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Önal G, Davutoğlu C, Şahin S. Investigation of cognitive functions in children with bone tumours and lymphoma in treatment process. Child Care Health Dev 2024; 50:e13139. [PMID: 37269221 DOI: 10.1111/cch.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/17/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Neurocognitive sequelae are among the most debilitating effects of cancer observed in children. Yet we know very little about the impact on neurocognitive functioning, especially cancer types that develop outside the central nervous system. This study aimed to assess and compare the cognitive functions (CoF) of children with bone tumours and lymphoma in the treatment process. METHODS The CoF of children with bone tumours (n = 44), lymphoma (n = 42) and their non-cancer peers (n = 55) were assessed with Dynamic Occupational Therapy Assessment for Children. The CoF of children with cancer were compared with their non-cancer peers. Then, children with bone tumours and lymphoma were compared in binary. RESULTS One-hundred forty-one children aged 6-12 years with a mean age of 9.4 (SD = 1.5) were included in this study. The orientation and visuomotor construction functions of children with bone tumours and orientation, praxis and visuomotor construction functions of children with lymphoma performed worse than their non-cancer peers (pk < 0.001). While orientation, spatial perception, visuomotor construction and thinking operations functions of children with bone tumours and lymphoma were similar (pk > 0.016), praxis functions of children with lymphoma were found to be worse than children with bone tumours (pk < 0.016). CONCLUSIONS Our findings show that children with bone tumours and lymphoma in the process of treatment are at risk for impairment of their CoF. The findings highlight the importance of assessing CoF in children with bone tumours and lymphoma and considering specific differences between groups. It is essential to assess CoF and develop early intervention plans in these children.
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Affiliation(s)
- Gözde Önal
- Faculty of Health Sciences, Department of Occupational Therapy, Ankara Medipol University, Ankara, Turkey
| | - Ceren Davutoğlu
- Faculty of Health Science, Department of Occupational Therapy, Erzurum Technical University, Erzurum, Turkey
| | - Sedef Şahin
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
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Whitaker AM, Kayser K. Neuropsychological surveillance model for survivors of pediatric cancer: A descriptive report of methodology and feasibility. Clin Neuropsychol 2022; 36:1746-1766. [PMID: 33941039 DOI: 10.1080/13854046.2021.1912831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Neuropsychological late effects of pediatric cancer may not become apparent for years after therapy; therefore, serial monitoring is necessary for detecting changes to ensure timely intervention. Unfortunately, lack of access to neuropsychologists, increased patient volume, insurance authorization and reimbursement issues, time required for neuropsychological evaluation, and practice effects related to repeat testing present many challenges to provision of neuropsychological care for survivors of childhood cancer. Models involving surveillance and monitoring have been proposed, though minimal data exist related to the implementation and feasibility of such models. Method: In this descriptive feasibility study, the Neuropsychology Consult Clinic (NCC) at Children's Hospital Los Angeles is presented, outlining a methodology and algorithm for neuropsychological surveillance of survivors of non-CNS pediatric cancer and an account of the first three years of clinic implementation. Participants included 215 survivors (x̅ age = 5.6 years), including 75.3% Latinx patients. Results: The overall clinic implementation was found to be feasible, with approximately 75% of patients "passing" the screening and 25% "failing" the screening. Clinical judgment only conflicted with the algorithm 8.6% of the time. However, several limitations to feasibility were noted, including validity concerns and ability/time to complete parent-reported outcomes using Spanish forms, as well as access to bilingual examiners. Conclusions: These preliminary data support the feasibility of the NCC model with limitations as outlined above. This is the first phase in a multiphase plan to develop an appropriate screening clinic for survivors of pediatric cancer, with the next phase focusing on sensitivity/specificity of measures.
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Affiliation(s)
- Ashley M Whitaker
- Cancer and Blood Disease Institute, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kimberly Kayser
- Cancer and Blood Disease Institute, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Bava L, Freyer DR, Radbill LM, Johns AL. Association of language proficiency, sociodemographics, and neurocognitive functioning in dual-language Latino survivors of childhood acute lymphoblastic leukemia and lymphoma. Pediatr Blood Cancer 2021; 68:e29118. [PMID: 34019328 DOI: 10.1002/pbc.29118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukemia and lymphoma (ALL/LL) are at risk for cognitive dysfunction, but little is known about its relationship with language proficiency and sociodemographics. PROCEDURE In this cross-sectional cohort study of Latino survivors of childhood ALL/LL, English and Spanish language proficiency and cognitive and academic functioning were measured and their associations determined using paired t-tests, Pearson correlations, and linear regressions. RESULTS Participants (N = 57; 50.9% female) had mean ages (years ± SD) of 4.3 ± 2.6 at diagnosis and 10.6 ± 2.9 at testing (range 6-16); mean time post treatment was 3.7 ± 2.6 years. The majority (73.7%) had low socioeconomic status (SES). Most (78.8%) were dual-language learners in English and Spanish. English proficiency was graded as limited-to-fluent and was significantly higher than Spanish (p < .001). Higher SES was correlated with higher English proficiency (r = 0.31, p = .020). Males had higher Spanish proficiency (r = -0.32, p = .034). Controlling for SES and sex, English proficiency accounted for 43% of cognitive functioning variance (F = 14.86, p < .001), 55% of reading comprehension variance (F = 22.14, p < .001), and 21% of mathematics variance (F = 5.76, p = .002). CONCLUSIONS Low language proficiency correlated with SES but was independently associated with lower cognitive and academic functioning. Research and surveillance for neurocognitive late effects in Latino ALL/LL survivors should incorporate measures of language proficiency and SES to account for their effects on cognitive and academic functioning.
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Affiliation(s)
- Laura Bava
- Survivorship and Supportive Care Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - David R Freyer
- Survivorship and Supportive Care Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Linda M Radbill
- Survivorship and Supportive Care Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Alexis L Johns
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Rosales P, Evangelista L, Guo Y, Agbayani CJG, Kain ZN, Fortier MA. Exploring Differences in Perceived Satisfaction, Resilience, and Achievement Between Hispanic and Non-Hispanic White Childhood Cancer Survivors. J Pediatr Health Care 2021; 35:196-204. [PMID: 33516620 DOI: 10.1016/j.pedhc.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To address gaps in understanding disparities of posttraumatic growth among childhood cancer survivors, the aims of this study were to (1) compare satisfaction, resilience, and achievement among Hispanic and non-Hispanic White survivors; and (2) examine relationships between sociodemographic and clinical factors with satisfaction, resilience, and achievement. METHOD Survivors (N = 116) at Children's Hospital of Orange County After Cancer Treatment Survivorship Program completed the Child Health and Illness Profile-Adolescent Edition. RESULTS Resilience (p = .003) and achievement (p = .005) were lower among Hispanic survivors. Resilience was positively associated with satisfaction (p < .01) and achievement (p < .01) and achievement was positively associated with years of schooling (p < .01). No differences were found between Hispanic and non-Hispanic White satisfaction scores (p = .95). DISCUSSION Our findings suggest ethnic disparities in posttraumatic growth in childhood cancer survivors. Interventions aimed at promoting posttraumatic growth are vital to address these differences.
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Raghubar KP, Orobio J, Ris MD, Heitzer AM, Roth A, Brown AL, Okcu MF, Chintagumpala M, Grosshans DR, Paulino AC, Mahajan A, Kahalley LS. Adaptive functioning in pediatric brain tumor survivors: An examination of ethnicity and socioeconomic status. Pediatr Blood Cancer 2019; 66:e27800. [PMID: 31134755 PMCID: PMC6730637 DOI: 10.1002/pbc.27800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/11/2019] [Accepted: 04/18/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Survivors of pediatric brain tumor are at risk for adaptive difficulties. The present study examined adaptive functioning in a multiethnic sample of survivors accounting for socioeconomic status, and whether demographic, diagnostic, and/or treatment-related variables predict adaptive outcomes. METHOD Participants included a multiethnic sample of survivors (58 Caucasian, 34 Hispanic, and 22 other non-Caucasian; M age = 14.05 years, SD = 4.33) who were approximately seven years post-treatment. Parents rated adaptive functioning and provided demographic information. Diagnostic and treatment-related information was abstracted from the electronic medical record. RESULTS Parent ratings of adaptive functioning were similar across Caucasian, Hispanic, and other non-Caucasian survivors covarying for family income and primary caregiver education, both of which served as proxies for socioeconomic status. All ethnic groups were rated lower than the normative mean in overall adaptive functioning as well as the specific domains of conceptual, social, and practical skills. Demographic, diagnostic, and treatment-related variables were differentially associated with adaptive functioning in survivors of pediatric brain tumor, though socioeconomic status emerged as a strong significant predictor of adaptive functioning domains. CONCLUSIONS Adaptive outcomes do not differ as a function of ethnicity after accounting for primary caregiver education and family income. Racial and ethnic minorities may be at increased risk for poorer outcomes given their overrepresentation at lower income levels. Assessing demographic and treatment-related variables early on may be helpful in identifying children likely to develop adaptive difficulties.
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Affiliation(s)
- Kimberly P. Raghubar
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - Jessica Orobio
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - M. Douglas Ris
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - Andrew M. Heitzer
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - Alexandra Roth
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - Austin L. Brown
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, United States
| | - M. Fatih Okcu
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, United States
| | - Murali Chintagumpala
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, United States
| | - David R. Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Arnold C. Paulino
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Anita Mahajan
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Lisa S. Kahalley
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
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Spann MN, Bansal R, Hao X, Rosen TS, Peterson BS. Prenatal socioeconomic status and social support are associated with neonatal brain morphology, toddler language and psychiatric symptoms. Child Neuropsychol 2019; 26:170-188. [PMID: 31385559 DOI: 10.1080/09297049.2019.1648641] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Few studies have assessed the association of parental socioeconomic status (SES) with brain measures in neonates, at a time when exposure to the postnatal environment is minimal. Social support may buffer the adverse consequences of SES, and has been associated with better cognitive - emotional development in children. We studied the association of prenatal SES and social support with neonatal brain structure, and toddler cognition, and psychiatric symptoms. In a sample of 37 healthy neonates, we correlated a measure of SES and marital/partner status (an index of social support) with morphological features of the cerebral surface measured on high-resolution MRI scans between the 1st - 6th weeks of postnatal life. We then assessed how SES relates to cognitive and behavioral outcomes at age 24-months. We found that neonates born to mothers with lower SES had greater local volumes at the surface of the right occipital lobe, left temporal pole, and left inferior frontal and anterior cingulate regions. Partner status moderated the associations of SES on neonatal brain morphology. Lower SES was associated with poorer language scores and less severe ADHD and ODD symptoms. In summary, SES was associated with neonatal brain structure and language and behavioral outcomes at toddler age. Future studies with a greater sample size and longitudinal MRI scans will help to determine whether prenatal SES continues to relate to early brain development in the same or different brain regions.
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Affiliation(s)
- Marisa N Spann
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Ravi Bansal
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Xuejun Hao
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Tove S Rosen
- Department of Pediatrics, Columbia University Irving Medical Center and the Children's Hospital of New York, New York, NY, USA
| | - Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Treviño M, Breitmeyer BG, Ris MD, Fletcher JM, Kamdar K, Okcu MF, Parke EM, Raghubar KP. Interactions between visual working memory and visual attention among survivors of pediatric acute lymphoblastic leukemia (ALL) and their healthy peers. J Clin Exp Neuropsychol 2019; 41:974-986. [PMID: 31327287 DOI: 10.1080/13803395.2019.1643453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: There is increasing concern for adverse cognitive late effects among survivors of pediatric acute lymphoblastic leukemia (ALL) given the widespread impact they have on academic achievement, particularly working memory and attention. We assessed performance among survivors and their healthy peers on a dual task paradigm measuring visual working memory (VWM) and visual attention independently and the dynamic relationship between the two. Assessing specific subsets within cognitive domains allows for understanding the distinct nature of cognitive impairments. Method: Participants were 34 survivors of ALL who have been off-treatment and disease free for 7.5 years; and 20 healthy controls, all between the ages of 10 and 18 years. We utilized behavioral single- and dual-task paradigms. In the dual tasks, participants maintained several items in VWM while performing a visual attention task (Eriksen Flanker Task) that required processing of a target stimulus while inhibiting the processing of distractor stimuli. The single tasks involved performing only the VWM task or only the visual attention task. Results: Results revealed survivors of ALL performed significantly worse than their healthy peers on the single visual attention task but not the single VWM task. Of particular interest, group differences were obtained on the dual VWM and visual attention tasks, such that the VWM and attention tasks reciprocally interfered with each other only among survivors and not their healthy peers. Conclusions: Our results highlight a core deficit in visual attention that is exacerbated by VWM demands among survivors of ALL. The implementation of tasks from cognitive neuroscience paradigms may be sensitive to cognitive impairments experienced by cancer survivors. Assessment and intervention practices among survivors of pediatric ALL are discussed.
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Affiliation(s)
- Melissa Treviño
- Department of Psychology, University of Houston , Houston , TX , USA
| | - Bruno G Breitmeyer
- Department of Psychology, University of Houston , Houston , TX , USA.,Center for Neuro-engineering & Cognitive Science, University of Houston , Houston , TX , USA
| | - M Douglas Ris
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine , Houston , TX , USA
| | - Jack M Fletcher
- Department of Psychology, University of Houston , Houston , TX , USA
| | - Kala Kamdar
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine , Houston , TX , USA
| | - M Fatih Okcu
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine , Houston , TX , USA
| | - Elyse M Parke
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine , Houston , TX , USA
| | - Kimberly P Raghubar
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine , Houston , TX , USA
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Goebel AM, Koustenis E, Rueckriegel SM, Pfuhlmann L, Brandsma R, Sival D, Skarabis H, Schuelke M, Hernáiz Driever P. Motor function in survivors of pediatric acute lymphoblastic leukemia treated with chemotherapy-only. Eur J Paediatr Neurol 2019; 23:304-316. [PMID: 30611625 DOI: 10.1016/j.ejpn.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 09/26/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Up to 43% of survivors of pediatric acute lymphoblastic leukemia (ALL) may exhibit fine-motor problems. Information on manual dexterity in this cohort is still limited. OBJECTIVES We tested survivors of childhood ALL treated with chemotherapy-only for fine-motor function in terms of drawing and handwriting abilities using a Digitizing Tablet (DT) with three tasks for drawing and handwriting of varying complexity, for ataxia using the International Cooperative Ataxia Rating Scale (ICARS), and for tremor and hand-eye coordination using the Nine Hole Steadiness Tester (NHST). RESULTS We examined a cohort of non-irradiated survivors (n = 31) after a median time of 3.5 years after end of therapy. In all tasks of the DT the cohort demonstrated significant (p < 0.05) impairment of speed, automation, and variability in at least two tasks and significantly more pressure. Impaired speed (SPV) inversely correlated with lag time since end of therapy. Dexterity performance of six survivors (19%) lay below the 5th percentile. No survivor exhibited ataxia, tremor, or impaired hand-steadiness. CONCLUSION Despite the absence of gross ataxia, tremor, and impaired hand-eye coordination, we nevertheless detected significant fine-motor impairment in a relevant number of survivors of childhood ALL. Prospective studies are needed to reveal the pathophysiological underpinnings and genetic risk factors for development of such deficits due to ALL and its treatment.
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Affiliation(s)
- Anna-Maria Goebel
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Elisabeth Koustenis
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Stefan M Rueckriegel
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neurosurgery, University Hospital Würzburg, Germany
| | - Laura Pfuhlmann
- Department of Neuropediatrics and NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Rick Brandsma
- Department of Neurology, University Medical Center Groningen, University of Groningen, Netherlands
| | - Deborah Sival
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Netherlands
| | - Horst Skarabis
- Institute of Sociology, Freie Universität Berlin, Germany
| | - Markus Schuelke
- Department of Neuropediatrics and NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.
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