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Chiang JA, Feghali PT, Whitaker AM. Processing speed in patients with pediatric cancer: Psychosocial considerations. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-8. [PMID: 39276375 DOI: 10.1080/21622965.2024.2403767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Pediatric cancer treatments may contribute to slower processing, while cultural considerations (e.g., SES) can influence outcomes and tend to be disproportionately lower in racial/ethnic minorities. Given increased risk for certain cancers in Hispanic/Latine children and rising Spanish exposure in the United States, the purpose of this study was to examine differences in processing speed between cancer survivors based on household language exposure: English vs. mixed language (ML; i.e. monolingual Spanish-speaking or bilingual Spanish/English-speaking). 128 patients ages 8-21 with leukemia/lymphoma completed screening. As expected, SES was lower in patients from ML households based on parental education (U = 355.00, p<.001) and estimated household income (U = 1031.500, p<.001). Despite this, processing speed (assessed using the written and oral trials of the Symbol Digit Modalities Test; SDMT) was average (SDMT-W x̅=-.13, SDMT-O x̅=.32), with no significant differences between language groups (F(2,120)=0.966, p=.384). Post-hoc analyses revealed time since diagnosis did not predict performance on oral trial for either group or the whole sample, while poorer performance on written trial was noted among the English-only group when further from diagnosis (SDMT-W F(1,57)=7.829, p=.007). Stable ML group trajectory regardless of time since diagnosis may reflect resiliency among children with Spanish exposure.
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Affiliation(s)
- Jenna A Chiang
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Cancer and Blood Disease Institute, Children's Hospital Los Angeles (CHLA), Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Division of Neurology, Neurological Institute, Children's Hospital Los Angeles (CHLA), Los Angeles, California, USA
| | - Paulina T Feghali
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Cancer and Blood Disease Institute, Children's Hospital Los Angeles (CHLA), Los Angeles, California, USA
| | - Ashley M Whitaker
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Cancer and Blood Disease Institute, Children's Hospital Los Angeles (CHLA), Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Baron Nelson M, O'Neil SH, Cho SJ, Dhanani S, Tanedo J, Shin BJ, Rodman J, Olch A, Wong K, Nelson MD, Finlay J, Lepore N. Dose-dependent cranial irradiation associations with brain structures and neuropsychological outcomes in children with posterior fossa brain tumors. Brain Behav 2024; 14:e70019. [PMID: 39295085 PMCID: PMC11410875 DOI: 10.1002/brb3.70019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Posterior fossa irradiation with or without whole brain irradiation results in high doses of radiation to the thalamus, hippocampus, and putamen, structures critical to cognitive functioning. As a result, children with brain tumors treated with cranial irradiation (CRT) may experience significant cognitive late effects. We sought to determine the effect of radiation to those structures on neuropsychological outcome. METHODS Forty-seven children with a history of posterior fossa tumor (17 treated with surgery; 11 with surgery and chemotherapy; and 19 with surgery, chemotherapy, and CRT) underwent neuroimaging and neuropsychological assessment at a mean of 4.8 years after treatment, along with 17 healthy sibling controls. The putamen, thalamus, and hippocampus were segmented on each participant's magnetic resonance imaging for diffusion indices and volumes, and in the radiation treatment group, radiation dose to each structure was calculated. RESULTS Performance on visuoconstruction and spatial learning and memory was lower in patient groups than controls. Volume of the thalamus, when controlling for age, was smaller in the patient group treated with CRT than other groups. Higher radiation doses to the putamen correlated with higher fractional anisotropy in that structure. Higher radiation dose to the hippocampus correlated with lower spatial learning, and higher dose to thalami and putamina to lower verbal and nonverbal reasoning. CONCLUSIONS All children with posterior fossa tumors, regardless of treatment modality, had cognitive deficits compared to their sibling controls. Posterior fossa irradiation may affect thalamic volume and aspects of verbal and nonverbal cognitive functioning.
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Affiliation(s)
- Mary Baron Nelson
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, California, USA
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Sharon H O'Neil
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, California, USA
- Neuropsychology Core, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Scarlet J Cho
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California, USA
| | - Sofia Dhanani
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
- Division of Child Neurology, Department of Neurology, Stanford University School of Medicine, Stanford, California, USA
| | - Jeffrey Tanedo
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Brandon J Shin
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
- Kansas City University, College of Osteopathic Medicine, Joplin, Missouri, USA
| | - Jack Rodman
- Biostatistics, Epidemiology, and Research Design (BERD), Southern California Translational Science Institute, Los Angeles, California, USA
| | - Arthur Olch
- Department of Radiation Oncology, Keck School of Medicine of USC and Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Kenneth Wong
- Department of Radiation Oncology, Keck School of Medicine of USC and Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Marvin D Nelson
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, California, USA
| | | | - Natasha Lepore
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, California, USA
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
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Schuerch K, Salzmann S, Steiner L, Lidzba K, Klein A, Roessler J, Everts R. Development of working memory, processing speed, and psychosocial functions in patients with pediatric cancer. Pediatr Res 2024:10.1038/s41390-024-03512-w. [PMID: 39210050 DOI: 10.1038/s41390-024-03512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
Many patients after pediatric cancer suffer from long-term cognitive difficulties. This study investigates the development of cognitive and psychosocial functions between diagnosis and one year after cancer treatment and reveals insight into the association between cognitive and psychosocial development and various risk factors. This retrospective clinical record review included fifty-seven patients, aged 4-16 years, that were examined at the beginning of the cancer treatment (T1) and one year after cancer treatment (T2) to evaluate the development of working memory (WM), processing speed (PS), psychosocial functions, and quality of life (QoL). About half of the patients showed stable/favorable cognitive development (PS 51.9%; WM 41.4%). The other half exhibited a non-favorable cognitive development, with a decrease of performance between T1 and T2. In 51.6-77.4%, psychosocial functions remained stable/increased between T1 and T2 and QoL scores remained stable in 42.9-61.9%. Changes in prosocial behavior correlated with the development of PS (r = 0.472, p = 0.010). Age at T1 predicted PS at T2 (p = 0.020) and sex predicted peer relations at T2 (p = 0.046). About half of the patients showed stable/favorable whereas the other half experiencing non-favorable cognitive development. The observed disparities in initial and subsequent cognitive performances highlight the importance of early individualized patient monitoring and interventions. IMPACT: We investigated the cognitive and psychosocial development of pediatric cancer patients between diagnosis and one year after termination of cancer treatment. About half of the patients showed stable or favorable cognitive development in processing speed and working memory. The other half exhibited a non-favorable cognitive development, with decreasing performance. Baseline working memory and processing speed was negatively correlated with the respective change score. Changes in prosocial behavior were positively correlated with the development of processing speed. Early individualized patient monitoring and intervention is of crucial importance after pediatric cancer and its treatment.
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Affiliation(s)
- Kirstin Schuerch
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Saskia Salzmann
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
- Graduate School for Health Science, University of Bern, Bern, Switzerland
| | - Leonie Steiner
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Karen Lidzba
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Klein
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jochen Roessler
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Regula Everts
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland.
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland.
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Qiu X, Kuang J, Huang Y, Wei C, Zheng X. The association between Weight-adjusted-Waist Index (WWI) and cognitive function in older adults: a cross-sectional NHANES 2011-2014 study. BMC Public Health 2024; 24:2152. [PMID: 39118100 PMCID: PMC11308487 DOI: 10.1186/s12889-024-19332-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 07/01/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The impact of obesity on cognitive function has engendered considerable interest. Weight-adjusted waist index (WWI) has emerged as a novel and innovative marker of obesity that reflects weight-independent abdominal obesity. However, the association between WWI and cognitive function remains unclear. To address this gap, the present study aims to explore the relationship between weight-adjusted waist index (WWI) and cognitive performance in older adults. METHODS We conducted a cross-sectional investigation using datasets from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. The study included 3,472 participants (48.59% male, 51.41% female) of various races (Mexican American, Other Hispanic, Non-Hispanic White, Non-Hispanic Black, and Other), with a mean age of 69.95 years (SD = 6.94). Multivariate regression and smoothing curve fitting were used to investigate the linear and nonlinear relationship between WWI and cognitive performance in the following domains: learning and memory, verbal fluency, and processing speed, as measured by Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest (CERAD-WL), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST), respectively. Subgroup analysis and interaction tests were conducted to examine the stability of this relationship across groups. Machine learning models based on random forests were used to analyze the predictive performance of WWI for cognitive function. RESULTS A total of 3,472 participants were included in the analysis. The results revealed significant negative associations between WWI and low scores on the CERAD-WL [-0.96 (-1.30, -0.62)], AFT [-0.77 (-1.05, -0.49)], and DSST [-3.67 (-4.55, -2.79)]. This relationship remained stable after converting WWI to a categorical variable. In addition, this significant negative association was more pronounced in men than women and diminished with advancing age. Non-linear threshold effects were observed, with correlations intensifying between WWI and CERAD-WL when WWI surpassed 12.25, AFT when WWI surpassed 11.54, and DSST when WWI surpassed 11.66. CONCLUSIONS A higher WWI, indicating increased abdominal obesity, was associated with deficits in learning, memory, verbal fluency, and processing speed among older adults. These findings suggest that abdominal obesity may play a crucial role in cognitive decline in this population. The stronger relationship observed between WWI and cognition in men highlights the need for gender-specific considerations in interventions targeting abdominal obesity. The results demonstrate the importance of interventions targeting abdominal obesity to preserve cognitive performance in older adults.
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Affiliation(s)
- Xichenhui Qiu
- Health Science Center, Shenzhen University, No. 1066, Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong Province, 518060, People's Republic of China
| | - Jiahao Kuang
- Health Science Center, Shenzhen University, No. 1066, Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong Province, 518060, People's Republic of China
| | - Yiqing Huang
- Health Science Center, Shenzhen University, No. 1066, Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong Province, 518060, People's Republic of China
| | - Changning Wei
- School of Tech X Academy, Shenzhen Polytechnic University, No. 7098, Liuxian Avenue Nanshan District, Shenzhen, Guangdong Province, 518118, People's Republic of China
| | - Xujuan Zheng
- Health Science Center, Shenzhen University, No. 1066, Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong Province, 518060, People's Republic of China.
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Güney Yılmaz G, Tanrıverdi M, Şahin S, Çakır FB. Cross-cultural adaptation, reliability, and validity of the Turkish Pediatric Quality of Life Inventory-Cognitive Functioning Scale (PedsQL TM-CFS) in children with cancer. Child Neuropsychol 2024:1-15. [PMID: 38832834 DOI: 10.1080/09297049.2024.2364205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
The Pediatric Quality of Life Inventory-Cognitive Functioning Scale (PedsQLTM-CFS) was developed as a brief, general, symptom-specific tool to measure cognitive function. The 6-item PedsQL™ Cognitive Functioning Scale and PedsQL 3.0 Cancer Module answered 369 parents and 330 children with 5-18 years. Parents also completed Behavior Rating Inventory of Executive Function (BRIEF). The PedsQL™ Cognitive Functioning Scale evidenced excellent reliability (parent proxy-report α = 0.980/Fleiss Kappa: 0.794; children self-report α = 0.963/Fleiss Kappa: 0.790). Both child self-report and parent proxy-report PedsQL™ Cognitive Functioning Scale scores exhibited significant correlations with all parent-report BRIEF summary and subscale scores (p < .05). Both child self-report and parent proxy-report PedsQL™ Cognitive Functioning Scale scores exhibited significant correlations with PedsQL 3.0 Cancer Module total score and subscale scores (p < .05). The PedsQLTM-CFS can be used in high-risk populations with substantial to perfect reliability, both in regards to total/subcategory scores as well as in children with cancer.
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Affiliation(s)
- Güleser Güney Yılmaz
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Türkiye
| | - Müberra Tanrıverdi
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Bezmialem Vakıf University, İstanbul, Türkiye
| | - Sedef Şahin
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Türkiye
| | - Fatma Betül Çakır
- Faculty of Medicine, Department of Pediatric Hematology and Oncology, Bezmialem Vakıf University, İstanbul, Türkiye
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Lam KKW, Ho KY, Liu APK, Liu CQ, Ng MH, Lam TC, Belay GM, Hammoda AO, Yang F, Yuen WM, Chan GCF. Effectiveness of Computerized Cognitive Training on Working Memory in Pediatric Cancer Survivors: A Systematic Review and Meta-analysis. Cancer Nurs 2024:00002820-990000000-00234. [PMID: 38527112 DOI: 10.1097/ncc.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND Interactive features of computerized cognitive training (CCT) may enhance adherence to training, providing a relatively low-cost intervention. A robust systematic review on the effectiveness of CCT for improving working memory (WM) among pediatric survivors with cancer is lacking. OBJECTIVE To summarize the available evidence and determine the effectiveness of CCT for WM among pediatric survivors with cancer. INTERVENTIONS/METHODS Five databases were searched. The Effective Public Health Practice Project was used to assess the study quality. ReviewerManager was used. The primary outcome was WM performance. Secondary outcomes included processing speed, attention, intervention adherence, and number of adverse events. RESULTS Six studies were included. Regarding overall quality, 1 study was weak, and 5 studies were moderate. Five studies reported a significant improvement of WM postintervention (P < .05). The meta-analysis of Cogmed interventions on symbolic WM revealed a significant difference between groups (vs placebo), with an overall pooled effect size of 0.71 (95% confidence interval, 0.02-1.41; P = .04). Two and 4 studies investigated the effects of CCT on processing speed and attention, respectively, with conflicting results. Four studies reported adherence of 80% or greater. Two studies reported no adverse events. CONCLUSIONS Computerized cognitive training using Cogmed has a significant positive effect on WM. The effects of CCT on processing speed and attention remain inconclusive. IMPLICATIONS FOR PRACTICE More rigorous trials should be conducted to elucidate the cognitive effects of CCT, particularly processing speed and attention, in the pediatric population with cancer. Further studies should consider combining CCT with other existing interventions to strengthen their effectiveness.
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Affiliation(s)
- Katherine K W Lam
- Author Affiliations: School of Nursing, Hong Kong Polytechnic University (Drs Lam, Ho, Hammoda, and Yuen; Mss Liu and Yang; and Messrs Ng, Lam, and Belay); and Hong Kong Children's Hospital (Drs Liu and Chan)
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Tonning Olsson I, Lundgren J, Hjorth L, Munck Af Rosenschöld P, Hammar Å, Perrin S. Neurocognitive development after pediatric brain tumor - a longitudinal, retrospective cohort study. Child Neuropsychol 2024; 30:22-44. [PMID: 36744788 DOI: 10.1080/09297049.2023.2172149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 01/18/2023] [Indexed: 02/07/2023]
Abstract
Survivors of Pediatric Brain Tumors (PBTs) treated with cranial radiation therapy (CRT) often experience a decline in neurocognitive test scores. Less is known about the neurocognitive development of non-irradiated survivors of PBTs. The aim of this study was to statistically model neurocognitive development after PBT in both irradiated and non-irradiated survivors and to find clinical variables associated with the rate of decline in neurocognitive scores. A total of 151 survivors were included in the study. Inclusion criteria: Diagnosis of PBT between 2001 and 2013 or earlier diagnosis of PBT and turning 18 years of age between 2006 and 2013. Exclusion criteria: Death within a year from diagnosis, neurocutaneous syndromes, severe intellectual disability. Clinical neurocognitive data were collected retrospectively from medical records. Multilevel linear modeling was used to evaluate the rate of decline in neurocognitive measures and factors associated with the same. A decline was found in most measures for both irradiated and non-irradiated survivors. Ventriculo-peritoneal (VP) shunting and treatment with whole-brain radiation therapy (WBRT) were associated with a faster decline in neurocognitive scores. Male sex and supratentorial lateral tumor were associated with lower scores. Verbal learning measures were either stable or improving. Survivors of PBTs show a pattern of decline in neurocognitive scores irrespective of treatment received, which suggests the need for routine screening for neurocognitive rehabilitation. However, survivors treated with WBRT and/or a VP shunt declined at a faster rate and appear to be at the highest risk of negative neurocognitive outcomes and to have the greatest need for neurocognitive rehabilitation.
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Affiliation(s)
- Ingrid Tonning Olsson
- Department of Psychology, Lund University, Lund, Sweden
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
| | - Johan Lundgren
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
| | - Lars Hjorth
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
| | - Per Munck Af Rosenschöld
- Medical Radiation Physics, Lund University, Lund, Sweden
- Radiation Physics, Dept of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Åsa Hammar
- Department of Psychology, Lund University, Lund, Sweden
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
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Cox E, Kiwan M, de Medeiros C, Chen-Lai J, Cassiani C, Tseng J, Johnston K, Timmons BW, Stinson JN, Bouffet E, Mabbott DJ. A web-based resource for exercise training in children treated for brain tumours to improve cognitive sequelae: Development and usability. Digit Health 2024; 10:20552076241272710. [PMID: 39262418 PMCID: PMC11387797 DOI: 10.1177/20552076241272710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/09/2024] [Indexed: 09/13/2024] Open
Abstract
Improving cognitive sequelae in children treated for brain tumours (CTBT) requires accessible interventions. While instructor-led exercise in a hospital setting is efficacious, it is not extended to communities. Objectives We aimed to (i) develop a website with educational resources/tools for community health and fitness professionals (HFP) to deliver exercise for CTBT in community settings to improve cognition and (ii) assess its usability by community HFP. It was hypothesized that the website would be learnable, clear, satisfactory and efficient to deliver exercise. Methods A scoping review determined the state of eHealth resources to support exercise for CTBT and identified knowledge and resource gaps. Three focus groups with HFP who served cancer survivors in hospital or community settings (n = 13) identified user needs; content analysis identified themes. Gaps from the scoping review and themes from focus groups informed website content. A questionnaire assessed its usability by community HFP (n = 4). Descriptive statistics inferred the website's learnability, clarity, satisfaction and efficiency. Open-ended responses identified issues. Results The scoping review revealed a lack of eHealth resources supporting exercise to improve cognition in CTBT and education for HFP to deliver exercise. Six themes were identified in the focus groups. HFP rated the website as sufficiently learnable, clear, satisfactory and efficient. Two minor issues were reported and addressed. Conclusion The website marks one of the first eHealth resources to increase accessibility of intervention to improve cognitive sequelae and ultimately quality of life in CTBT. HFP also gain access to education and tools to deliver exercise in community settings.
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Affiliation(s)
- Elizabeth Cox
- Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Marium Kiwan
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | - Julie Tseng
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Brian W Timmons
- McMaster Children's Hospital, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | - Jennifer N Stinson
- Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Eric Bouffet
- Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Donald J Mabbott
- Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Castle J, Shaw G, Weller D, Fielder E, Egnuni T, Singh M, Skinner R, von Zglinicki T, Clifford SC, Short SC, Miwa S, Hicks D. In vivo modeling recapitulates radiotherapy delivery and late-effect profile for childhood medulloblastoma. Neurooncol Adv 2024; 6:vdae091. [PMID: 38946880 PMCID: PMC11212071 DOI: 10.1093/noajnl/vdae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background Medulloblastoma (MB) is the most common malignant pediatric brain tumor, with 5-year survival rates > 70%. Cranial radiotherapy (CRT) to the whole brain, with posterior fossa boost (PFB), underpins treatment for non-infants; however, radiotherapeutic insult to the normal brain has deleterious consequences to neurocognitive and physical functioning, and causes accelerated aging/frailty. Approaches to ameliorate radiotherapy-induced late-effects are lacking and a paucity of appropriate model systems hinders their development. Methods We have developed a clinically relevant in vivo model system that recapitulates the radiotherapy dose, targeting, and developmental stage of childhood medulloblastoma. Consistent with human regimens, age-equivalent (postnatal days 35-37) male C57Bl/6J mice received computerized tomography image-guided CRT (human-equivalent 37.5 Gy EQD2, n = 12) ± PFB (human-equivalent 48.7 Gy EQD2, n = 12), via the small animal radiation research platform and were longitudinally assessed for > 12 months. Results CRT was well tolerated, independent of PFB receipt. Compared to a sham-irradiated group (n = 12), irradiated mice were significantly frailer following irradiation (frailty index; P = .0002) and had reduced physical functioning; time to fall from a rotating rod (rotarod; P = .026) and grip strength (P = .006) were significantly lower. Neurocognitive deficits were consistent with childhood MB survivors; irradiated mice displayed significantly worse working memory (Y-maze; P = .009) and exhibited spatial memory deficits (Barnes maze; P = .029). Receipt of PFB did not induce a more severe late-effect profile. Conclusions Our in vivo model mirrored childhood MB radiotherapy and recapitulated features observed in the late-effect profile of MB survivors. Our clinically relevant model will facilitate both the elucidation of novel/target mechanisms underpinning MB late effects and the development of novel interventions for their amelioration.
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Affiliation(s)
- Jemma Castle
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gary Shaw
- Leeds Institute of Medical Research, Wellcome Trust Brenner Building, St James’s University Hospital, Beckett St, Leeds, UK
| | - Dominic Weller
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Edward Fielder
- Biosciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Teklu Egnuni
- Leeds Institute of Medical Research, Wellcome Trust Brenner Building, St James’s University Hospital, Beckett St, Leeds, UK
| | - Mankaran Singh
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Roderick Skinner
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas von Zglinicki
- Biosciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susan C Short
- Leeds Institute of Medical Research, Wellcome Trust Brenner Building, St James’s University Hospital, Beckett St, Leeds, UK
| | - Satomi Miwa
- Biosciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Debbie Hicks
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Verity SJ, Halliday G, Hill RM, Ryles J, Bailey S. Methylphenidate improves cognitive function and health-related quality of life in survivors of childhood brain tumours. Neuropsychol Rehabil 2024; 34:133-153. [PMID: 36580420 DOI: 10.1080/09602011.2022.2157446] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The growing population of survivors of childhood brain tumors present the challenge of long-term quality of survival. The domains most affected by tumor and treatment are those implicated in development of typical intellectual functions: attention, working memory, and processing speed, with consequent effects upon function and quality of life. In this paper we present service evaluation data on the 12-month effect upon processing speed, visual and auditory attentional domains in 29 patients receiving methylphenidate aged 5-16 years (Mean=10.6). METHODS Patients received immediate-release methylphenidate and were converted to modified-release as appropriate. Mean optimal dose of immediate-release methylphenidate was 0.34 mg/kg per dose (range 0.2-0.67). RESULTS Patients showed a significant positive impact of methylphenidate on attention in all tests of selective visual attention from the Test of Everyday Attention for Children 2. A significant improvement was also shown on response time. Significant change was not found on psychometric measures of sustained auditory or visual attention, or selective auditory attention. Ratings of Health-Related Quality of Life showed a positive benefit of methylphenidate at 12 months. Side effects were minimal and not statistically significant. CONCLUSIONS Survivors of childhood brain tumor with attentional and processing speed deficit show clinical benefit from methylphenidate.
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Affiliation(s)
- Sarah J Verity
- Department of Paediatric Neuro Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Gail Halliday
- Department of Paediatric Neuro Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Rebecca M Hill
- Department of Paediatric Neuro Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Jade Ryles
- Department of Paediatric Neuro Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Simon Bailey
- Department of Paediatric Neuro Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
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11
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Lassaletta Á, Morales JS, Valenzuela PL, Esteso B, Kahalley LS, Mabbott DJ, Unnikrishnan S, Panizo E, Calvo F. Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis. World J Pediatr 2023; 19:727-740. [PMID: 37154861 PMCID: PMC10348930 DOI: 10.1007/s12519-023-00726-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Advances in cancer treatments, particularly the development of radiation therapy, have led to improvements in survival outcomes in children with brain tumors. However, radiation therapy is associated with significant long-term neurocognitive morbidity. The present systematic review and meta-analysis aimed to compare the neurocognitive outcomes of children and adolescents with brain tumors treated with photon radiation (XRT) or proton therapy (PBRT). METHODS A systematic search was conducted (PubMed, Embase, Cochrane, and Web of Science from inception until 02/01/2022) for studies comparing the neurocognitive outcomes of children and adolescents with brain tumors treated with XRT vs. PBRT. The pooled mean differences (expressed as Z scores) were calculated using a random effects method for those endpoints analyzed by a minimum of three studies. RESULTS Totally 10 studies (n = 630 patients, average age range: 1-20 years) met the inclusion criteria. Patients who had received PBRT achieved significantly higher scores (difference in Z scores ranging from 0.29-0.75, all P < 0.05 and significant in sensitivity analyses) after treatment than those who had received XRT for most analyzed neurocognitive outcomes (i.e., intelligence quotient, verbal comprehension and perceptual reasoning indices, visual motor integration, and verbal memory). No robust significant differences (P > 0.05 in main analyses or sensitivity analyses) were found for nonverbal memory, verbal working memory and working memory index, processing speed index, or focused attention. CONCLUSIONS Pediatric brain tumor patients who receive PBRT achieve significantly higher scores on most neurocognitive outcomes than those who receive XRT. Larger studies with long-term follow-ups are needed to confirm these results.
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Affiliation(s)
- Álvaro Lassaletta
- Radiation Oncology Department, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta 1, 28027, Madrid, Spain.
- Pediatric Neuro-Oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Javier S Morales
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - Pedro L Valenzuela
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain
- Systems Biology Department, University of Alcalá, Madrid, Spain
| | - Borja Esteso
- Clinical Neuropsychology Unit, Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Lisa S Kahalley
- Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - Donald J Mabbott
- The Hospital for Sick Children, Toronto, ON, Canada
- The University of Toronto, Toronto, ON, Canada
| | | | - Elena Panizo
- Radiation Oncology Department, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta 1, 28027, Madrid, Spain
| | - Felipe Calvo
- Radiation Oncology Department, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta 1, 28027, Madrid, Spain
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12
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Dowling AV, Seitzman BA, Mitchell TJ, Olufawo M, Dierker DL, Anandarajah H, Dworetsky A, McMichael A, Jiang C, Barbour DL, Schlaggar BL, Limbrick DD, Strahle JM, Rubin JB, Shimony JS, Perkins SM. Cognition and Brain System Segregation in Pediatric Brain Tumor Patients Treated with Proton Therapy. Int J Part Ther 2023; 10:32-42. [PMID: 37823016 PMCID: PMC10563667 DOI: 10.14338/ijpt-22-00039.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/18/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose Pediatric brain tumor patients often experience significant cognitive sequelae. Resting-state functional MRI (rsfMRI) provides a measure of brain network organization, and we hypothesize that pediatric brain tumor patients treated with proton therapy will demonstrate abnormal brain network architecture related to cognitive outcome and radiation dosimetry. Participants and Methods Pediatric brain tumor patients treated with proton therapy were enrolled on a prospective study of cognitive assessment using the NIH Toolbox Cognitive Domain. rsfMRI was obtained in participants able to complete unsedated MRI. Brain system segregation (BSS), a measure of brain network architecture, was calculated for the whole brain, the high-level cognition association systems, and the sensory-motor systems. Results Twenty-six participants were enrolled in the study for cognitive assessment, and 18 completed rsfMRI. There were baseline cognitive deficits in attention and inhibition and processing speed prior to radiation with worsening performance over time in multiple domains. Average BSS across the whole brain was significantly decreased in participants compared with healthy controls (1.089 and 1.101, respectively; P = 0.001). Average segregation of association systems was significantly lower in participants than in controls (P < 0.001) while there was no difference in the sensory motor networks (P = 0.70). Right hippocampus dose was associated with worse attention and inhibition (P < 0.05) and decreased segregation in the dorsal attention network (P < 0.05). Conclusion Higher mean dose to the right hippocampus correlated with worse dorsal attention network segregation and worse attention and inhibition cognitive performance. Patients demonstrated alterations in brain network organization of association systems measured with rsfMRI; however, somatosensory system segregation was no different from healthy children. Further work with preradiation rsfMRI is needed to assess the effects of surgery and presence of a tumor on brain network architecture.
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Affiliation(s)
- Anna V. Dowling
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Benjamin A. Seitzman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Timothy J. Mitchell
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Olufawo
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Donna L. Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hari Anandarajah
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Ally Dworetsky
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Alana McMichael
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine Jiang
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
| | - Dennis L. Barbour
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
| | | | - David D. Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer M. Strahle
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua B. Rubin
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephanie M. Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
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13
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Helligsoe ASL, Henriksen LT, Kenborg L, Lassen-Ramshad Y, Wu LM, Winther JF, Hasle H, Amidi A. Neurocognitive function and health-related quality of life in a nationwide cohort of long-term childhood brain tumor survivors. Neurooncol Pract 2023; 10:140-151. [PMID: 36970169 PMCID: PMC10037941 DOI: 10.1093/nop/npac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Childhood brain tumor survivors are at high risk of late effects, especially neurocognitive impairment. Limited data are available examining neurocognitive function and associations with quality of life (QoL) in childhood brain tumor survivors. Our aim was to examine neurocognitive function in childhood brain tumor survivors, and associations with QoL and symptom burden. Methods Five-year survivors of brain tumors over the age of 15 were identified in the Danish Childhood Cancer Registry (n = 423). Eligible and consenting participants completed neuropsychological tests and questionnaires assessing QoL, insomnia, fatigue, anxiety, and depression. Survivors treated with radiation (n = 59) were statistically compared with survivors not treated with radiation (n = 102). Results In total, 170 survivors participated (40.2% participation rate). Sixty-six percent of the survivors who completed neurocognitive tests (n = 161) exhibited overall neurocognitive impairment. Survivors treated with radiation, especially whole-brain irradiation, exhibited poorer neurocognitive outcomes than survivors not treated with radiation. Neurocognitive outcomes for survivors treated with surgery were below normative expectations. Furthermore, a number of survivors experienced significant fatigue (40%), anxiety (23%), insomnia (13%), and/or depression (6%). Survivors treated with radiation reported lower quality of life (QoL) and higher symptom burden scores than survivors not treated with radiation; particularly in physical functioning, and social functioning with symptoms of fatigue. Neurocognitive impairment was not associated with QoL or symptom burden. Conclusions In this study, a majority of the childhood brain tumor survivors experienced neurocognitive impairment, reduced QoL, and high symptom burden. Although not associated with each other, it is apparent that childhood brain tumor survivors experience not only neurocognitive dysfunction but may also experience QoL impairments and significant symptom burden.
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Affiliation(s)
- Anne Sophie L Helligsoe
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Louise T Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Denmark
| | | | - Lisa M Wu
- Unit for Psychooncology & Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Jeanette F Winther
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Denmark
- Aarhus University Hospital, Denmark
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Ali Amidi
- Unit for Psychooncology & Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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14
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Mash LE, Kahalley LS, Raghubar KP, Goodrich-Hunsaker NJ, Abildskov TJ, De Leon LA, MacLeod M, Stancel H, Parsons K, Biekman B, Desai NK, Grosshans DR, Paulino AC, Chu ZD, Whitehead WE, Okcu MF, Chintagumpala M, Wilde EA. Cognitive Sparing in Proton versus Photon Radiotherapy for Pediatric Brain Tumor Is Associated with White Matter Integrity: An Exploratory Study. Cancers (Basel) 2023; 15:cancers15061844. [PMID: 36980730 PMCID: PMC10047305 DOI: 10.3390/cancers15061844] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Radiotherapy for pediatric brain tumors is associated with reduced white matter structural integrity and neurocognitive decline. Superior cognitive outcomes have been reported following proton radiotherapy (PRT) compared to photon radiotherapy (XRT), presumably due to improved sparing of normal brain tissue. This exploratory study examined the relationship between white matter change and late cognitive effects in pediatric brain tumor survivors treated with XRT versus PRT. Pediatric brain tumor survivors treated with XRT (n = 10) or PRT (n = 12) underwent neuropsychological testing and diffusion weighted imaging >7 years post-radiotherapy. A healthy comparison group (n = 23) was also recruited. Participants completed age-appropriate measures of intellectual functioning, visual-motor integration, and motor coordination. Tractography was conducted using automated fiber quantification (AFQ). Fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) were extracted from 12 tracts of interest. Overall, both white matter integrity (FA) and neuropsychological performance were lower in XRT patients while PRT patients were similar to healthy control participants with respect to both FA and cognitive functioning. These findings support improved long-term outcomes in PRT versus XRT. This exploratory study is the first to directly support for white matter integrity as a mechanism of cognitive sparing in PRT.
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Affiliation(s)
- Lisa E Mash
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Lisa S Kahalley
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX 77030, USA
| | - Kimberly P Raghubar
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | | | - Tracy J Abildskov
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Luz A De Leon
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Marianne MacLeod
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Heather Stancel
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Kelley Parsons
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Houston, TX 77030, USA
- Psychology Service, Texas Children's Hospital, Houston, TX 77030, USA
| | - Brian Biekman
- Department of Psychology, University of Houston, Houston, TX 77204, USA
| | - Nilesh K Desai
- Department of Radiology, Division of Neuroradiology, Texas Children's Hospital, Houston, TX 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - David R Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Arnold C Paulino
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zili D Chu
- Department of Radiology, Division of Neuroradiology, Texas Children's Hospital, Houston, TX 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - William E Whitehead
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mehmet Fatih Okcu
- Department of Pediatrics, Division of Hematology Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Murali Chintagumpala
- Department of Pediatrics, Division of Hematology Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Department of Pediatrics, Division of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
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15
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Peterson RK, Ng R, Ludwig NN, Jacobson LA. Tumor region associated with specific processing speed outcomes. Pediatr Blood Cancer 2023; 70:e30167. [PMID: 36625401 PMCID: PMC10101562 DOI: 10.1002/pbc.30167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Processing speed (PS) is a vulnerable cognitive skill in pediatric cancer survivors as a consequence of treatments and, less consistently, tumor region. Studies conventionally examine graphomotor PS; emerging research suggests other aspects of PS may be impacted. This study examined types of PS in pediatric brain tumor survivors to determine which aspects are impaired. Given discordance across studies, we additionally investigated the relationship between brain region and PS. METHODS The sample consisted of 167 pediatric brain tumor patients (100 supratentorial). PS (oral naming, semantic fluency, phonemic fluency, motor speed, graphomotor speed, visual scanning) was gathered via clinical neuropsychological assessment. To examine PS by region, infratentorial and supratentorial groups were matched on age at diagnosis and neuropsychological assessment, and time since diagnosis. RESULTS The whole sample performed below normative means on measures of oral naming (p < .001), phonemic fluency (p < .001), motor speed (p = .03), visual scanning (p < .001), and graphomotor speed (p < .001). Only oral naming differed by region (p = .03), with infratentorial tumors associated with slower performance. After controlling for known medical and demographic risk factors, brain region remained a significant predictor of performance (p = .04). Among the whole sample, greater than expected proportions of patients with impairment (i.e., >1 standard deviation below the normative mean) were seen across all PS measures. Infratentorial tumors had higher rates of impairments across all PS measures except phonemic fluency. CONCLUSIONS Results indicate pediatric brain tumor survivors demonstrate weaknesses in multiple aspects of PS, suggesting impairments are not secondary to peripheral motor slowing alone. Additionally, tumor region may predict some but not all neuropsychological outcomes in this population.
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Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rowena Ng
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Natasha N Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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16
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Peterson RK, Holingue C, Jacobson LA. Sluggish cognitive tempo profiles in survivors of childhood cancer as compared to children with attention-deficit/hyperactivity disorder. Support Care Cancer 2022; 30:7553-7560. [PMID: 35676341 PMCID: PMC10076037 DOI: 10.1007/s00520-022-07188-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Neurocognitive late effects including problems with attention have been reported in pediatric oncology survivors. While some researchers have characterized these late effects as similar to symptoms of attention-deficit/hyperactivity disorder, inattentive presentation (ADHD-I), there remains some controversy as to whether these concerns in oncology patients are best conceptualized according to an ADHD-I or sluggish cognitive tempo (SCT) framework. The aim of this study was to describe SCT symptoms in children with ADHD-I or oncology diagnoses; identify groups of SCT symptoms among children with brain tumors (BT), acute lymphoblastic leukemia (ALL), or ADHD-I; and identify whether specific SCT profiles are associated with these diagnoses. METHODS The sample was comprised of 364 youth (146 BT, 149 ADHD-I, 69 ALL) referred for a neuropsychological evaluation at an academic medical center. Caregivers completed the SCT scale as part of the clinical evaluation. RESULTS Groups differed on mean scores for the SCT scales (Total, Sleepy/sluggish, Low initiation, and Daydreamy) by diagnosis (all p < 0.05), with the ADHD-I group having higher SCT symptoms on all scales. Latent profile analysis showed significant differences between latent SCT classes according to ADHD-I versus cancer diagnosis. The ADHD-I group was significantly more likely to be in the high SCT class compared to the oncology groups. CONCLUSION Findings add to the understanding of SCT symptoms in pediatric oncology survivors. There is utility in applying the SCT framework to the oncology population; however, pediatric survivors are likely to be rated differently than youth with ADHD-I. Implications and future directions are discussed.
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Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, 1750 E. Fairmount Ave, Baltimore, MD, 21231, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Calliope Holingue
- Department of Neuropsychology, Kennedy Krieger Institute, 1750 E. Fairmount Ave, Baltimore, MD, 21231, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, 1750 E. Fairmount Ave, Baltimore, MD, 21231, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Abstract
OBJECTIVE The relationship between fatigue and cognition has not been fully elucidated in children and adolescent survivors of brain tumours. The aim of the present study was to investigate the potential relationship between fatigue and cognitive impairments in these survivors, as this group is at risk for both types of deficits. METHODS Survivors of paediatric brain tumours (n = 45) underwent a neuropsychological testing on average 4 years after diagnosis. Mean age at follow-up was 13.41 years. Cognition was assessed with neuropsychological tests, and fatigue with the Pediatric Quality of Life (PedsQL™) Multidimensional Fatigue Scale. Regression analysis, adjusted for cranial radiotherapy and age at diagnosis, was used to investigate the associations between cognitive variables and fatigue subscales. Cognitive variables associated with fatigue were subsequently exploratively assessed. RESULTS Significant associations were found for cognitive fatigue and measures of cognitive processing speed; Coding: p = .003, r = .583, 95% CI [9.61; 22.83] and Symbol Search: p = .001, r = .585, 95% CI [10.54; 24.87]. Slower processing speed was associated with poorer results for cognitive fatigue. Survivors with the largest decrease in processing speed from baseline to follow-up also experienced the most cognitive fatigue. Survivors expressed more cognitive fatigue compared to other types of fatigue. CONCLUSIONS The association between cognitive fatigue and cognitive processing speed in children and adolescents treated for brain tumours is in concordance with the results previously reported in adults. Some survivors experience fatigue without impairment in processing speed, indicating the need for comprehensive assessments. Moreover, the study supports that fatigue is a multidimensional concept which should be measured accordingly.
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18
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Oprandi MC, Oldrati V, delle Fave M, Panzeri D, Gandola L, Massimino M, Bardoni A, Poggi G. Processing Speed and Time since Diagnosis Predict Adaptive Functioning Measured with WeeFIM in Pediatric Brain Tumor Survivors. Cancers (Basel) 2021; 13:cancers13194776. [PMID: 34638261 PMCID: PMC8508451 DOI: 10.3390/cancers13194776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Brain tumor (BT) survivors show difficulties in adaptive functioning (AF) and in acquiring independence (e.g., graduating, finding employment, building strong relationships, and being independent). The aim of our observational retrospective study is to explore the contribution of different clinical and cognitive variables in explaining and predicting the AF outcomes of BT survivors, measured with the Functional Independence Measure for Children (WeeFIM). The analysis demonstrated that processing speed and time since diagnosis are the main explanatory variables. Other clinical factors, such as age at diagnosis and hydrocephalus, differentially influence functional skills according to distinct domains (i.e., self-care, mobility, and cognition). The identification of the clinical factors influencing AF could suggest targets on which to focus attention. By successfully assessing, understanding, and managing AF, it will be possible to improve its management in pediatric BT survivors. Abstract (1) Background: Brain tumor (BT) survivors show difficulties in the acquisition of developmental milestones, related to academic achievement, vocational employment, social relationships, and autonomy. The skills underlying adaptive functioning (AF) are usually damaged in BT survivors due to the presence of the brain tumor, treatment-related factors, and other neurological sequelae. In this study, we aimed to explore the contribution of different cognitive factors in children with BT to AF, considering diagnosis-related variables. (2) Methods: Standardized cognitive assessment was undertaken and clinical information was collected from a retrospective cohort of 78 children with a BT, aged between 6 and 18 year old at the time of the assessment. Regression models were computed to investigate the influence of the selected variables on daily functional skills as measured by the Functional Independence Measure for Children (WeeFIM). (3) Results: The analyses showed that the main explanatory variables are processing speed and time since diagnosis. Other clinical variables, such as age at diagnosis and hydrocephalus, differentially influence functional skills according to distinct domains (i.e., self-care, mobility, and cognition). (4) Conclusions: The main explanatory variables of AF that emerged in our models point to a potential target of improving AF management in pediatric BT survivors.
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Affiliation(s)
- Maria Chiara Oprandi
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
- Correspondence:
| | - Viola Oldrati
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
| | - Morena delle Fave
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
| | - Daniele Panzeri
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
| | - Lorenza Gandola
- Department of Medical Oncology and Hematology, Pediatrics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (M.M.)
| | - Maura Massimino
- Department of Medical Oncology and Hematology, Pediatrics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (M.M.)
| | - Alessandra Bardoni
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
| | - Geraldina Poggi
- Neuro-Oncological and Neuropsychological Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (V.O.); (M.d.F.); (D.P.); (A.B.); (G.P.)
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19
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Alexander TC, Krull KR. Effects of chemotherapy for acute lymphoblastic leukemia on cognitive function in animal models of contemporary protocols: A systematic literature review. Neurosci Biobehav Rev 2021; 129:206-217. [PMID: 34352229 DOI: 10.1016/j.neubiorev.2021.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 10/29/2020] [Accepted: 07/28/2021] [Indexed: 11/20/2022]
Abstract
Survival rates of childhood acute lymphoblastic leukemia (ALL) have improved greatly due to advanced therapies and supportive care. Intrathecal chemotherapy replaced cranial radiation due to radiation-induced neurotoxicity and late-effects. Survivors treated with chemotherapy-only experience neurologic and cognitive problems following cessation of treatment. Very long-term cognitive outcomes remain unclear. Animal models are being generated to assess late-effects of chemotherapy on cognitive function. Although, few address juvenile models of chemotherapy-induced cognitive impairment (CICI) and developing brain, results of this review outline neurocognitive effects of chemotherapy consistent with childhood ALL therapy. Studies demonstrate deficits across cognitive domains including spatial memory, executive function, short-term memory, anxiety and depression. Inflammation, oxidative stress, excitotoxity, and other metabolic disruptions may lead to neurodegeneration associated with cognitive impairment observed in ALL survivors. Interventions directly targeting these mechanisms may prevent and/or promote recovery of cognitive function and improve long-term outcomes. Evidence suggests success of anti-inflammatory and antioxidant treatments in reducing cognitive decline. Animal models provide basis for assessing effects of chemotherapy on neurologic processes to guide future clinical investigations.
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Affiliation(s)
- Tyler C Alexander
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States.
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20
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Weusthof K, Lüttich P, Regnery S, König L, Bernhardt D, Witt O, Herfarth K, Unterberg A, Jungk C, Farnia B, Combs SE, Debus J, Rieken S, Harrabi S, Adeberg S. Neurocognitive Outcomes in Pediatric Patients Following Brain Irradiation. Cancers (Basel) 2021; 13:cancers13143538. [PMID: 34298751 PMCID: PMC8307409 DOI: 10.3390/cancers13143538] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/16/2022] Open
Abstract
Advanced radiation techniques can reduce the severity of neurocognitive sequelae in young brain tumor patients. In the present analysis, we sought to compare neurocognitive outcomes after proton irradiation with patients who underwent photon radiotherapy (RT) and surgery. Neurocognitive outcomes were evaluated in 103 pediatric brain tumor patients (proton RT n = 26, photon RT n = 30, surgery n = 47) before and after treatment. Comparison of neurocognitive outcomes following different treatment modalities were analyzed over four years after treatment completion. Longitudinal analyses included 42 months of follow-up after proton RT and 55 months after photon RT and surgery. Neurocognitive assessment included standardized tests examining seven domains. A comparison of neurocognitive outcomes after RT (proton and photon with >90% additional surgery) and surgery showed no significant differences in any neurocognitive domain. Neurocognitive functioning tests after proton RT failed to identify alterations compared to baseline testing. Long-term follow up over four years after photon RT showed a decrease in non-verbal intelligence (-9.6%; p = 0.01) and visuospatial construction (-14.9%; p = 0.02). After surgery, there was a decline in non-verbal intelligence (-10.7%; p = 0.01) and processing speed (14.9%; p = 0.002). Differences in neurocognitive outcomes between RT and surgical cohorts in direct intermodal comparison at long-term follow-up were not identified in our study, suggesting that modern radiation therapy does not affect cognition as much as in the past. There were no alterations in long-term neurocognitive abilities after proton RT, whereas decline of processing speed, non-verbal intelligence, and visuospatial abilities were observed after both photon RT and surgery. Domains dependent on intact white matter structures appear particularly vulnerable to brain tumor treatment irrespective of treatment approach.
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Affiliation(s)
- Katharina Weusthof
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Peggy Lüttich
- Section of Pediatric Brain Tumors, Department of Pediatric Oncology, Hematology and Immunology, University Medical Center for Children and Adolescents, 69120 Heidelberg, Germany; (P.L.); (O.W.)
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Technische Universität München, 81675 München, Germany; (D.B.); (S.E.C.)
- Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Olaf Witt
- Section of Pediatric Brain Tumors, Department of Pediatric Oncology, Hematology and Immunology, University Medical Center for Children and Adolescents, 69120 Heidelberg, Germany; (P.L.); (O.W.)
- Translational Program, Hopp Children’s Cancer Center at NCT Heidelberg (KiTZ), 69120 Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (A.U.); (C.J.)
| | - Christine Jungk
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (A.U.); (C.J.)
| | - Benjamin Farnia
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA;
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technische Universität München, 81675 München, Germany; (D.B.); (S.E.C.)
- Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital Goettingen, 37075 Goettingen, Germany;
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-56-8201
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21
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Tsang DS, Kim L, Liu ZA, Janzen L, Khandwala M, Bouffet E, Laperriere N, Dama H, Keilty D, Craig T, Ramaswamy V, Hodgson DC, Mabbott D. Intellectual changes after radiation for children with brain tumors: which brain structures are most important? Neuro Oncol 2021; 23:487-497. [PMID: 33151327 DOI: 10.1093/neuonc/noaa217] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the contribution of radiation dose to different intracranial structures on changes in intellectual function for children with brain tumors. METHODS We evaluated children with brain tumors treated in 2005-2017 who had longitudinal neuropsychological assessments and available photon dosimetric data (if radiation therapy [RT] given). Full Scale Intelligence Quotient (FSIQ) and index scores were evaluated (perceptual reasoning index [PRI], processing speed index [PSI], verbal comprehension index [VCI], and working memory index [WMI]). Multivariable linear mixed effects models were used to model endpoints, with age at RT and dose to different brain regions as fixed effects and patient-specific random intercepts. P-values (P*) were adjusted for multiple comparisons. RESULTS Sixty-nine patients were included, 56 of whom received RT. Median neuropsychological follow-up was 3.2 years. Right temporal lobe mean dose was strongly associated with decline in FSIQ (P* = 0.005); with each gray increase in mean dose, there was a decrease of 0.052 FSIQ points per year. Dose to 50% (D50) of the supratentorial brain was associated with decline in PSI (P* = 0.006) and WMI (P* = 0.001). Right and left hippocampus D50 were individually strongly associated with declines in VCI (P* = 0.009 for each). Presence of a ventriculoperitoneal shunt decreased FSIQ by 10 points. CONCLUSIONS We reported associations between dosimetry to specific brain regions and intellectual outcomes, with suggested avoidance structures during RT planning. These models can help clinicians anticipate changes in neurocognition post-RT and guide selection of an optimal RT plan.
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Affiliation(s)
- Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laurence Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Laura Janzen
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children; Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Khandwala
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hitesh Dama
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Dana Keilty
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donald Mabbott
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children; Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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22
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Gutierrez M, Arán Filippetti V, Lemos V. Executive functioning in pediatric acute lymphoblastic leukemia: CHEXI parent-report vs performance-based assessment. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Early neuropsychological profile of children diagnosed with a brain tumor predicts later academic difficulties at school age. Childs Nerv Syst 2021; 37:447-456. [PMID: 32754867 DOI: 10.1007/s00381-020-04847-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Children diagnosed with a brain tumor (BT) in the first years of their life are at high risk of cognitive and neuropsychological problems, more school difficulties, and an increased need for educational support. To improve this condition, it will be beneficial to be able to identify the neuropsychological variables that are early predictors of school competences at later ages. METHODS We longitudinally assessed 30 school-age BT children with a diagnosis before the age of 5 who were administered cognitive and neuropsychological evaluations before entering school or in the first 2 school years and who were followed up for academic performance at least one year after the first evaluation. A discriminant function analysis was conducted to detect the early neuropsychological profile that best predicted those children who turned out to need school support or not; we tested 5 block multiple regression models, one for each academic variable entering as predictors the neuropsychological variables that significantly discriminated the two groups. RESULTS A total of 93.3% of the cases were correctly classified according to the discriminant function in "with vs. without" educational support. Visual attention abilities were highly correlated with resulting school problems, both for reading (accuracy and speed) and math (operations) at school age. CONCLUSIONS Analysis provided evidence that the early neuropsychological profile may predict academic difficulties for both reading and math at school age and that visual attention seems to play an important role in both these academic abilities, allowing clinicians to identify children with major difficulties in/from early years and to intervene beforehand.
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24
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Spitzhüttl JS, Kronbichler M, Kronbichler L, Benzing V, Siegwart V, Pastore‐Wapp M, Kiefer C, Slavova N, Grotzer M, Roebers CM, Steinlin M, Leibundgut K, Everts R. Impact of non-CNS childhood cancer on resting-state connectivity and its association with cognition. Brain Behav 2021; 11:e01931. [PMID: 33205895 PMCID: PMC7821559 DOI: 10.1002/brb3.1931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/10/2020] [Accepted: 10/09/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Non-central nervous system cancer in childhood (non-CNS CC) and its treatments pose a major threat to brain development, with implications for functional networks. Structural and functional alterations might underlie the cognitive late-effects identified in survivors of non-CNS CC. The present study evaluated resting-state functional networks and their associations with cognition in a mixed sample of non-CNS CC survivors (i.e., leukemia, lymphoma, and other non-CNS solid tumors). METHODS Forty-three patients (off-therapy for at least 1 year and aged 7-16 years) were compared with 43 healthy controls matched for age and sex. High-resolution T1-weighted structural magnetic resonance and resting-state functional magnetic resonance imaging were acquired. Executive functions, attention, processing speed, and memory were assessed outside the scanner. RESULTS Cognitive performance was within the normal range for both groups; however, patients after CNS-directed therapy showed lower executive functions than controls. Seed-based connectivity analyses revealed that patients exhibited stronger functional connectivity between fronto- and temporo-parietal pathways and weaker connectivity between parietal-cerebellar and temporal-occipital pathways in the right hemisphere than controls. Functional hyperconnectivity was related to weaker memory performance in the patients' group. CONCLUSION These data suggest that even in the absence of brain tumors, non-CNS CC and its treatment can lead to persistent cerebral alterations in resting-state network connectivity.
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Affiliation(s)
- Janine S. Spitzhüttl
- Department of PsychologyUniversity of BernBernSwitzerland
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
| | - Martin Kronbichler
- Centre for Cognitive Neuroscience and Department of PsychologyUniversity of SalzburgSalzburgAustria
- Neuroscience InstituteChristian‐Doppler Medical CentreParacelsus Medical UniversitySalzburgAustria
| | - Lisa Kronbichler
- Centre for Cognitive Neuroscience and Department of PsychologyUniversity of SalzburgSalzburgAustria
- Neuroscience InstituteChristian‐Doppler Medical CentreParacelsus Medical UniversitySalzburgAustria
- Department of Psychiatry, Psychotherapy and PsychosomaticsChristian‐Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Valentin Benzing
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
- Institute of Sport ScienceUniversity of BernBernSwitzerland
| | - Valerie Siegwart
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
| | - Manuela Pastore‐Wapp
- Support Center for Advanced Neuroimaging (SCAN)Institute of Diagnostic and Interventional Neuroradiology, InselspitalBern University Hospital, and University of BernBernSwitzerland
| | - Claus Kiefer
- Support Center for Advanced Neuroimaging (SCAN)Institute of Diagnostic and Interventional Neuroradiology, InselspitalBern University Hospital, and University of BernBernSwitzerland
| | - Nedelina Slavova
- Support Center for Advanced Neuroimaging (SCAN)Institute of Diagnostic and Interventional Neuroradiology, InselspitalBern University Hospital, and University of BernBernSwitzerland
| | - Michael Grotzer
- Department of Pediatric OncologyUniversity Children's Hospital ZurichZurichSwitzerland
| | | | - Maja Steinlin
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
| | - Kurt Leibundgut
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
| | - Regula Everts
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
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25
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Predictors of cognitive function in pediatric brain tumor patients: Pre-surgery through 24-month follow-up. APPLIED NEUROPSYCHOLOGY. CHILD 2021; 10:340-347. [PMID: 31887256 PMCID: PMC7326643 DOI: 10.1080/21622965.2019.1706179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to examine the feasibility of cognitive assessment from pre-surgery through 2-year follow-up in a sample of pediatric brain tumor (BT) patients. We sought to investigate cognitive function over the course of diagnosis and treatment, and as a function of presenting problems, tumor location, treatment type, and tumor severity. Using a prospective, longitudinal design, standardized IQ measures were administered to pediatric BT patients (ages 6-16) prior to surgery (n = 25), 6 months post-diagnosis (n = 24), and 24 months post-diagnosis (n = 23). Group differences emerged based on tumor severity and treatment type at multiple time points, including prior to surgical intervention; children with high grade tumors performed more poorly than children with low grade tumors, and children receiving surgery plus adjuvant therapy performed more poorly than children who received surgery only. When considered together, an analysis of covariance demonstrated that tumor grade significantly accounted for variability in cognitive functioning, while treatment type did not. Although there is overlap clinically between tumor severity and treatment received, results suggest that tumor severity is an important factor contributing to variability in cognitive functioning and should also be considered when monitoring risk for cognitive deficits in children diagnosed with BT.
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26
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Siegwart V, Benzing V, Spitzhuettl J, Schmidt M, Grotzer M, Steinlin M, Leibundgut K, Roebers C, Everts R. Cognition, psychosocial functioning, and health-related quality of life among childhood cancer survivors. Neuropsychol Rehabil 2020; 32:922-945. [DOI: 10.1080/09602011.2020.1844243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Valerie Siegwart
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Valentin Benzing
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Janine Spitzhuettl
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Michael Grotzer
- Department of Pediatric Oncology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Claudia Roebers
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Regula Everts
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
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27
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Kahalley LS, Douglas Ris M, Mahajan A, Fatih Okcu M, Chintagumpala M, Paulino AC, Whitehead WE, Minard CG, Stancel HH, Orobio J, Xue JJ, Warren EA, Grosshans DR. Prospective, longitudinal comparison of neurocognitive change in pediatric brain tumor patients treated with proton radiotherapy versus surgery only. Neuro Oncol 2020; 21:809-818. [PMID: 30753584 DOI: 10.1093/neuonc/noz041] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Proton radiotherapy (PRT) reduces the volume of normal tissue receiving radiation dose, which may lead to better neurocognitive outcomes. We examined change in neurocognitive scores over time in pediatric brain tumor patients treated with proton craniospinal irradiation (CSI), proton focal RT, or surgery only. METHODS Patients received annual neurocognitive evaluations for up to 6 years. We examined Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI) scores. General linear mixed models examined change in scores over time by treatment group, adjusting for significant covariates. RESULTS Scores from 93 patients treated between 2012 and 2017 (22 proton CSI, 31 proton focal, and 40 surgery only) were examined. Treatment groups were similar on gender (51.6% male), age at treatment (median = 9.7 y), and length of follow-up (median = 2.9 y). The surgery only group had proportionately more gliomas (P < 0.001), and the proton CSI group had more infratentorial tumors (P = 0.001) and higher total RT dose (P = 0.004). The proton focal and surgery only groups exhibited stable neurocognitive scores over time across all indexes (all P > 0.05). In the proton CSI group, WMI, PSI, and FSIQ scores declined significantly (P = 0.036, 0.004, and 0.017, respectively), while VCI and PRI scores were stable (all P > 0.05). CONCLUSIONS Focal PRT was associated with stable neurocognitive functioning into survivorship. Outcomes were similar whether patients received focal PRT or no radiotherapy, even in neurocognitive domains known to be particularly radiosensitive. Proton CSI emerged as a neurocognitive risk factor, consistent with photon outcomes research.
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Affiliation(s)
- Lisa S Kahalley
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston Texas
| | - M Douglas Ris
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston Texas
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minneosta
| | - M Fatih Okcu
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas
| | - Murali Chintagumpala
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas
| | - Arnold C Paulino
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William E Whitehead
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Heather H Stancel
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston Texas
| | - Jessica Orobio
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston Texas
| | - Judy J Xue
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston Texas.,Rice University
| | - Emily A Warren
- University of Houston, Department of Psychology, Houston, Texas
| | - David R Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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28
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Quality of survival assessment in European childhood brain tumour trials, for children below the age of 5 years. Eur J Paediatr Neurol 2020; 25:59-67. [PMID: 31753708 DOI: 10.1016/j.ejpn.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/03/2019] [Accepted: 10/12/2019] [Indexed: 11/23/2022]
Abstract
The highest incidence rate of childhood brain tumours is in children below the age of five years, who are particularly vulnerable to the effects of treatments. The assessment of quality of survival (QoS) in multiple domains is essential to compare the outcomes for different tumour types and treatment regimens. The aim of this position statement is to present the domains of health and functioning to be assessed in children from birth to five years, to advance the collection of a common QoS data set in European brain tumour trials. The QoS group of the European Society of Paediatric Oncology (SIOP-E) Brain Tumour group conducted consensus discussions over a period of six years to establish domains of QoS that should be prioritised in clinical trials involving children under 5 years. The domains of health and functioning that were agreed to affect QoS included: medical outcomes (e.g. vision, hearing, mobility, endocrine), emotion, behaviour, adaptive behaviour, and cognitive functioning. As for children aged five years and older, a 'core plus' approach is suggested in which core assessments are recommended for all clinical trials. The core component for children from birth to three years includes indirect assessment which, in this age-group, requires proxy assessment by a parent, of cognitive, emotional and behaviour variables and both direct and indirect endocrine measures. For children from four years of age direct cognitive assessment is also recommended as 'core'. The 'plus' components enable the addition of assessments which can be selected by individual countries and/or by, age-, treatment-, tumour type- and tumour location-specific trials.
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Papini C, Dineen RA, Walker DA, Thomas S, Pitchford NJ. Neuropsychological outcomes of children with Optic Pathway Glioma. Sci Rep 2020; 10:3344. [PMID: 32094393 PMCID: PMC7039908 DOI: 10.1038/s41598-020-59896-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/03/2020] [Indexed: 11/09/2022] Open
Abstract
Optic Pathway Glioma (OPG) is a relatively common brain tumour in childhood; however, there is scarce understanding of neuropsychological sequelae in these survivors. In this study, 12 children with diagnosis of OPG before 6 years of age received a comprehensive standardised assessment of visual perception, general intelligence and academic achievement, using adjustments to visual materials of the tests, to examine the extent of concurrent impairment in these functional domains. Information about vision, clinical and socio-demographic factors were extracted from medical records to assess the associations of neuropsychological outcomes with clinical and socio-demographic factors. Children with OPG exhibited high within-patient variability and moderate group-level impairment compared to test norms. Visual perception was the most impaired domain, while scholastic progression was age-appropriate overall. For cognition, core verbal and visuo-spatial reasoning skills were intact, whereas deficits were found in working memory and processing speed. Visual function was associated with tasks that rely on visual input. Children with OPG are at moderate risk of neuropsychological impairment, especially for visual perception and cognitive proficiency. Future research should elucidate further the relative contribution of vision loss and neurofibromatosis type 1 co-diagnosis within a large sample.
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Affiliation(s)
- Chiara Papini
- School of Psychology, University of Nottingham, Nottingham, UK.,Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Robert A Dineen
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - David A Walker
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.,Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shery Thomas
- Ophthalmology Department, Nottingham University Hospitals, Nottingham, UK
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Greenberger BA, Yock TI. The role of proton therapy in pediatric malignancies: Recent advances and future directions. Semin Oncol 2020; 47:8-22. [PMID: 32139101 DOI: 10.1053/j.seminoncol.2020.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 11/11/2022]
Abstract
Proton radiotherapy has promised an advantage in safely treating pediatric malignancies with an increased capability to spare normal tissues, reducing the risk of both acute and late toxicity. The past decade has seen the proliferation of more than 30 proton facilities in the United States, with increased capacity to provide access to approximately 3,000 children per year who will require radiotherapy for their disease. We provide a review of the initial efforts to describe outcomes after proton therapy across the common pediatric disease sites. We discuss the main attempts to assess comparative efficacy between proton and photon radiotherapy concerning toxicity. We also discuss recent efforts of multi-institutional registries aimed at accelerating research to better define the optimal treatment paradigm for children requiring radiotherapy for cure.
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Affiliation(s)
- Benjamin A Greenberger
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Francis H. Burr Proton Therapy Center, Boston, MA.
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Kahalley LS, Peterson R, Ris MD, Janzen L, Okcu MF, Grosshans DR, Ramaswamy V, Paulino AC, Hodgson D, Mahajan A, Tsang DS, Laperriere N, Whitehead WE, Dauser RC, Taylor MD, Conklin HM, Chintagumpala M, Bouffet E, Mabbott D. Superior Intellectual Outcomes After Proton Radiotherapy Compared With Photon Radiotherapy for Pediatric Medulloblastoma. J Clin Oncol 2019; 38:454-461. [PMID: 31774710 DOI: 10.1200/jco.19.01706] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Proton radiotherapy (PRT) may lessen the neuropsychological risk traditionally associated with cranial radiotherapy for the treatment of pediatric brain tumors by reducing the dose to normal tissue compared with that of photon radiotherapy (XRT). We examined the change in intellectual scores over time in patients with pediatric medulloblastoma treated with craniospinal PRT versus XRT. METHODS Intelligence test scores were obtained for a sample of pediatric patients treated between 2007 and 2018 on the same medulloblastoma protocols that differed only in radiotherapy modality (PRT v XRT). Growth curve analyses compared change in scores over time since diagnosis between groups. RESULTS Longitudinal intelligence data from 79 patients (37 PRT, 42 XRT) were examined. Groups were similar on most demographic/clinical variables, including sex (67.1% male), age at diagnosis (mean, 8.6 years), craniospinal irradiation dose (median, 23.4 Gy), length of follow-up (mean, 4.3 years), and parental education (mean, 14.3 years). Boost dose (P < .001) and boost margin (P = .001) differed between groups. Adjusting for covariates, the PRT group exhibited superior long-term outcomes in global intelligence quotient (IQ), perceptual reasoning, and working memory compared with the XRT group (all P < .05). The XRT group exhibited a significant decline in global IQ, working memory, and processing speed (all P < .05). The PRT group exhibited stable scores over time in all domains with the exception of processing speed (P = .003). CONCLUSION To our knowledge, this is the first study to compare intellectual trajectories between pediatric patients treated for medulloblastoma with PRT versus those treated with XRT on comparable, contemporary protocols. PRT was associated with more favorable intellectual outcomes in most domains compared with XRT, although processing speed emerged as a vulnerable domain for both groups. This study provides the strongest evidence to date of an intellectual sparing advantage with PRT in the treatment of pediatric medulloblastoma.
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Affiliation(s)
- Lisa S Kahalley
- Baylor College of Medicine, Houston, TX.,Texas Children's Hospital, Houston, TX
| | | | - M Douglas Ris
- Baylor College of Medicine, Houston, TX.,Texas Children's Hospital, Houston, TX
| | - Laura Janzen
- The Hospital for Sick Children, Toronto, ON, Canada
| | - M Fatih Okcu
- Baylor College of Medicine, Houston, TX.,Texas Children's Hospital, Houston, TX
| | | | - Vijay Ramaswamy
- The Hospital for Sick Children, Toronto, ON, Canada.,The University of Toronto, Toronto, ON, Canada
| | | | - David Hodgson
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Derek S Tsang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - William E Whitehead
- Baylor College of Medicine, Houston, TX.,Texas Children's Hospital, Houston, TX
| | - Robert C Dauser
- Baylor College of Medicine, Houston, TX.,Texas Children's Hospital, Houston, TX
| | - Michael D Taylor
- The Hospital for Sick Children, Toronto, ON, Canada.,The University of Toronto, Toronto, ON, Canada
| | | | | | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada.,The University of Toronto, Toronto, ON, Canada
| | - Donald Mabbott
- The Hospital for Sick Children, Toronto, ON, Canada.,The University of Toronto, Toronto, ON, Canada
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Mendoza LK, Ashford JM, Willard VW, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, Jeha S, Wang F, Zhang H, Conklin HM. Social Functioning of Childhood Cancer Survivors after Computerized Cognitive Training: A Randomized Controlled Trial. CHILDREN-BASEL 2019; 6:children6100105. [PMID: 31569616 PMCID: PMC6826733 DOI: 10.3390/children6100105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 11/16/2022]
Abstract
Childhood cancer survivors are at risk for cognitive and social deficits. Previous findings indicate computerized cognitive training can result in an improvement of cognitive skills. The current objective was to investigate whether these cognitive gains generalize to social functioning benefits. Sixty-eight survivors of childhood cancer were randomly assigned to a computerized cognitive intervention (mean age 12.21 ± 2.47 years, 4.97 ± 3.02 years off-treatment) or waitlist control group (mean age 11.82 ± 2.42 years, 5.04 ± 2.41 years off-treatment). Conners 3 Parent and Self-Report forms were completed pre-intervention, immediately post-intervention and six-months post-intervention. Piecewise linear mixed-effects models indicated no significant differences in Peer Relations between groups at baseline and no difference in change between groups from pre- to immediate post-intervention or post- to six-months post-intervention (ps > 0.40). Baseline Family Relations problems were significantly elevated in the control group relative to the intervention group (p < 0.01), with a significantly greater decline from pre- to immediate post-intervention (p < 0.05) and no difference in change between groups from post- to six-months post-intervention (p > 0.80). The study results suggest cognitive gains from computerized training do not generalize to social functioning. Training focused on skill-based social processing (e.g., affect recognition) may be more efficacious.
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Affiliation(s)
| | - Jason M Ashford
- St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | | | - Kellie N Clark
- St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | | | | | | | - Sima Jeha
- St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | - Fang Wang
- St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | - Hui Zhang
- St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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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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Sharkey CM, Clawson AH, Mullins LL, Brinkman TM, Pui CH, Hudson MM, Krull KR. The relationship of child executive functions to parenting capacities in childhood acute lymphoblastic leukemia survivors. Pediatr Blood Cancer 2019; 66:e27761. [PMID: 31033172 PMCID: PMC6657494 DOI: 10.1002/pbc.27761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current study examined associations between child executive functions and parenting capacities in long-term survivors of childhood acute lymphoblastic leukemia (ALL). METHODS Participants included 188 parent-child dyads; children were at least 8 years of age, 5 years postdiagnosis of ALL, and previously treated with chemotherapy only. Parents completed the Parental Protection Scale (PPS), Child Vulnerability Scale (CVS), and Decision-Making Questionnaire (DMQ). Children completed measures of executive functioning and general cognitive abilities. Multivariate multiple regression examined associations between child executive functioning and parenting, while controlling for child age, treatment risk, maternal education, and child intelligence quotient. An exploratory aim identified latent profiles of parenting capacities. RESULTS Higher child cognitive flexibility (β = -0.16, P = .02) and planning abilities (β = -0.16, P = .049) were related to less parental overprotection. No other neurocognitive measures were related to child autonomy in decision making or perceived child vulnerability. For the exploratory aim, we found (a) a large class defined by normative parenting (94.3%) and (b) a small class characterized by higher levels of child vulnerability and overprotection. Class membership was unrelated to executive functioning, but higher maternal education was related to higher odds of class 2 membership (OR = 0.58, P = .04). CONCLUSIONS Results suggest that parents respond to child executive function difficulties with greater overprotection, which may be adaptive but not conducive to the development of independence. Although most parents report normative levels of child vulnerability and overprotection, a small subset demonstrate parenting practices that may place some survivors at risk for adverse outcomes.
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Affiliation(s)
| | | | | | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital,Department of Psychology, St. Jude Children’s Research Hospital
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital,Department of Oncology, St. Jude Children’s Research Hospital
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital,Department of Psychology, St. Jude Children’s Research Hospital
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Aleksonis HA, Wier R, Pearson MM, Cannistraci CJ, Anderson AW, Kuttesch JF, Compas BE, Hoskinson KR. Associations among diffusion tensor imaging and neurocognitive function in survivors of pediatric brain tumor: A pilot study. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:111-122. [PMID: 31146596 DOI: 10.1080/21622965.2019.1613993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to determine associations among neurocognitive outcomes and white matter integrity in the inferior fronto-occipital fasciculus (IFOF), uncinate fasciculus (UF), and genu of the corpus callosum (gCC) in survivors of pediatric brain tumor and healthy controls (HCs). Eleven survivors (ages 8-16; >2 years post-treatment) and 14 HCs underwent MRI; diffusion tensor imaging tractography (DSI Studio) was used to assess white matter integrity. Participants completed neuropsychological assessment of overall cognitive ability, executive function, processing speed, divided attention, and memory. As previously reported, survivors performed significantly worse than HCs on measures of overall IQ, working memory, processing speed, and executive function (ps < .01), but not on measures of long-delay memory. Mean fractional anisotropy was significantly lower in survivors than HC in the right IFOF, left UF, and gCC (ps < .05). Correlations with the total sample revealed a number of significant positive associations among white matter tracts and scores on neurocognitive measures. Survivors show deficits on measures of cognitive function and decreased white matter integrity compared to HCs. Results revealed a more general pattern of associations among white matter pathways and neurocognitive outcomes than initially hypothesized. It is possible that survivors with diffuse pathology from treatment effects (i.e., hydrocephalus or posterior fossa syndrome) show more general decreases in cognitive functioning and white matter integrity. Additional research with a larger and more diverse group of survivors is needed to better understand white matter integrity and neurocognitive outcome associations in this population.
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Affiliation(s)
- Holly A Aleksonis
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ryan Wier
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Matthew M Pearson
- Institute for Neurology and Neurosurgery, Sacred Heart Medical Group, Pensacola, Florida, USA
| | - Christopher J Cannistraci
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam W Anderson
- Vanderbilt University Institute of Imaging Science, Nashville, Tennessee, USA
| | - John F Kuttesch
- Pediatric Hematology and Oncology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Bruce E Compas
- Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Lofstad GE, Reinfjell T, Weider S, Diseth TH, Hestad K. Neurocognitive Outcome and Compensating Possibilities in Children and Adolescents Treated for Acute Lymphoblastic Leukemia With Chemotherapy Only. Front Psychol 2019; 10:1027. [PMID: 31156497 PMCID: PMC6532365 DOI: 10.3389/fpsyg.2019.01027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/17/2019] [Indexed: 11/29/2022] Open
Abstract
Aim: To examine the neurocognitive outcomes in children and adolescents with acute lymphoblastic leukemia (ALL) in remission who were treated with systemic chemotherapy only (CTO). Methods: Neurocognitive performances in 36 children and adolescents, aged 8.4-15.3 years, in long-term remission from ALL 4.3-12.4 years post diagnosis, without relapse, and with no pre-diagnosis history of neurodevelopmental disorder were compared with 36 healthy controls matched for gender, age, and parents' socio-economic status. The former patients and the healthy controls completed an extensive battery of standardized neuropsychological tests. Results: Survivors who were treated by CTO obtained significantly lower scores than did healthy controls on the domains of Copy and drawing (p = 0.001; Cohen's d 0.85; after controlling for Type 1 errors q = 0.006), Arithmetic (p = 0.001; Cohen's d 0.80; after controlling for Type 1 errors, q = 0.006), and Tactile sensory functions (p = 0.008; Cohen's d 0.65; after controlling for Type 1 errors, q = 0.03). Fifty percent of the ALL group were more than 1 SD below the control groups mean on Copy and drawing. There was an interaction between age and group (ALL vs. Control, p = 0.042) on Copy and drawing, indicating that the youngest ALL patients exhibited the worst performance. The oldest ALL patients performed equal to or better than the controls. A tendency in the same direction was seen for Arithmetic and Tactile sensory functions. The ALL survivors exhibited a steeper rising learning slope on repeated tests, with lower scores on a tactile problem-solving task, tactile sensory tests, verbal memory, and visual attention, but they performed as well as the controls when stimuli were repeated. Conclusion: The results indicate that neurocognitive long-term sequelae in ALL survivors are limited to specific domains - particularly complex drawing, arithmetic, and tactile processing, and novelty processing. Cognitive deficits are shown among the youngest ALL patients. Intervention programs and school programs should account for difficulties with processing new information and taking advantage of repetitions as a strength, which may prevent survivors from falling behind their peers.
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Affiliation(s)
| | - Trude Reinfjell
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Siri Weider
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trond H. Diseth
- Division of Paediatric and Adolescent Medicine, Department of Child and Adolescent Mental Health in Hospitals, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Hestad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Health and Nursing Science, Inland Norway University of Applied Sciences, Elverum, Norway
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Chidambaram S, Elangovan V, Mahajan V, Ganesan P, Radhakrishnan V. Neurocognitive and Neuroanatomical Changes in Children with Acute Lymphoblastic Leukemia Treated with the Modified BFM-95 Protocol. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_138_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: The use of cranial radiotherapy for central nervous system (CNS) prophylaxis in children with acute lymphoblastic leukemia (ALL) is debated owing to its effect on neurocognitive functioning, as only <30% of the patients present with low risk in India and majority of the patients with high risk have to be treated with cranial radiation therapy (CRT) to prevent relapse. Given the increasing number of ALL survivors in India, the effect of CRT on neurocognitive functioning in children with ALL needs to be studied. Methods: Children (n = 44) with ALL who received CRT, intrathecal methotrexate (IT-MTX), and high-dose methotrexate (HD-MTX) for CNS prophylaxis as part of the modified Berlin-Frankfurt-Munster 95 protocol were included. Neurocognitive assessments and magnetic resonance image were performed to assess neurocognitive functioning and neuroanatomical structures, respectively. Five assessments were performed during the induction, end of re-induction I and II, commencement of maintenance, and end of maintenance phases of the modified BFM-95 protocol. Neurocognitive data of children with ALL were compared with those of healthy children (n = 60) at the baseline and after the final assessment. Results: A significant deterioration was observed in the performance intelligence, visuospatial ability, processing speed, and verbal retention domains after the completion of CNS prophylaxis. Three children had white matter changes on magnetic resonance imaging and showed reduced functioning in performance intelligence quotient, working memory, visual immediate and delayed memory, processing speed, verbal retention, visuospatial ability, processing speed, attention, planning and fine motor skills, and verbal comprehension. Children with ALL had poorer neuropsychological functioning when compared with healthy children. Conclusion: CNS prophylactic therapy as part of the BFM-95 protocol had an adverse effect on the neuropsychological functioning of children with ALL, and the effect was more pronounced when CRT was added to the treatment.
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Affiliation(s)
| | - Vidhubala Elangovan
- Departments of Psycho-Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Vandana Mahajan
- Departments of Radiology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Prasanth Ganesan
- Departments of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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Hardy KK, Willard VW, Gioia A, Sharkey C, Walsh KS. Attention-mediated neurocognitive profiles in survivors of pediatric brain tumors: comparison to children with neurodevelopmental ADHD. Neuro Oncol 2019; 20:705-715. [PMID: 29016979 DOI: 10.1093/neuonc/nox174] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Attention and working memory symptoms are among the most common late effects in survivors of pediatric brain tumors, and are often associated with academic and psychosocial difficulties. Diagnostic and treatment approaches derived from the literature on attention-deficit hyperactivity disorder (ADHD) have frequently been applied to survivors, yet the extent of overlap in cognitive profiles between these groups is unclear. The objective of the present study is to compare neurocognition in survivors of brain tumors and children with neurodevelopmental ADHD. Methods Neuropsychological data were abstracted from clinically referred brain tumor survivors (n = 105, Mage = 12.0 y, 52.4% male) and children with ADHD (n = 178, Mage = 11.1 y, 64.0% male). Data consist of a battery of parent-report questionnaires and performance-based neuropsychological measures. Results Twenty-five survivors (23.8%) of pediatric brain tumors met symptom criteria for ADHD. Participants with neurodevelopmental ADHD and survivors who met ADHD criteria had significantly greater parent- (P < 0.001) and teacher-reported (P < 0.001) working memory and behavior regulation difficulties than survivors of tumor who did not meet criteria. Children with ADHD symptoms also performed worse on measures of sustained attention than survivors without ADHD symptoms (P < 0.001). Additionally, survivors with ADHD symptoms had greater performance-based working memory difficulties than either survivors without attention problems or children with neurodevelopmental ADHD (P = 0.002). Conclusions Nearly a quarter of survivors with attention symptoms have functional profiles that are similar to children with neurodevelopmental ADHD. They also experience more neurocognitive impairments than survivors without attentional difficulties, particularly in working memory. Screening for ADHD symptoms may help providers triage a subset of individuals in need of earlier or additional neuropsychological assessment.
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Richard AE, Hodges EK, Heinrich KP. Visual Attention and Math Performance in Survivors of Childhood Acute Lymphoblastic Leukemia. Arch Clin Neuropsychol 2018; 33:1015-1023. [PMID: 29373636 DOI: 10.1093/arclin/acy002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
Objective Attentional and academic difficulties, particularly in math, are common in survivors of childhood acute lymphoblastic leukemia (ALL). Of cognitive deficits experienced by survivors of childhood ALL, attention deficits may be particularly responsive to intervention. However, it is unknown whether deficits in particular aspects of attention are associated with deficits in math skills. The current study investigated relationships between math calculation skills, performance on an objective measure of sustained attention, and parent- and teacher-reported attention difficulties. Method Twenty-four survivors of childhood ALL (Mage = 13.5 years, SD = 2.8 years) completed a computerized measure of sustained attention and response control and a written measure of math calculation skills in the context of a comprehensive clinical neuropsychological evaluation. Parent and teacher ratings of inattention and impulsivity were obtained. Results Visual response control and visual attention accounted for 26.4% of the variance observed among math performance scores after controlling for IQ (p < .05). Teacher-rated, but not parent-rated, inattention was significantly negatively correlated with math calculation scores. Conclusions Consistency of responses to visual stimuli on a computerized measure of attention is a unique predictor of variance in math performance among survivors of childhood ALL. Objective testing of visual response control, rather than parent-rated attentional problems, may have clinical utility in identifying ALL survivors at risk for math difficulties.
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Affiliation(s)
- Annette E Richard
- Department of Psychiatry, Neuropsychology Section, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elise K Hodges
- Department of Psychiatry, Neuropsychology Section, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kimberley P Heinrich
- Department of Psychiatry, Neuropsychology Section, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Stavinoha PL, Askins MA, Powell SK, Pillay Smiley N, Robert RS. Neurocognitive and Psychosocial Outcomes in Pediatric Brain Tumor Survivors. Bioengineering (Basel) 2018; 5:E73. [PMID: 30208602 PMCID: PMC6164803 DOI: 10.3390/bioengineering5030073] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 01/15/2023] Open
Abstract
The late neurocognitive and psychosocial effects of treatment for pediatric brain tumor (PBT) represent important areas of clinical focus and ongoing research. Neurocognitive sequelae and associated problems with learning and socioemotional development negatively impact PBT survivors' overall health-related quality of life, educational attainment and employment rates. Multiple factors including tumor features and associated complications, treatment methods, individual protective and vulnerability factors and accessibility of environmental supports contribute to the neurocognitive and psychosocial outcomes in PBT survivors. Declines in overall measured intelligence are common and may persist years after treatment. Core deficits in attention, processing speed and working memory are postulated to underlie problems with overall intellectual development, academic achievement and career attainment. Additionally, psychological problems after PBT can include depression, anxiety and psychosocial adjustment issues. Several intervention paradigms are briefly described, though to date research on innovative, specific and effective interventions for neurocognitive late effects is still in its early stages. This article reviews the existing research for understanding PBT late effects and highlights the need for innovative research to enhance neurocognitive and psychosocial outcomes in PBT survivors.
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Affiliation(s)
- Peter L Stavinoha
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Martha A Askins
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Stephanie K Powell
- Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Natasha Pillay Smiley
- Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Rhonda S Robert
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Kesler SR, Ogg R, Reddick WE, Phillips N, Scoggins M, Glass JO, Cheung YT, Pui CH, Robison LL, Hudson MM, Krull KR. Brain Network Connectivity and Executive Function in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia. Brain Connect 2018; 8:333-342. [PMID: 29936880 PMCID: PMC6103246 DOI: 10.1089/brain.2017.0574] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chemotherapeutic agents used to treat acute lymphoblastic leukemia (ALL), the most common cancer affecting young children, have been associated with long-term cognitive impairments that reduce quality of life. Executive dysfunction is one of the most consistently observed deficits and can have substantial and pervasive effects on academic success, occupational achievement, psychosocial function, and psychiatric status. We examined the neural mechanisms of executive dysfunction by measuring structural and functional connectomes in 161 long-term survivors of pediatric ALL, age 8-21 years, who were treated on a single contemporary chemotherapy-only protocol for standard/high- or low-risk disease. Lower global efficiency, a measure of information exchange and network integration, of both structural and functional connectomes was found in survivors with executive dysfunction compared with those without dysfunction (p < 0.046). Patients with standard/high- versus low-risk disease and those who received greater number of intrathecal treatments containing methotrexate had the lowest network efficiencies. Patients with executive dysfunction also showed hyperconnectivity in sensorimotor, visual, and auditory-processing regions (p = 0.037) and poor separation between sensorimotor, executive/attention, salience, and default mode networks (p < 0.0001). Connectome disruption was consistent with a pattern of delayed neurodevelopment that may be associated with reduced resilience, adaptability, and flexibility of the brain network. These findings highlight the need for interventions that will prevent or manage cognitive impairment in survivors of pediatric acute lymphoblastic leukemia.
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Affiliation(s)
- Shelli R. Kesler
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Ogg
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wilburn E. Reddick
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nicholas Phillips
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew Scoggins
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John O. Glass
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yin Ting Cheung
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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42
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Satapathy S, Kaushal T, Bakhshi S, Chadda RK. Non-pharmacological Interventions for Pediatric Cancer Patients: A Comparative Review and Emerging Needs in India. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1323-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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43
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Krull KR, Hardy KK, Kahalley LS, Schuitema I, Kesler SR. Neurocognitive Outcomes and Interventions in Long-Term Survivors of Childhood Cancer. J Clin Oncol 2018; 36:2181-2189. [PMID: 29874137 DOI: 10.1200/jco.2017.76.4696] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recent research has demonstrated that survivors of childhood cancer are at risk for a myriad of late effects that affect physical and mental quality of life. We discuss the patterns and prevalence of neurocognitive problems commonly experienced by survivors of CNS tumors and acute lymphoblastic leukemia, the two most commonly researched cancer diagnoses. Research documenting the direct effects of tumor location and treatment type and intensity is presented, and patient characteristics that moderate outcomes (eg, age at diagnosis and sex) are discussed. Potential biologic mechanisms of neurotoxic treatment exposures, such as cranial irradiation and intrathecal and high-dose antimetabolite chemotherapy, are reviewed. Genetic, brain imaging, and neurochemical biomarkers of neurocognitive impairment are discussed. Long-term survivors of childhood cancer are also at risk for physical morbidity (eg, cardiac, pulmonary, endocrine) and problems with health behaviors (eg, sleep); research is reviewed that demonstrates these health problems contribute to neurocognitive impairment in survivors with or without exposure to neurotoxic therapies. We conclude this review with a discussion of literature supporting specific interventions that may be beneficial in the treatment of survivors who already experience neurocognitive impairment, as well as in the prevention of impairment manifestation.
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Affiliation(s)
- Kevin R Krull
- Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Lisa S. Kahalley, Baylor College of Medicine; Shelli R. Kesler, University of Texas MD Anderson Cancer Center, Houston, TX; and Ilse Schuitema, Leiden University, Leiden, the Netherlands
| | - Kristina K Hardy
- Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Lisa S. Kahalley, Baylor College of Medicine; Shelli R. Kesler, University of Texas MD Anderson Cancer Center, Houston, TX; and Ilse Schuitema, Leiden University, Leiden, the Netherlands
| | - Lisa S Kahalley
- Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Lisa S. Kahalley, Baylor College of Medicine; Shelli R. Kesler, University of Texas MD Anderson Cancer Center, Houston, TX; and Ilse Schuitema, Leiden University, Leiden, the Netherlands
| | - Ilse Schuitema
- Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Lisa S. Kahalley, Baylor College of Medicine; Shelli R. Kesler, University of Texas MD Anderson Cancer Center, Houston, TX; and Ilse Schuitema, Leiden University, Leiden, the Netherlands
| | - Shelli R Kesler
- Kevin R. Krull, St Jude Children's Research Hospital, Memphis, TN; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Lisa S. Kahalley, Baylor College of Medicine; Shelli R. Kesler, University of Texas MD Anderson Cancer Center, Houston, TX; and Ilse Schuitema, Leiden University, Leiden, the Netherlands
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44
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Jacobson LA, Mahone EM, Yeates KO, Ris MD. Processing speed in children treated for brain tumors: effects of radiation therapy and age. Child Neuropsychol 2018; 25:217-231. [PMID: 29621934 DOI: 10.1080/09297049.2018.1456517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The current study examined processing speed in children two years post-treatment for brain tumors (BT) with radiation therapy (RT) compared to those treated with without RT. Participants included 59 children (4-17 years) with BT assessed as part of the Brain Radiation Investigative Study Consortium (BRISC). Processing speed was assessed at two time points: Time1 (3-9 months post-surgery) for 26 children who received whole brain or focal RT (RT group) and 33 treated without RT (no-RT group), and again two years later (Time2) for 42 participants (17 RT, 25 no-RT). Linear mixed effects (LME) regression analyses examined differences in cognitive and motor speed between groups and across visits, with age at Time1 (age1) treated as a moderating variable, and sex and primary tumor size as covariates. No effects for treatment group or visit were found for motor speed (Pegboard) or mean reaction time (Attention Network Task). On the Wechsler Processing Speed Index (PSI), the no-RT group performed better than the RT group, with a group-by-age interaction such that across visits, the difference between the no-RT and RT groups was larger among children who were older at initial treatment (≥10 years) than among those who were younger (<10 years). Cumulative brain injury earlier in life (tumor, surgery, plus RT) may result in greater impact on more complex tasks of cognitive efficiency. Children receiving RT showed reduced processing speed over time, with a larger group difference among those who were over 10 years at treatment.
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Affiliation(s)
- Lisa A Jacobson
- a Department of Neuropsychology , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Neuropsychology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - E Mark Mahone
- a Department of Neuropsychology , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Neuropsychology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Keith O Yeates
- c Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute , University of Calgary , Calgary , Canada
| | - M Douglas Ris
- d Department of Pediatrics, Section of Psychology , Texas Children's Hospital , Houston , TX , USA.,e Department of Pediatrics, Section of Psychology , Baylor College of Medicine , Houston , TX , USA
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Raj SP, Narad ME, Salloum R, Platt A, Thompson A, Baum KT, Wade SL. Development of a Web-Based Psychosocial Intervention for Adolescent and Young Adult Survivors of Pediatric Brain Tumor. J Adolesc Young Adult Oncol 2018; 7:187-195. [DOI: 10.1089/jayao.2017.0084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Stacey P. Raj
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- School of Psychology, Xavier University, Cincinnati, Ohio
| | - Megan E. Narad
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ralph Salloum
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Amber Platt
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aimee Thompson
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Shari L. Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
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46
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Scafidi J, Ritter J, Talbot BM, Edwards J, Chew LJ, Gallo V. Age-Dependent Cellular and Behavioral Deficits Induced by Molecularly Targeted Drugs Are Reversible. Cancer Res 2018; 78:2081-2095. [PMID: 29559476 DOI: 10.1158/0008-5472.can-17-2254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/12/2018] [Accepted: 02/09/2018] [Indexed: 11/16/2022]
Abstract
Newly developed targeted anticancer drugs inhibit signaling pathways commonly altered in adult and pediatric cancers. However, as these pathways are also essential for normal brain development, concerns have emerged of neurologic sequelae resulting specifically from their application in pediatric cancers. The neural substrates and age dependency of these drug-induced effects in vivo are unknown, and their long-term behavioral consequences have not been characterized. This study defines the age-dependent cellular and behavioral effects of these drugs on normally developing brains and determines their reversibility with post-drug intervention. Mice at different postnatal ages received short courses of molecularly targeted drugs in regimens analagous to clinical treatment. Analysis of rapidly developing brain structures important for sensorimotor and cognitive function showed that, while adult administration was without effect, earlier neonatal administration of targeted therapies attenuated white matter oligodendroglia and hippocampal neuronal development more profoundly than later administration, leading to long-lasting behavioral deficits. This functional impairment was reversed by rehabilitation with physical and cognitive enrichment. Our findings demonstrate age-dependent, reversible effects of these drugs on brain development, which are important considerations as treatment options expand for pediatric cancers.Significance: Targeted therapeutics elicit age-dependent long-term consequences on the developing brain that can be ameliorated with environmental enrichment. Cancer Res; 78(8); 2081-95. ©2018 AACR.
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Affiliation(s)
- Joseph Scafidi
- Neurology, Children's National Health System, Washington, D.C. .,Center for Neuroscience Research, Children's Research Institute, Children's National Health System, Washington, D.C
| | - Jonathan Ritter
- Center for Neuroscience Research, Children's Research Institute, Children's National Health System, Washington, D.C
| | - Brooke M Talbot
- Center for Neuroscience Research, Children's Research Institute, Children's National Health System, Washington, D.C
| | - Jorge Edwards
- Center for Neuroscience Research, Children's Research Institute, Children's National Health System, Washington, D.C
| | - Li-Jin Chew
- Center for Neuroscience Research, Children's Research Institute, Children's National Health System, Washington, D.C
| | - Vittorio Gallo
- Center for Neuroscience Research, Children's Research Institute, Children's National Health System, Washington, D.C
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47
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Irestorm E, Perrin S, Tonning Olsson I. Pretreatment Cognition in Patients Diagnosed With Pediatric Brain Tumors. Pediatr Neurol 2018; 79:28-33. [PMID: 29249552 DOI: 10.1016/j.pediatrneurol.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/30/2017] [Accepted: 11/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a large body of literature identifying risk factors for the long-term cognitive alterations found in survivors of pediatric brain tumors. Less is known about baseline cognitive functioning in this population, but studies suggest that cognitive dysfunctions are often present at the time of diagnosis. This study aimed to identify potential risk factors for lower cognitive function at the time of pediatric brain tumor diagnosis. METHODS Participants were children and adolescents (n = 101) diagnosed with a pediatric brain tumor between 2006 and 2015, who underwent a pretreatment neuropsychologic assessment. Multivariate regression models were used to estimate the association between gender, age at diagnosis, tumor size and location, increased intracranial pressure, epilepsy, and six different indicators of cognitive functioning. RESULTS Overall, cognitive performance was relatively intact, with results close to norm means, but impairments were found in memory and cognitive processing speed. Male gender, older age, epilepsy, increased intracranial pressure, and larger tumors were all associated with lower cognitive function at the time of brain tumor diagnosis; whereas tumor location was not. CONCLUSIONS Pretreatment neuropsychologic assessments, with some adjustments, can be carried out with children and adolescents with brain tumors. Our study adds to a small but growing body of literature documenting cognitive impairments at the time of diagnosis; these impairments may partly explain the longer-term deficits that commonly occur in pediatric brain tumor survivors. Consistent with previous research, pretreatment impairments were more common among boys, older children, and those with increased intracranial pressure, epilepsy, and larger tumors. The relationship between baseline and longer-term cognitive deficits requires further examination.
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Affiliation(s)
- Elin Irestorm
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden.
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Ingrid Tonning Olsson
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden; Department of Psychology, Lund University, Lund, Sweden
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Benzing V, Eggenberger N, Spitzhüttl J, Siegwart V, Pastore-Wapp M, Kiefer C, Slavova N, Grotzer M, Heinks T, Schmidt M, Conzelmann A, Steinlin M, Everts R, Leibundgut K. The Brainfit study: efficacy of cognitive training and exergaming in pediatric cancer survivors - a randomized controlled trial. BMC Cancer 2018; 18:18. [PMID: 29298678 PMCID: PMC5753470 DOI: 10.1186/s12885-017-3933-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cancer survival comes at a price: pediatric cancer survivors bear a high risk for a wide range of cognitive difficulties. Therefore, interventions targeting these difficulties are required. The aim of the present clinical trial is to extend empirical evidence about efficacy of cognitive and physical training in pediatric cancer survivors. It is hypothesized that early cognitive and physical interventions affect the remediation of pediatric cancer survivors in terms of improved executive functions (primary outcome). Additional positive effects of cognitive and physical intervention to other areas such as memory and attention are expected (secondary outcome). Changes in cognitive performance are expected to be associated with structural and functional changes in the brain. METHODS Overall, 150 pediatric cancer survivors and 50 matched controls will be included in this trial. The cancer survivors will be randomly assigned to either a computerized cognitive training, a physical training (exergaming) or a waiting control group. They will be assessed with neuropsychological tests, tests of sport motor performance and physical fitness before and after 8 weeks of training and again at a 3-months follow-up. Moreover, neuroimaging will be performed at each of the three time points to investigate the training impact on brain structure and function. DISCUSSION With increasing cancer survival rates, evidence-based interventions are of particular importance. New insights into training-related plasticity in the developing brain will further help to develop tailored rehabilitation programs for pediatric cancer survivors. TRIAL REGISTRATION KEK BE 196/15; KEK ZH 2015-0397; ICTRP NCT02749877 ; date of registration: 30.11.2016; date of first participant enrolment: .18.01.2017.
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Affiliation(s)
- Valentin Benzing
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Noëmi Eggenberger
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Janine Spitzhüttl
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Insitute of Psychology, University of Bern, Bern, Switzerland
| | - Valerie Siegwart
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuela Pastore-Wapp
- Division of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claus Kiefer
- Division of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nedelina Slavova
- Division of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Grotzer
- Division of Pediatric Oncology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Theda Heinks
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Achim Conzelmann
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Maja Steinlin
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Center for Cognition, Learning and Memory, CCLM, University of Bern, Bern, Switzerland
| | - Regula Everts
- Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Center for Cognition, Learning and Memory, CCLM, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- Division of Pediatric Hematology and Oncology, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Wegenschimmel B, Leiss U, Veigl M, Rosenmayr V, Formann A, Slavc I, Pletschko T. Do we still need IQ-scores? Misleading interpretations of neurocognitive outcome in pediatric patients with medulloblastoma: a retrospective study. J Neurooncol 2017; 135:361-369. [PMID: 28779461 PMCID: PMC5663794 DOI: 10.1007/s11060-017-2582-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/23/2017] [Indexed: 11/26/2022]
Abstract
Over the past decades, many studies used global outcome measures like the IQ when reporting cognitive outcome of pediatric brain tumor patients, assuming that intelligence is a singular and homogeneous construct. In contrast, especially in clinical neuropsychology, the assessment and interpretation of distinct neurocognitive domains emerged as standard. By definition, the full scale IQ (FIQ) is a score attempting to measure intelligence. It is established by calculating the average performance of a number of subtests. Therefore, FIQ depends on the subtests that are used and the influence neurocognitive functions have on these performances. Consequently, the present study investigated the impact of neuropsychological domains on the singular "g-factor" concept and analysed the consequences for interpretation of clinical outcome. The sample consisted of 37 pediatric patients with medulloblastoma, assessed 0-3 years after diagnosis with the Wechsler Intelligence Scales. Information processing speed and visuomotor function were measured by the Trailmaking Test, Form A. Our findings indicate that FIQ was considerably impacted by processing speed and visuomotor coordination, which leaded to an underestimation of the general cognitive performance of many patients. One year after diagnosis, when patients showed the largest norm-deviation, this effect seemed to be at its peak. As already recommended in international guidelines, a comprehensive neuropsychological test battery is necessary to fully understand cognitive outcome. If IQ-tests are used, a detailed subtest analysis with respect to the impact of processing speed seems essential. Otherwise patients may be at risk for wrong decision making, especially in educational guidance.
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Affiliation(s)
- Barbara Wegenschimmel
- Association for the Promotion of Childhood and Adolescent Neurology, Psychiatry, Psychology and Psychotherapy (kjnp3), Vienna, Austria
| | - Ulrike Leiss
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Michaela Veigl
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Verena Rosenmayr
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | | | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Thomas Pletschko
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
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50
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Willard VW, Conklin HM, Huang L, Zhang H, Kahalley LS. Concordance of parent-, teacher- and self-report ratings on the Conners 3 in adolescent survivors of cancer. Psychol Assess 2017; 28:1110-8. [PMID: 27537005 DOI: 10.1037/pas0000265] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Survivors of childhood cancer are at risk for attention problems. The objectives of this study were to assess concordance between parent-, teacher-, and self-report ratings on a measure of attention (Conners Rating Scales, 3rd ed.; Conners, 2008) in adolescent survivors of childhood cancer and to examine associations with a performance-based task. The Conners 3 was completed by 80 survivors of pediatric cancer (39 brain tumor, 41 acute lymphoblastic leukemia; ages 12–17; at least 1 year posttreatment; 51.3% male) as well as their parents and 1 teacher. In addition, survivors completed a continuous performance test. Parents and teachers demonstrated moderate agreement on most subscales; however, agreement was weaker than would be expected based on the normative sample. Agreement between self- and proxy ratings was more variable. The strongest associations for all raters were observed on the Learning Problems subscale. There were significant mean differences between parent and teacher ratings, with parents reporting more problems across subscales. Only self-ratings of Inattention were significantly associated with the continuous performance test (omission errors). Agreement across raters in assessment of attentional functioning in adolescent survivors of childhood cancer is modest. Findings support the need to obtain multiple ratings of behavior, including both proxy- and self-report, when assessing youth with cancer, particularly adolescents.
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Affiliation(s)
| | | | - Lu Huang
- Department of Biostatistics, St. Jude Children's Research Hospital
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital
| | - Lisa S Kahalley
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine
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