The proposed research plan will immediately advance the state of cancer survivor research and patient care for the following Fiscal Year 2022 (FY22) Peer Reviewed Cancer Research Program Topic Areas: (1) brain cancer, (2) pediatric brain tumors, and (3) pediatric, adolescent, and young adult cancers. While long-term survival has improved, many youth previously treated for a childhood brain tumor experience lasting effects (e.g., negative physical effects, decreased educational attainment, decreased quality of life, poor psychosocial functioning, and second cancers). As a result, continued medical care is needed even after treatment is completed. Unfortunately, little is known about the long-term functioning of youth diagnosed with juvenile pilocytic astrocytoma (JPA), the most common brain tumor in children. The objective of the proposed study is to utilize a biopsychosocial framework (i.e., biological, psychological, and social risk factors) to determine if youth treated for a JPA experience lasting effects after treatment completion. Specifically, the study will (1) compare the functioning of JPA survivors to their peers and (2) determine what factors can identify those at highest risk for negative effects. In addition, the study will explore the use of brain imaging and biomarkers to further identify those at risk for later impairments in functioning. These aims are directly relevant to the intent of the Behavioral Health Science Award: to develop strategies to address survivorship issues including quality of life, overall mental health, psychological impact of recurrence, and/or survivor permanent disability. This research will not only help survivors of JPA and their families, but results are expected to generalize to the larger pediatric low-grade glioma population. Given current prevalence rates, the scarcity of available information and lack of standardized follow-up recommendations for JPA survivors is a critical knowledge gap in pediatric cancer survivorship, which may adversely affect active-duty Service Members, Veterans, and other military beneficiaries. The functioning of JPA survivors must be appreciated in relation to their larger environment, including their family and the military health system. For example, a survivor experiencing lasting negative effects (e.g., poor mental health, delayed educational attainment) may also negatively impact parental mission readiness secondary to higher care needs. Lasting effects that go untreated may also negatively impact later productivity and health care costs. Results from the proposed study will immediately advance our knowledge regarding surveillance needs of this unique group of survivors and highlight areas for future intervention or changes to standard survivorship clinical care practices. Such knowledge will have wide-ranging impact for the care delivered by the military health system and for the larger U.S. survivor population.