Neurocognitive effects of treatment for childhood cancer

Abstract

We review research on the neuropsychological effects that central nervous system (CNS) cancer treatments have on the cognitive abilities of children and adolescents. The authors focus on the two most common malignancies of childhood: leukemias and brain tumors. The literature review is structured so as to separate out earlier studies, generally those published prior to 1995, as opposed to manuscripts that have been published within the past decade. This is an important distinction for both leukemia and brain tumors. Earlier studies were ground breaking in that they began to map out what could be expected in terms of intelligence and academic problems in survivors of pediatric malignancies. Survivorship in this population has and continues to markedly increase and this is largely due to changes in treatment protocols. Research on neurocognitive effects of disease and treatment in pediatric oncology has become increasingly sophisticated, and this literature review not only reflects this trend, but highlights the growing collaboration between neuropsychology, cognitive neuroscience, and neuro-imaging. Thus, our goal was to provide a historical foundation, lead the reader towards the progression of research methodology up to the current state of the art, and perhaps most importantly, discuss future directions. These directions are especially relevant to the concepts of remediation and treatment of cognitive problems, and this is emphasized at the conclusion of the review.

Chemotherapy-only treatment effects on long-term neurocognitive functioning in childhood ALL survivors: a review and meta-analysis

“…The results of these studies have been mixed, although many have shown decreased functioning in cognitive domains such as working memory and attention. 15,36,37 These findings, paired with our results, indicate that intelligence, as a measure of overall cognitive function, and several individual neurocognitive domains may be affected.We did not find a significant decrement in attention/concentration, which has been described in other studies of pediatric leukemia treated with chemotherapy only. 16,18,38 It is possible that our null results were due to the challenges of measuring a complex construct such as attention, which was variably defined and assessed in the included studies.…”

“…11,12 Results have varied on the negative effects of chemotherapy without radiation in pediatric cancer populations. [13][14][15] Individual studies in the past have shown some negative effects of treatment. However, most of these studies were hindered by small sample size and lack of appropriate controls, which makes it challenging to interpret and generalize their findings.…”

Neurodevelopmental impact on children treated for medulloblastoma: A review and proposed conceptual model

“…Accommodations within school environment may also reduce the impact on academic performance and facilitate rehabilitation (Butler and Haser 2006;Butler and Mulhern 2005;Nagel et al 2006;Palmer and Leigh in press;Palmer et al 2007). Slowed processing speed will require extended time for completing assignments, homework and tests.…”

Multiprofessional follow‐up programmes are needed to address psychosocial, neurocognitive and educational issues in children with brain tumours

“…As children who survive brain tumours face the risk of late neurocognitive deficits 10, 11, 12, as well as endocrine 4 and neurological 3 dysfunctions, the psychological burden on the children, parents and the whole family is great. The child's cognitive problems must also be recognised early and taken into consideration when planning the child's schooling 13, 14.…”