Oxidative Stress, Motor Abilities, and Behavioral Adjustment in Children Treated for Acute Lymphoblastic Leukemia

Abstract

Purpose/Objectives To examine associations among oxidative stress, fine and visual motor abilities, and behavioral adjustment in children receiving chemotherapy for acute lymphoblastic leukemia (ALL). Design A prospective repeated measures design was used. Serial cerebrospinal fluid (CSF) samples were collected during scheduled lumbar punctures. Setting Two pediatric oncology settings in the southwestern United States. Sample Eighty-nine children with ALL were followed from diagnosis to end of chemotherapy. Methods CSF was analyzed for oxidative stress biomarkers. Children completed fine motor dexterity, visual processing speed and visual-motor integration measures at three time points. Parents completed child behavior ratings at the same times. Main Research Variables Main research variables were oxidative stress, fine motor dexterity, visual processing, visual motor integration, and behavioral adjustment. Findings Children with ALL had below average fine motor dexterity, visual processing speed, and visual-motor integration following the induction phase of ALL therapy. By end of therapy, visual processing speed normalized, while fine motor dexterity and visual-motor integration remained below average. Oxidative stress measures correlated with fine motor dexterity and visual-motor integration. Decreased motor functioning was associated with increased hyperactivity and anxiety. Conclusions Oxidative stress occurs following chemotherapy for childhood ALL and is related to impaired fine motor and visual symptoms. Implications for Nursing Early intervention should be considered to prevent fine motor and visual spatial deficits and behavioral problems. Knowledge Translation Basic science findings that chemotherapy induces oxidative stress were validated in a clinical study of children with ALL. Oxidative stress increases risk for fine motor and visual spatial problems.

Influence of Inflammatory and Oxidative Stress Pathways on Longitudinal Symptom Experiences in Children With Leukemia

“…The majority of childhood cancer symptom research has been among heterogeneous groupings of pediatric oncology diagnoses (Hinds et al, 2007), which limits ability to tailor inventions for children, as specific diagnoses and treatment modalities are likely associated with associated with symptom severity and why significant variations occur even when disease and treatment are similar. Based on our prior work, we focused on the selectedThe potential influence of inflammatory and oxidative stress responses during the most intensive phase of childhood leukemia treatment that may influence symptom toxicities and should be explored (Caron et al, 2009;Hockenberry et al, 2014Hockenberry et al, , 2015Moore et al, 2015Moore et al, , 2018Rodgers et al, 2016;Stenzel et al, 2010).…”

“…Understanding of the underlying mechanisms associated with symptom severity is limited; nor is it clear why significant variations in symptomology and severity occur across patients even when disease and treatment are similar. Based on our prior work, in the present study, we focused on selected inflammatory and oxidative stress responses during the most intensive phase of childhood leukemia treatment, which potentially influence symptom toxicities (Caron et al, 2009; Hockenberry et al, 2014, 2015; Moore et al, 2015, 2018; Rodgers et al, 2016; Stenzel et al, 2010).…”

Investigating fine motor deficits during maintenance therapy in children with acute lymphoblastic leukemia

“…It was reported that children with ALL on maintenance therapy were potentially at risk for fine motor impairments 13 . Previous longitudinal studies assessing fine motor skills after approximately one year 4,9 and/or two years of treatment 10‐12 revealed conflicting results. A study conducted by Reinders‐Messelink et al 4 .…”

“…F I G U R E 1 Flow chart of patient recruitment tially at risk for fine motor impairments. 13 Previous longitudinal studies assessing fine motor skills after approximately one year 4,9 and/or two years of treatment [10][11][12] revealed conflicting results.…”

“…In contrast, other studies indicated that fine motor dexterity performance improved along the course of treatment 9 and could reach average age-related norms near the end of therapy approximately after two years of treatment. 11,12 Decreased muscle strength had been detected in children with ALL along the course of treatment. Deconditioning and weakness of upper limbs had been reported during the maintenance phase of therapy, 14,15 while Marchese et al 16 revealed an early weakness in lower extremities before and during delayed intensification therapy.…”