Cognitive training programs for childhood cancer patients and survivors: A critical review and future directions

Abstract

A robust literature has developed documenting neurocognitive late effects in survivors of leukemia and central nervous system (CNS) tumors, the most frequent cancer diagnoses of childhood. Patterns of late effects include deficits in attention and concentration, working memory, processing speed, and executive function, as well as other domains. As childhood cancer survivors are living longer, ameliorating deficits both in broad and specific neurocognitive domains has been increasingly recognized as an endeavor of paramount importance. Interventions to improve cognitive functioning were first applied to the field of pediatric oncology in the 1990s, based on strategies used effectively with adults who had sustained a traumatic brain injury (TBI). Compilation and modification of these techniques has led to the development of structured cognitive training programs, with the effectiveness and feasibility of such interventions currently an active area of research. Consequently, the purpose of this critical review is to: (1) review cognitive training programs intended to remediate or prevent neurocognitive deficits in pediatric cancer patients and survivors, (2) critically analyze training program strengths and weaknesses to inform practice, and (3) provide recommendations for future directions of clinical care and research.

Cognitive deficits and psychopathological symptoms among children with medulloblastoma

“…The present study showed that age at treatment, gender and time since diagnosis were not important factors associated with cognitive deficits. In previous studies, the rate of IQ decline was found to be associated with several factors, including younger age at time of treatment, longer time since diagnosis and female gender, as well as clinical variables such as hydrocephalus, use of radiotherapy and radiotherapy dose and the volume of the brain that received treatment (Mulhern, Merchant, Gajjar, Reddick, & Kun, ; Olson & Sands, ). These relationships were not demonstrated in the current study.…”

“…As survival rates continue to improve, it is important to understand how MB treatments affect survivors’ cognitive and psychological functioning and therefore, overall quality of life (Margelisch et al, ; Zeltzer et al, ). Children who receive treatments targeting the central nervous system, such as MB patients, are at an increased risk of developing cognitive late effects in comparison with survivors of other types of childhood cancer (Conklin et al, ; Olson & Sands, ; Palmer et al, ). Evidence indicates that age at treatment (i.e., younger), longer time since diagnosis, female gender, treatment intensity, type of chemotherapy (especially methotrexate), craniospinal irradiation, perioperative complications and possibly hydrocephalus, increase the risk of low cognitive functioning after treatment (Margelisch et al, ).…”

Declines Noted in Cognitive Processes and Association With Achievement Among Children With Leukemia

“…Importantly interventions to address negative sequelae are underway, but presently considered to be under developed (see for example a review of cognitive training programs Olson & Sands, 2015). Knowledge of the affected cognitive processes during treatment could inform interventions to prevent or manage changes and decrease the deleterious effects on school achievement and everyday function.…”

Proton Beam Radiation Therapy: The Future May Prove Brighter for Pediatric Patients With Brain Tumors

“…25 The negative impact of PBRT upon the Processing Speed Index, a critically important and broad skill that directly relates to one’s overall cognitive processing speed on a range of everyday tasks such as thinking, problem solving, reading, and writing, is consistent with the late effects of XRT and has been correlated with impairment in the growth of normal-appearing white matter. 26–28 …”