.142 - 6. DANVA - Total Errors Z Score 0.14 0.95 -.071 -.234 -.254* -.277* - 7. ACQ Neutral Attribution 0.48 0.23 -.034 -.006 -.204 -.179 .205 -.063 - 8. Jack and Jill – Switched/Unwitnessed 6.13 3.00 .506** .510** .277* .360** -.003 -.129 -.103 - 9. Irony and Empathy Actor Beliefs 14.54 3.64 .262* .202 .364** .342* -.062 -.332* -.062 .353** - 10. Irony and Empathy Actor Intentions 14.46 4.78 .521** .387** .451** .364** -.069 -.016 -.072 .629** .534** - 11. PedsQL - Survivor Physical Function (CR) 75.03 22.12 .080 .244* -.110 .079 -.083 -.122 .013 .027 .138 -.025 - 12. FAD-GFS - Family Function (SR) 1.76 0.40 .127 .016 -.004 -.170 -.024 .140 -.203 -.046 -.183 .065 -.035 - 13. NRI-RQV - Closeness (SR) 3.66 1.00 .174 .240* -.022 .306* .229 -.218 .126 .028 .073 .132 .324** -.301* - 14. NRI-RQV - Closeness (FR) 3.51 0.61 -.079 .072 -.148 -.114 .329* .050 -.228 -.121 .156 -.132 .326* .102 .133 Note: *p < 0.5; **p < .01; ***p<.001; CR = Caregiver Report; SR = Self Report; FR = Friend Report R 2 F(6,53) B SE β t p-value Overall Model 0.38 5.43 <0.01 Diagnosis (BT vs ST) 0.114 0.27 0.057 0.43 0.671 Survivor Sex 0.614 0.25 0.303 2.44 0.018 Age of Diagnosis 0.058 0.04 0.164 1.43 0.159 FAD-GFS - Family Function (SR) -0.628 0.29 -0.251 -2.18 0.034 PedsQL - Survivor Physical Function (CR) 0.012 0.005 0.278 2.44 0.018 Survivor Processing Speed 0.008 0.007 0.134 1.20 0.235 Information & Authors Information Version history V1 Version 1 11 June 2025 Peer review timeline Published Children's Health Care Version of Record 31 Mar 2026 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords brain tumors long term survival solid tumors Authors Affiliations Matthew C. Hocking [email protected] The Children's Hospital of Philadelphia View all articles by this author Peter M. Fantozzi The University of Kansas View all articles by this author Amanda P. Swartz The Children's Hospital of Philadelphia View all articles by this author Manali Zope The Children's Hospital of Philadelphia View all articles by this author Metrics & Citations Metrics Article Usage 197 views 161 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Matthew C. Hocking, Peter M. Fantozzi, Amanda P. Swartz, et al. Friendship Quality Among Survivors of Pediatric Brain Tumors and Survivors of Non-Central Nervous System Solid Tumors. Authorea . 11 June 2025. DOI: https://doi.org/10.22541/au.174962433.36003352/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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