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.

Purpose This study investigated the interaction between neighborhood-level social determinants of health (SDOH) and neurological risk on cognitive outcomes in children treated for brain tumors (CTBT). Additionally, the impact of redlining practices on cognitive outcomes was explored. Methods A retrospective chart review of 161 CTBT aged 5-17 was conducted. Cognitive outcomes were measured using standardized neuropsychological assessments, and SDOH were assessed using the Childhood Opportunity Index (COI) and redlining data. The Neurological Predictor Scale (NPS) measured treatment-related neurological risk. Results Compared to those in moderate and high-opportunity neighborhoods, children living in low-opportunity neighborhoods exhibited lower intellectual functioning (IF) (F[2,154]=17.7, p < .01, η 2 = .19), processing speed (PS) ( F[2,89] = 4.41, p = .015, η 2 = .09), perceptual reasoning (PR) (F[2,64] = 3.60, p = .03, η 2 = .10), and verbal reasoning (VR) ( F[2,90] = 10.09, p < .01, η 2 = .18) scores. COI levels moderated the association between NPS and IF ( F [2,174] = .038, p = .013), with a negative effect of NPS on IF in high-opportunity neighborhoods ( t = -3.82, p < .01). Children from neighborhoods less affected by redlining had better IF performance, U = 94.50, Z = -2.30, p = .021. Conclusions This study highlights the role of neurological risk and neighborhood-level SODH in cognitive outcomes in CTBT. These findings underscore the need for targeted interventions and policies aimed at mitigating the effects of systemic inequities. Future research should explore early interventions to support cognitive development in survivors from communities with less resources.