1
|
Mahajan A, Stavinoha PL, Rongthong W, Brodin NP, McGovern SL, El Naqa I, Palmer JD, Vennarini S, Indelicato DJ, Aridgides P, Bowers DC, Kremer L, Ronckers C, Constine L, Avanzo M. Neurocognitive Effects and Necrosis in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:401-416. [PMID: 33810950 DOI: 10.1016/j.ijrobp.2020.11.073] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE A PENTEC review of childhood cancer survivors who received brain radiation therapy (RT) was performed to develop models that aid in developing dose constraints for RT-associated central nervous system (CNS) morbidities. METHODS AND MATERIALS A comprehensive literature search, through the PENTEC initiative, was performed to identify published data pertaining to 6 specific CNS toxicities in children treated with brain RT. Treatment and outcome data on survivors were extracted and used to generate normal tissue complication probability (NTCP) models. RESULTS The search identified investigations pertaining to 2 of the 6 predefined CNS outcomes: neurocognition and brain necrosis. For neurocognition, models for 2 post-RT outcomes were developed to (1) calculate the risk for a below-average intelligence quotient (IQ) (IQ <85) and (2) estimate the expected IQ value. The models suggest that there is a 5% risk of a subsequent IQ <85 when 10%, 20%, 50%, or 100% of the brain is irradiated to 35.7, 29.1, 22.2, or 18.1 Gy, respectively (all at 2 Gy/fraction and without methotrexate). Methotrexate (MTX) increased the risk for an IQ <85 similar to a generalized uniform brain dose of 5.9 Gy. The model for predicting expected IQ also includes the effect of dose, age, and MTX. Each of these factors has an independent, but probably cumulative effect on IQ. The necrosis model estimates a 5% risk of necrosis for children after 59.8 Gy or 63.6 Gy (2 Gy/fraction) to any part of the brain if delivered as primary RT or reirradiation, respectively. CONCLUSIONS This PENTEC comprehensive review establishes objective relationships between patient age, RT dose, RT volume, and MTX to subsequent risks of neurocognitive injury and necrosis. A lack of consistent RT data and outcome reporting in the published literature hindered investigation of the other predefined CNS morbidity endpoints.
Collapse
Affiliation(s)
- Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Peter L Stavinoha
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Warissara Rongthong
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Patrik Brodin
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Susan L McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Joshua D Palmer
- Department of Radiation Oncology, James Cancer Hospital at Ohio State University, Nationwide Children's Hospital, Columbus, Ohio
| | - Sabina Vennarini
- Proton Therapy Center, Azienda Provinciale per I Servizi Sanitari, Trento, Italy
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Paul Aridgides
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel C Bowers
- Division of Pediatric Hematology and Oncology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Leontien Kremer
- Department of Pediatrics, UMC Amsterdam, Location AMC, Amsterdam, the Netherlands; Department of Pediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | - Cecile Ronckers
- Department of Pediatrics, UMC Amsterdam, Location AMC, Amsterdam, the Netherlands; Department of Pediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands; Institute of Biostatistics and Registry Research, Medical University Brandenburg-Theodor Fontane, Neuruppin, Germany
| | - Louis Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Michele Avanzo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| |
Collapse
|
2
|
Srsich AR, McCurdy MD, Fantozzi PM, Hocking MC. Predicting neuropsychological late effects in pediatric brain tumor survivors using the Neurological Predictor Scale and the Pediatric Neuro-Oncology Rating of Treatment Intensity. J Int Neuropsychol Soc 2024; 30:380-388. [PMID: 37746790 DOI: 10.1017/s1355617723000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
OBJECTIVE The Neurological Predictor Scale (NPS) quantifies cumulative exposure to tumor- and treatment-related neurological risks. The Pediatric Neuro-Oncology Rating of Treatment Intensity (PNORTI) measures the intensity of different treatment modalities, but research is needed to establish whether it is associated with late effects. This study evaluated the predictive validity of the NPS and PNORTI for neuropsychological outcomes in pediatric brain tumor survivors. METHOD A retrospective chart review was completed of pediatric brain tumor survivors (PBTS) (n = 161, Mage = 13.47, SD = 2.80) who were at least 2 years from the end of tumor-directed treatment. Attention, intellectual functioning, perceptual reasoning, processing speed, verbal reasoning, and working memory were analyzed in relation to the NPS and PNORTI. RESULTS NPS scores ranged from 1 to 11 (M = 5.57, SD = 2.27) and PNORTI scores ranged from 1 (n = 101; 62.7%) to 3 (n = 18; 11.2%). When controlling for age, sex, SES factors, and time since treatment, NPS scores significantly predicted intellectual functioning [F(7,149) = 12.86, p < .001, R2 = .38] and processing speed [F(7,84) = 5.28, p < .001, R2 = .31]. PNORTI scores did not significantly predict neuropsychological outcomes. CONCLUSIONS The findings suggest that the NPS has value in predicting IF and processing speed above-and-beyond demographic variables. The PNORTI was not associated with neuropsychological outcomes. Future research should consider establishing clinical cutoff scores for the NPS to help determine which survivors are most at risk for neuropsychological late effects and warrant additional assessment.
Collapse
Affiliation(s)
| | | | | | - Matthew C Hocking
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
3
|
Singh S, Joshi V, Upadhyay A. Amyloids and brain cancer: molecular linkages and crossovers. Biosci Rep 2023; 43:BSR20230489. [PMID: 37335084 PMCID: PMC10548166 DOI: 10.1042/bsr20230489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023] Open
Abstract
Amyloids are high-order proteinaceous formations deposited in both intra- and extracellular spaces. These aggregates have tendencies to deregulate cellular physiology in multiple ways; for example, altered metabolism, mitochondrial dysfunctions, immune modulation, etc. When amyloids are formed in brain tissues, the endpoint often is death of neurons. However, interesting but least understood is a close connection of amyloids with another set of conditions in which brain cells proliferate at an extraordinary rate and form tumor inside brain. Glioblastoma is one such condition. Increasing number of evidence indicate a possible link between amyloid formation and depositions in brain tumors. Several proteins associated with cell cycle regulation and apoptotic pathways themselves have shown to possess high tendencies to form amyloids. Tumor suppressor protein p53 is one prominent example that mutate, oligomerize and form amyloids leading to loss- or gain-of-functions and cause increased cell proliferation and malignancies. In this review article, we present available examples, genetic links and common pathways that indicate that possibly the two distantly placed pathways: amyloid formation and developing cancers in the brain have similarities and are mechanistically intertwined together.
Collapse
Affiliation(s)
- Shalini Singh
- Department of Bioscience and Bioengineering, Indian Institute of Technology Jodhpur, Jheepasani, Jodhpur, Rajasthan 342001, India
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, U.S.A
| | - Vibhuti Joshi
- Department of Bioscience and Bioengineering, Indian Institute of Technology Jodhpur, Jheepasani, Jodhpur, Rajasthan 342001, India
- Department of Biotechnology, School of Engineering and Applied Sciences, Bennett University, Greater Noida, Uttar Pradesh 201310, India
| | - Arun Upadhyay
- Department of Bioscience and Bioengineering, Indian Institute of Technology Jodhpur, Jheepasani, Jodhpur, Rajasthan 342001, India
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, U.S.A
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Kautiainen R, Aleksonis H, King TZ. A Systematic Review of Host Genomic Variation and Neuropsychological Outcomes for Pediatric Cancer Survivors. Neuropsychol Rev 2023; 33:278-306. [PMID: 35305234 DOI: 10.1007/s11065-022-09539-2] [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: 05/26/2021] [Accepted: 01/25/2022] [Indexed: 10/18/2022]
Abstract
Pediatric survivors of brain tumors and acute lymphoblastic leukemia (ALL) are at risk for long-term deficits in their neuropsychological functioning. Researchers have begun examining associations between germline single nucleotide polymorphisms (SNPs), which interact with cancer treatment, and neuropsychological outcomes. This review synthesizes the impact of treatment-related toxicity from germline SNPs by neuropsychological domain (i.e., working memory, processing speed, psychological functioning) in pediatric survivors. By focusing on specific neuropsychological domains, this review will examine outcome measurement and critique methodology. Fourteen studies were identified and included in this review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All studies were published in peer-reviewed journals in English by November 24th, 2021. Reviewed studies were not of sufficient quality for a meta-analysis due to varying measurement strategies, gaps in reported descriptive variables, and low power. All neuropsychological domains evaluated in this review had associations with SNPs, except fine motor and visual integration abilities. Only five SNPs had consistent neuropsychological findings in more than one study or cohort. Future research and replication studies should use validated measures of discrete skills that are central to empirically validated models of survivors' long-term outcomes (i.e., attention, working memory, processing speed). Researchers should examine SNPs across pathophysiological pathways to investigate additive genetic risk in pediatric cancer survivors. Two SNPs were identified that confer resiliency in neuropsychological functioning, and future work should investigate resiliency genotypes and their underlying biological mechanisms.
Collapse
Affiliation(s)
- Rella Kautiainen
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Holly Aleksonis
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Tricia Z King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, Georgia.
| |
Collapse
|
6
|
Weiler-Wichtl LJ, Fries J, Fohn-Erhold V, Schwarzinger A, Holzer AE, Pletschko T, Furtner-Srajer J, Prayer D, Bär P, Slavc I, Peyrl A, Azizi A, Hansl R, Leiss U. Initial Evidence for Positive Effects of a Psychological Preparation Program for MRI "iMReady" in Children with Neurofibromatosis Type I and Brain Tumors-How to Meet the Patients' Needs Best. J Clin Med 2023; 12:jcm12051902. [PMID: 36902689 PMCID: PMC10003409 DOI: 10.3390/jcm12051902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/08/2023] Open
Abstract
To provide an effective alternative to sedation during MRI examinations in pediatric cancer and NF1 patients, the aims of the present study were to (1) exploratively evaluate a behavioral MRI training program, to (2) investigate potential moderators, as well as to (3) assess the patients' well-being over the course of the intervention. A total of n = 87 patients of the neuro-oncology unit (mean age: 6.83 years) underwent a two-step MRI preparation program, including training inside the scanner, and were recorded using a process-oriented screening. In addition to the retrospective analysis of all data, a subset of 17 patients were also analyzed prospectively. Overall, 80% of the children receiving MRI preparation underwent the MRI scan without sedation, making the success rate almost five times higher than that of a group of 18 children that opted out of the training program. Memory, attentional difficulties, and hyperactivity were significant neuropsychological moderators for successful scanning. The training was associated with favorable psychological well-being. These findings suggest that our MRI preparation could present an alternative to sedation of young patients undergoing MRI examinations as well as a promising tool for improving patients' treatment-related well-being.
Collapse
Affiliation(s)
- Liesa Josephine Weiler-Wichtl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-34262
| | - Jonathan Fries
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Verena Fohn-Erhold
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Agathe Schwarzinger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Angelika Elisabeth Holzer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Interdisciplinary Follow-Up Clinic for Childhood Cancer Survivors (IONA), Österreichische Gesundheitskasse (ÖGK), 1060 Vienna, Austria
| | - Thomas Pletschko
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Julia Furtner-Srajer
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniela Prayer
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Paul Bär
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Amedeo Azizi
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Rita Hansl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Ulrike Leiss
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| |
Collapse
|
7
|
Peterson RK, Jacobson LA. Changes in executive function in pediatric brain tumor survivors. Pediatr Blood Cancer 2022; 69:e29483. [PMID: 34842333 DOI: 10.1002/pbc.29483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pediatric oncology survivors are at risk for executive function (EF) and working memory (WM) deficits, which can be measured via performance-based measures or rating scales. Previous studies have shown these measurement methods to be weakly correlated. This study aimed to describe parent-rated EF and performance-based WM (PBWM) in pediatric brain tumor (BT) survivors, examine change in EF and PBWM across time, and investigate the relationship between parent-rated WM and PBWM. METHOD The sample included 56 patients diagnosed with a BT in childhood (Mage = 6.94 years; SD = 4.05) seen twice for clinical neuropsychological evaluation. PBWM was examined via the auditory WM scale from a Wechsler intelligence measure or Differential Ability Scales-II. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF)/BRIEF-P/BRIEF-2 as a measure of global EF (Global Executive Composite [GEC]), metacognitive skills (Metacognitive Index/Cognitive Regulation Index [MI/CRI]), behavioral regulation (Behavior Regulation Index [BRI]), and emotional regulation (Emotion Regulation Index [ERI]). RESULTS GEC, MI/CRI, and ERI at Time 1 were significantly above the mean (p < .01); BRI and PBWM did not differ from the normative mean. All measures were significantly higher than the normative mean at Time 2 (p < .05). PBWM was both clinically and statistically elevated (p < .001). There was a significant change across time in PBWM (p < .05), but not GEC, MI/CRI, ERI, or BRI. PBWM was weakly correlated with the BRIEF WM subscale at Time 1 and Time 2 (all p > .05). CONCLUSIONS Multiple measures of EF should be considered when providing diagnoses and recommendations for pediatric BT survivors. Furthermore, given declines across time, findings document need for continued monitoring and reassessment of survivors as they get further out from treatment.
Collapse
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
| | - 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
| |
Collapse
|
8
|
Stavinoha PL, Trinh-Wong T, Rodriguez LN, Stewart CM, Frost K. Educational Pain Points for Pediatric Brain Tumor Survivors: Review of Risks and Remedies. CHILDREN 2021; 8:children8121125. [PMID: 34943320 PMCID: PMC8700207 DOI: 10.3390/children8121125] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/29/2023]
Abstract
Evolving treatment paradigms have led to increased survival rates for children diagnosed with a brain tumor, and this has increasingly shifted clinical and research focus to morbidity and quality of life among survivors. Among unfavorable outcomes, survivors of pediatric brain tumors are at risk for academic failure and low educational attainment, which may then contribute to lower health related quality of life, lower income and vocational status, and a greater likelihood of dependence on others in adulthood. Several specific risk factors for lower educational performance and attainment have been investigated. These are typically examined in isolation from one another which clouds understanding of the full range and potential interplay of contributors to educational difficulties. This review integrates and summarizes what is known about the direct and indirect barriers to educational success and performance (i.e., educational pain points) to enhance clinician knowledge of factors to consider when working with pediatric brain tumor survivors. Specific barriers to educational success include neurocognitive difficulties, school absences, psychosocial challenges, challenges to knowledge and communication, and physical and sensory difficulties. Finally, we discuss the current state of educational interventions and supports and offer recommendations for future research to improve educational outcomes for pediatric brain tumor survivors.
Collapse
|
9
|
Fox ME, Turner JA, Crosson B, Morris RD, King TZ. Functional Connectivity Networks and Their Recruitment During Working Memory Tasks in Adult Survivors of Childhood Brain Tumors. Brain Connect 2021; 11:822-837. [PMID: 33858201 DOI: 10.1089/brain.2020.0800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Assessments of functional connectivity of default mode network (DMN) and positive task-related networks (TRNs) using independent component analysis (ICA) may help describe long-term effects of childhood brain tumors and adjuvant treatments. Methods: Aiming to identify potential neuronal markers that may aid in prognosis and inform interventions to optimize outcomes, this study used ICA to evaluate the presence of functional connectivity networks and their recruitment during a letter n-back task in 23 adult survivors of childhood posterior fossa tumors (9 low grade, 14 high grade) at least 5 years past diagnosis compared with 40 age- and sex-matched healthy peers. Results: DMN components generally demonstrated increasing disengagement as task difficulty increased, and relationships between effective DMN disengagement and improved performance were observed in healthy controls (HCs). Low-grade brain tumor survivors (LGS) demonstrated unique patterns in DMN recruitment that suggested increased involvement of the medial prefrontal cortex in LGS during tasks. TRN components generally demonstrated increasing engagement, which was related to improved task performance in HCs for one executive control network (ECN) component. High-grade brain tumor survivors (HGS) demonstrated distinct challenges recruiting an ECN component at more difficult task levels and showed a relationship between recruitment of another ECN component and task performance, indicating a potential compensatory mechanism for some HGS. Conclusions: Findings suggest the importance of cognitive intervention in both survivor groups and the necessity to track LGS despite their cognitive abilities often resembling those of their healthy peers. Impact statement Distinct functional connectivity patterns were identified between both adult survivor of childhood brain tumor groups and peers during attention and working memory tasks, reflecting different damage and recovery from treatment. Survivors of low-grade tumors demonstrated unique patterns of recruitment of default mode network components in the context of similar cognitive abilities, whereas survivors of high-grade tumors demonstrated poorer cognitive abilities and may be utilizing compensatory executive control network components in the face of challenging tasks. Long-term clinical follow-up and cognitive remediation is warranted for both groups, including low grade cerebellar tumor patients who have traditionally not been monitored as closely.
Collapse
Affiliation(s)
- Michelle E Fox
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Jessica A Turner
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
| | - Bruce Crosson
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA.,Departments of Neurology and of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Center of Excellence for Visual and Neurocognitive Rehabilitation, Decatur, Georgia, USA
| | - Robin D Morris
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
| | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Neuroscience Institute, Georgia State University, Atlanta, Georgia, USA
| |
Collapse
|
10
|
Willard VW, Gordon ML, Means B, Brennan RC, Conklin HM, Merchant TE, Vinitsky A, Harman JL. Social–Emotional Functioning in Preschool-Aged Children With Cancer: Comparisons Between Children With Brain and Non-CNS Solid Tumors. J Pediatr Psychol 2021; 46:790-800. [DOI: 10.1093/jpepsy/jsab018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/31/2022] Open
Abstract
Abstract
Objectives
The preschool years (ages 4–6) are essential for the development of social–emotional skills, such as problem solving, emotion regulation, and conflict resolution. For children with cancer treated during this period, especially those with brain tumors, there are questions regarding the consequences of missed normative social experiences. The objective of this pilot study was to explore the social–emotional functioning of young children with brain tumors, as compared to those with non-CNS solid tumors, who have recently completed treatment.
Methods
Children with brain (n = 23) or solid tumors (n = 20) 4–6 years of age (5.42 ± 0.73 years; 60.5% male, 65.1% white) who were 8.21 (SD = 2.42) months post-treatment completed objective measures (Challenging Situations Task, NEPSY-II) of social functioning while a caregiver completed questionnaires (e.g., BASC-3, NIH Toolbox Emotion Measures).
Results
A large portion of the sample (brain tumor: 65.2%, solid tumor: 44.4%) fell in the clinical range on parent-report measures of peer interaction. There were no statistically significant differences between patient groups across measures, but effect sizes suggest youth with brain tumors potentially experienced more difficulties on some indices. All children were more likely to choose prosocial responses when presented with a challenging social situation where they were physically provoked (e.g., hit) versus socially provoked (e.g., left out).
Conclusions
Preschool-aged children with cancer may experience weaknesses in social functioning shortly after treatment, with youth with brain tumors potentially demonstrating greater concerns. Emphasizing social interaction is critical to ensure young children have the opportunity to develop critical social–emotional skills.
Collapse
Affiliation(s)
- Victoria W Willard
- Departments of Psychology, Oncology, & Radiation Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Mallorie L Gordon
- Departments of Psychology, Oncology, & Radiation Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Bethany Means
- Departments of Psychology, Oncology, & Radiation Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Rachel C Brennan
- Departments of Psychology, Oncology, & Radiation Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Heather M Conklin
- Departments of Psychology, Oncology, & Radiation Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Thomas E Merchant
- Departments of Psychology, Oncology, & Radiation Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Anna Vinitsky
- Departments of Psychology, Oncology, & Radiation Oncology, St Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer L Harman
- Departments of Psychology, Oncology, & Radiation Oncology, St Jude Children’s Research Hospital, Memphis, TN
| |
Collapse
|
11
|
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]
|
12
|
Siciliano RE, Thigpen JC, Desjardins L, Cook JL, Steele EH, Gruhn MA, Ichinose M, Park S, Esbenshade AJ, Pastakia D, Wellons JC, Compas BE. Working memory training in pediatric brain tumor survivors after recent diagnosis: Challenges and initial effects. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:412-421. [PMID: 33501845 DOI: 10.1080/21622965.2021.1875226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Research shows promise for cognitive interventions for children diagnosed with brain tumors. Interventions have been delivered approximately 5 years postdiagnosis on average, yet recent evidence shows cognitive deficits may appear near diagnosis. The present study assessed the feasibility and initial effects of working memory training in children with brain tumors delivered soon after diagnosis and followed 2 years postdiagnosis. Children completed baseline assessments 10 months postdiagnosis and were randomized to complete adaptive or nonadaptive (i.e., control) Cogmed Working Memory Training. Children were administered the WISC-IV Working Memory Index (WMI) and NIH Toolbox Cognitive Battery (NTCB), and parents completed attentional and executive function measures at four time points. On average, participants completed half of prescribed Cogmed sessions. Retention for the three follow-up assessments proved difficult. For both Cogmed groups, WMI and NTCB scores significantly improved immediately postintervention compared to baseline scores. Significant differences were not maintained at the remaining follow-ups. There was preliminary evidence for improved executive function at the final follow-up on parent-reported measures. Working memory training closer to diagnosis proved difficult, though results suggest evidence of cognitive improvement. Future studies should continue to examine potentially efficacious interventions for children with brain tumors and optimal delivery windows to maximize impact.
Collapse
Affiliation(s)
- Rachel E Siciliano
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Jennifer C Thigpen
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Leandra Desjardins
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Ellen H Steele
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Meredith A Gruhn
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Megan Ichinose
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Adam J Esbenshade
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Devang Pastakia
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John C Wellons
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| |
Collapse
|
13
|
Pauly-Takacs K, Moulin CJA. Retained ability to extract gist in childhood-acquired amnesia: Insights from a single case. Neurocase 2020; 26:156-166. [PMID: 32420799 DOI: 10.1080/13554794.2020.1766081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This paper presents the performance of a young amnesic person (CJ) in the DRM task. CJ was found to be sensitive to the DRM manipulation at a level comparable to controls in recognition and at a level higher than controls in free recall. Detailed analyses of recall intrusions lent further support to the finding that CJ is able to extract gist on the basis of semantic associations. Results are discussed with reference to relevant theory as well as the potential role of an impaired and immature cognitive system in adopting a semantic gist strategy in the absence of episodic memory.
Collapse
Affiliation(s)
- Kata Pauly-Takacs
- Leeds School of Social Sciences, Leeds Beckett University , Leeds, UK
| | - Chris J A Moulin
- Laboratoire De Psychologie Et NeuroCognition, UMR 5105, Université Grenoble Alpes , Grenoble, France.,Institute Universitaire De France , France
| |
Collapse
|
14
|
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.
Collapse
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.
| | | |
Collapse
|
15
|
Olivier TW, Bass JK, Ashford JM, Beaulieu R, Scott SM, Schreiber JE, Palmer S, Mabbott DJ, Swain MA, Bonner M, Boyle R, Chapeiski ML, Evankovich KD, Armstrong CL, Knight SJ, Wu S, Onar-Thomas A, Gajjar A, Conklin HM. Cognitive Implications of Ototoxicity in Pediatric Patients With Embryonal Brain Tumors. J Clin Oncol 2019; 37:1566-1575. [PMID: 31046551 PMCID: PMC6599406 DOI: 10.1200/jco.18.01358] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Sensorineural hearing loss (SNHL) is associated with intellectual and academic declines in children treated for embryonal brain tumors. This study expands upon existing research by examining core neurocognitive processes that may result in reading difficulties in children with treatment-related ototoxicity. PATIENTS AND METHODS Prospectively gathered, serial, neuropsychological and audiology data for 260 children and young adults age 3 to 21 years (mean, 9.15 years) enrolled in a multisite research and treatment protocol, which included surgery, risk-adapted craniospinal irradiation (average risk, n = 186; high risk, n = 74), and chemotherapy, were analyzed using linear mixed models. Participants were assessed at baseline and up to 5 years after diagnosis and grouped according to degree of SNHL. Included were 196 children with intact hearing or mild to moderate SNHL (Chang grade 0, 1a, 1b, or 2a) and 64 children with severe SNHL (Chang grade 2b or greater). Performance on eight neurocognitive variables targeting reading outcomes (eg, phonemics, fluency, comprehension) and contributory cognitive processes (eg, working memory, processing speed) was analyzed. RESULTS Participants with severe SNHL performed significantly worse on all variables compared with children with normal or mild to moderate SNHL (P ≤ .05), except for tasks assessing awareness of sounds and working memory. Controlling for age at diagnosis and risk-adapted craniospinal irradiation dose, performance on the following four variables remained significantly lower for children with severe SNHL: phonemic skills, phonetic decoding, reading comprehension, and speed of information processing (P ≤ .05). CONCLUSION Children with severe SNHL exhibit greater reading difficulties over time. Specifically, they seem to struggle most with phonological skills and processing speed, which affect higher level skills such as reading comprehension.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Michelle A Swain
- 4 Royal Children's Hospital Brisbane, Herston, Queensland, Australia
| | | | - Robyn Boyle
- 6 Sydney Children's Hospital, Randwick, New South Wales, Australia
| | | | | | | | - Sarah J Knight
- 8 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Shengjie Wu
- 1 St Jude Children's Research Hospital, Memphis, TN
| | | | - Amar Gajjar
- 1 St Jude Children's Research Hospital, Memphis, TN
| | | |
Collapse
|
16
|
Loughan AR, Braun SE, Lanoye A. Executive dysfunction in neuro-oncology: Behavior Rating Inventory of Executive Function in adult primary brain tumor patients. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:393-402. [PMID: 30714410 DOI: 10.1080/23279095.2018.1553175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adult primary brain tumor (PBT) survivors report persistent cognitive difficulties before, during, and after treatment, which are problematic for everyday functioning. Cognitive domains often affected by cancer treatment appear to be attention and executive functioning (EF). One validated measure developed to assess an individual's EF within daily living is the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A). To date, no published research has investigated the EF profile of PBT patients using the BRIEF-A. Seventy-four PBT patients completed the BRIEF-A. Descriptive analyses were conducted to determine the self-reported EF profile in PBT patients. T-tests preliminarily compared the performance of PBT patients to four other comparison groups: mild cognitive impairment (MCI; n = 23), attention-deficit/hyperactivity disorder-unmedicated (ADHD-U; n = 27), traumatic brain injury (TBI; n = 23), and healthy controls (HC; n = 26). PBT BRIEF-A group means were average across subscales and indexes, yet the prevalence of significant elevations ranged from 12 to 50%. The Metacognition Index demonstrated 38% elevation prevalence compared to 22% in Behavioral Regulation. Approximately 61% of the sample had at least one clinically elevated scaled score. PBT patients reported significantly more EF impairment than HC and significantly less than ADHD-U. No significant differences were found between the PBT and MCI groups or PBT and TBI groups. Despite group means not reaching clinical impairment, a substantial proportion of patients with PBTs endorse executive dysfunction. Elevations were most prominent in metacognitive abilities over behavioral dysregulation. Notably, the EF profile of PBT patients was remarkably similar to that of MCI and TBI, increased when compared to HC, and well below ADHD-U.
Collapse
Affiliation(s)
- Ashlee R Loughan
- Department of Neurology Division of Neuro-oncology, Virginia Commonwealth University and Massey Cancer Center McGlothlin Medical Education Center, Richmond, Virginia, USA
| | - Sarah E Braun
- Department of Neurology Division of Neuro-oncology, Virginia Commonwealth University and Massey Cancer Center McGlothlin Medical Education Center, Richmond, Virginia, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Autumn Lanoye
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| |
Collapse
|
17
|
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.
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
Peterson RK, Katzenstein JM. Working memory and processing speed among pediatric brain tumor patients treated with photon or proton beam radiation therapy. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1510330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rachel K. Peterson
- Psychology Department, The Hospital for Sick Children, Toronto, ON, Canada
| | | |
Collapse
|
20
|
Harman JL, Molnar AE, Cox LE, Jurbergs N, Russell KM, Wise J, Willard VW. Parent-reported executive functioning in young children treated for cancer. Child Neuropsychol 2018; 25:548-560. [DOI: 10.1080/09297049.2018.1503647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jennifer L. Harman
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Andrew E. Molnar
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Lauren E. Cox
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Niki Jurbergs
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kathryn M. Russell
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jillian Wise
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Victoria W. Willard
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| |
Collapse
|
21
|
Conklin HM, Ashford JM, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, Ogg RJ, Jeha S, Huang L, Zhang H. Long-Term Efficacy of Computerized Cognitive Training Among Survivors of Childhood Cancer: A Single-Blind Randomized Controlled Trial. J Pediatr Psychol 2017; 42:220-231. [PMID: 27342301 DOI: 10.1093/jpepsy/jsw057] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/27/2016] [Indexed: 11/12/2022] Open
Abstract
Objective To investigate the long-term efficacy of computerized cognitive training in improving cognitive outcomes among childhood cancer survivors. Methods Sixty-eight survivors of childhood acute lymphoblastic leukemia (ALL) or brain tumor (BT) were randomly assigned to computerized cognitive intervention (23 ALL/11 BT, age = 12.21 ± 2.47) or a waitlist control group (24 ALL/10 BT, age = 11.82 ± 2.42). Cognitive assessments were completed pre-, immediately post-, and 6 months postintervention. Results A prior report showed training led to immediate improvement in working memory, attention and processing speed. In the current study, piecewise linear mixed effects modeling revealed that working memory and processing speed were unchanged from immediate to 6 months postintervention (intervention β = -.04 to .01, p = .26 to .95; control β = -.06 to .01, p = .23-.97), but group differences on an attention measure did not persist. Conclusion Cognitive benefits are maintained 6 months following computerized cognitive training, adding to potential clinical utility of this intervention approach.
Collapse
Affiliation(s)
- Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jason M Ashford
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kellie N Clark
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Kristina K Hardy
- Neuropsychology Division, Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC, USA.,Department of Psychiatry and Behavioral Science, George Washington University School of Medicine, Washington, DC, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Robert J Ogg
- Division of Translational Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lu Huang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| |
Collapse
|
22
|
Desjardins L, Thigpen JC, Kobritz M, Bettis AH, Gruhn MA, Ichinose M, Hoskinson K, Fraley C, Vreeland A, McNally C, Compas BE. Parent reports of children's working memory, coping, and emotional/behavioral adjustment in pediatric brain tumor patients: A pilot study. Child Neuropsychol 2017; 24:959-974. [PMID: 28969482 DOI: 10.1080/09297049.2017.1365828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neurocognitive problems in childhood survivors of brain tumors are well documented. Further, research has shown that problems in cognitive functioning may be associated with impairment in the use of complex strategies needed to cope with stress, including secondary control coping strategies (e.g., acceptance and cognitive reappraisal) which have been associated with fewer adjustment problems. The present study measured cognitive function, coping strategies, and adjustment in children ages 6-16 years at the time of brain tumor diagnosis and at two follow-up time-points up to 1 year post-diagnosis. In a prospective design, working memory was assessed in a total of 29 pediatric brain tumor patients prior to undergoing surgery, child self-reported coping was assessed at 6 months post-diagnosis, and parent-reported child adjustment was assessed at 12 months post-diagnosis. Significant correlations were found between working memory difficulties and secondary control coping. Secondary control coping was also negatively correlated with child attention and total problems. Regression analyses did not support secondary control coping mediating the association between working memory difficulties and child attention or total problems. These findings represent the first longitudinal assessment of the association between working memory, coping, and adjustment across the first year of a child's brain tumor diagnosis and suggest a possible role for early interventions addressing both working memory difficulties and coping in children with brain tumors.
Collapse
Affiliation(s)
- Leandra Desjardins
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Jennifer C Thigpen
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Molly Kobritz
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Alexandra H Bettis
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Meredith A Gruhn
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Megan Ichinose
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Kristen Hoskinson
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Claire Fraley
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Allison Vreeland
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Colleen McNally
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| | - Bruce E Compas
- a Department of Psychology & Human Development , Vanderbilt University , Nashville , TN , USA
| |
Collapse
|
23
|
Raghubar KP, Mahone EM, Yeates KO, Cecil KM, Makola M, Ris MD. [Formula: see text]Working memory and attention in pediatric brain tumor patients treated with and without radiation therapy. Child Neuropsychol 2017; 23:642-654. [PMID: 27225618 PMCID: PMC5124420 DOI: 10.1080/09297049.2016.1183608] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children are at risk for cognitive difficulties following the diagnosis and treatment of a brain tumor. Longitudinal studies have consistently demonstrated declines on measures of intellectual functioning, and recently it has been proposed that specific neurocognitive processes underlie these changes, including working memory, processing speed, and attention. However, a fine-grained examination of the affected neurocognitive processes is required to inform intervention efforts. Radiation therapy (RT) impacts white matter integrity, likely affecting those cognitive processes supported by distributed neural networks. This study examined working memory and attention in children during the early delayed stages of recovery following surgical resection and RT. The participants included 27 children diagnosed with pediatric brain tumor, treated with (n = 12) or without (n = 15) RT, who completed experimental and standardized measures of working memory and attention (n-back and digit span tasks). Children treated with radiation performed less well than those who did not receive radiation on the n-back measure, though performance at the 0-back level was considerably poorer than would be expected for both groups, perhaps suggesting difficulties with more basic processes such as vigilance. Along these lines, marginal differences were noted on digit span forward. The findings are discussed with respect to models of attention and working memory, and the interplay between the two.
Collapse
Affiliation(s)
- Kimberly P. Raghubar
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - E. Mark Mahone
- Department of Neuropsychology, Kennedy Krieger Institute and Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Kim M. Cecil
- Cincinnati Department of Radiology, Children’s Hospital Medical Center, OH, USA
| | - Monwabisi Makola
- Cincinnati Department of Radiology, Children’s Hospital Medical Center, OH, USA
| | - M. Douglas Ris
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| |
Collapse
|
24
|
Profiles of Executive Function Across Children with Distinct Brain Disorders: Traumatic Brain Injury, Stroke, and Brain Tumor. J Int Neuropsychol Soc 2017; 23:529-538. [PMID: 28502261 DOI: 10.1017/s1355617717000364] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study examined whether children with distinct brain disorders show different profiles of strengths and weaknesses in executive functions, and differ from children without brain disorder. METHODS Participants were children with traumatic brain injury (N=82; 8-13 years of age), arterial ischemic stroke (N=36; 6-16 years of age), and brain tumor (N=74; 9-18 years of age), each with a corresponding matched comparison group consisting of children with orthopedic injury (N=61), asthma (N=15), and classmates without medical illness (N=68), respectively. Shifting, inhibition, and working memory were assessed, respectively, using three Test of Everyday Attention: Children's Version (TEA-Ch) subtests: Creature Counting, Walk-Don't-Walk, and Code Transmission. Comparison groups did not differ in TEA-Ch performance and were merged into a single control group. Profile analysis was used to examine group differences in TEA-Ch subtest scaled scores after controlling for maternal education and age. RESULTS As a whole, children with brain disorder performed more poorly than controls on measures of executive function. Relative to controls, the three brain injury groups showed significantly different profiles of executive functions. Importantly, post hoc tests revealed that performance on TEA-Ch subtests differed among the brain disorder groups. CONCLUSIONS Results suggest that different childhood brain disorders result in distinct patterns of executive function deficits that differ from children without brain disorder. Implications for clinical practice and future research are discussed. (JINS, 2017, 23, 529-538).
Collapse
|
25
|
Carlson-Green B, Puig J, Bendel A. Feasibility and efficacy of an extended trial of home-based working memory training for pediatric brain tumor survivors: a pilot study. Neurooncol Pract 2017; 4:111-120. [PMID: 31385985 PMCID: PMC6655366 DOI: 10.1093/nop/npw015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Impaired working memory appears to play a key role in some of the neurocognitive late effects of pediatric brain tumor treatments, including declines in intellectual and executive functioning. Recent studies of pediatric cancer survivors suggest Cogmed® Working Memory Training is effective at improving working memory, although pediatric brain tumor survivors may demonstrate a less robust response than children with other cancers. The current study sought to determine if an extended course of Cogmed (35 sessions) was both feasible and efficacious for brain tumor survivors and if improvements were observable in near-transfer and far-transfer working memory measures as well as parent rating scores at 6 months post-treatment. METHODS Twenty pediatric brain tumor survivors ages 8 to 18 years with working memory deficits completed 35 sessions of Cogmed. Assessments of working memory and academic skills were completed at baseline, completion of training, and 6-month follow-up and parents completed questionnaires at baseline and 6-month follow-up. RESULTS Participants showed significant improvements in working memory at training completion and 6-month follow-up and math achievement at 6-month follow-up. Parents reported executive functioning improvements at follow-up as compared with baseline. Participants' program-based working memory skills did not change significantly between sessions 25 and 35, suggesting that extended training did not provide additional benefit. CONCLUSIONS This study replicates and extends previous research by: (1) demonstrating that brain tumor survivors at high risk for neurocognitive late effects can complete and benefit from working memory training, (2) identifying a point of diminished returns on training time investment, and (3) demonstrating benefits 6 months post-intervention.
Collapse
Affiliation(s)
- Bonnie Carlson-Green
- Psychological Services (B.C.-G), Cancer and Blood Disorders Clinic at Children's of Minnesota, Children's Hospitals & Clinics of Minnesota, 345 North Smith Avenue, St Paul, MN 55102 (A.B); University of Minnesota, Division of Clinical Neuroscience, 2512 S. 7th St., Minneapolis, MN 55454 (J.P)
| | - Jennifer Puig
- Psychological Services (B.C.-G), Cancer and Blood Disorders Clinic at Children's of Minnesota, Children's Hospitals & Clinics of Minnesota, 345 North Smith Avenue, St Paul, MN 55102 (A.B); University of Minnesota, Division of Clinical Neuroscience, 2512 S. 7th St., Minneapolis, MN 55454 (J.P)
| | - Anne Bendel
- Psychological Services (B.C.-G), Cancer and Blood Disorders Clinic at Children's of Minnesota, Children's Hospitals & Clinics of Minnesota, 345 North Smith Avenue, St Paul, MN 55102 (A.B); University of Minnesota, Division of Clinical Neuroscience, 2512 S. 7th St., Minneapolis, MN 55454 (J.P)
| |
Collapse
|
26
|
Taiwo Z, Na S, King TZ. The Neurological Predictor Scale: A predictive tool for long-term core cognitive outcomes in survivors of childhood brain tumors. Pediatr Blood Cancer 2017; 64:172-179. [PMID: 27566994 DOI: 10.1002/pbc.26203] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Prior research has demonstrated the reliability and validity of the Neurological Predictor Scale (NPS) in relation to intelligence and adaptive functioning in survivors of pediatric brain tumors. To extend these findings, this study examined the relationship between the NPS and core neurocognitive skills hypothesized to underlie broad outcome measures of IQ and adaptive functioning. METHOD Sixty-one adulthood survivors of childhood brain cancers (Mage = 24 years, SD = 6) on average 16 years after diagnosis completed neuropsychological assessments examining attention (Wechsler Memory Scale Digit Span Forward), processing speed (Symbol Digit Modalities Test), and working memory (Auditory Consonant Trigrams). The medical information necessary to compute the NPS was extracted from a thorough medical record review. RESULTS The NPS score significantly predicted processing speed (R2 = 0.28, P < 0.05) and working memory (R2 = 0.15, P < .05) outcomes over and above each individual risk factor. NPS was significantly associated with attention outcomes after covarying for age (R2 = 0.13, P < 0.05) over and above each risk factor except presence of hormone deficiency, hydrocephalus, and chemotherapy. These three variables were not significantly associated with attention outcomes in this sample. CONCLUSIONS Our findings suggest that survivors with more treatments and neurological sequelae experience greater deficits in working memory, processing speed, and attention. Further, the NPS affords the ability to predict how cumulative neurological factors impact core cognitive outcomes many years after initial diagnosis.
Collapse
Affiliation(s)
- Zinat Taiwo
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Sabrina Na
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, Georgia.,Neuroscience Institute, Georgia State University, Atlanta, Georgia
| |
Collapse
|
27
|
Cognitive outcomes among survivors of focal low-grade brainstem tumors diagnosed in childhood. J Neurooncol 2016; 129:311-7. [PMID: 27311729 DOI: 10.1007/s11060-016-2176-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/04/2016] [Indexed: 10/21/2022]
Abstract
Pediatric focal low-grade brainstem tumors are associated with excellent prognosis. Surgical resection and conformal radiation therapy are front-line treatment options; radiation therapy (RT) serves as an excellent treatment for disease progression. Given high survival rates and limited research regarding functional outcomes, the current study examined neurocognitive outcomes in a group of low-grade brainstem glioma survivors. Forty-three survivors of focal low-grade brainstem gliomas underwent neurocognitive assessment (58 % male; median = 6.9 years at diagnosis; median = 14.9 years at latest assessment). Treatment included combinations of surgery, chemotherapy, and RT with 70 % ultimately receiving RT. Neurocognitive outcomes were evaluated through retrospective chart review. Intellectual and academic performance were significantly different from normative expectations (full scale IQ = 86.5 ± 16.8; reading comprehension = 91.3 ± 16.4; math reasoning = 88.2 ± 18.9; reference group = 100 ± 15). Further, the percentage performing below average exceeded the expected 16 % in the normative sample (full scale IQ = 43 %; reading comprehension = 37 %; math reasoning = 50 %). Mean parent ratings did not reflect concerns regarding internalizing and externalizing behaviors or executive functioning (internalizing = 54.9 ± 12.7; externalizing = 51.6 ± 14.6, global executive composite = 57.1 ± 16.0; reference group = 50 ± 10); however, the proportion with clinically elevated scores was higher than the expected 16 % (internalizing = 42 %; externalizing = 26 %; global executive composite = 38 %). Mean performance fell below average for visual-motor coordination (81.8 ± 13.2) and parent ratings of adaptive functioning (73.4 ± 24.2), with 65 and 62 % falling outside the average range, respectively. There were no significant differences between those receiving and not receiving RT. Multiple cognitive domains were significantly different from normative expectations. Despite focal disease and treatment targeting subcortical brain regions, neurocognitive risks exist that may impact treatment planning and caregiver education.
Collapse
|
28
|
Netson KL, Ashford JM, Skinner T, Carty L, Wu S, Merchant TE, Conklin HM. Executive dysfunction is associated with poorer health-related quality of life in pediatric brain tumor survivors. J Neurooncol 2016; 128:313-21. [PMID: 27033060 DOI: 10.1007/s11060-016-2113-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
Abstract
Children with a brain tumor (BT) are at risk for a number of physical and cognitive problems that may lower their health-related quality of life (HRQoL). Executive functioning (EF) and intellectual ability are hypothesized to associate with HRQoL and deficits in these areas may be amenable to interventions. This study aimed to investigate intellectual function, EF, and HRQoL following conformal radiation therapy (CRT) for pediatric BT. Forty-five BT survivors (age 12.68 ± 2.56) treated with CRT participated. Thirty-six siblings of BT patients (age 12.36 ± 2.13) and 33 survivors of non-CNS solid tumors (ST; age 12.18 ± 2.88) were comparison groups. IQ estimate (Wechsler Abbreviated Scale of Intelligence; WASI), EF ratings (Behavior Rating Inventory of Executive Function; BRIEF), and HRQoL ratings (KINDL-R) were obtained. BT survivors reported lower overall HRQoL than ST survivors (p = .012). Parents reported lower overall HRQoL for BT survivors than siblings (p = .014). Parent-report on individual areas of HRQoL was higher than self-report for most subscales. IQ and HRQoL ratings were not related (Parent r = .17, p = .27; Child r = .11, p = .49). EF ratings correlated with Parent (r = -.15 to -.73) but not Child HRQoL ratings. Children with BT experienced poorer HRQoL than controls. Children's HRQoL was consistently rated higher by parent- than self-report across all domains. HRQoL was associated with EF, but not with IQ. These findings identify interventions targeting EF (e.g., cognitive rehabilitation, medication) as a possible avenue for improving HRQoL in childhood BT survivors.
Collapse
Affiliation(s)
- Kelli L Netson
- Department of Psychiatry & Behavioral Sciences, KU School of Medicine-Wichita, Wichita, KS, USA
| | - Jason M Ashford
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Shengjie Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| |
Collapse
|
29
|
Roddy E, Mueller S. Late Effects of Treatment of Pediatric Central Nervous System Tumors. J Child Neurol 2016; 31:237-54. [PMID: 26045296 DOI: 10.1177/0883073815587944] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/21/2015] [Indexed: 12/18/2022]
Abstract
Central nervous system tumors represent the most common solid malignancy in childhood. Improvement in treatment approaches have led to a significant increase in survival rates, with over 70% of children now surviving beyond 5 years. As more and more children with CNS tumors have longer survival times, it is important to be aware of the long-term morbidities caused not only by the tumor itself but also by tumor treatment. The most common side effects including poor neurocognition, endocrine dysfunction, neurological and vascular late effects, as well as secondary malignancies, are discussed within this article.
Collapse
Affiliation(s)
- Erika Roddy
- School of Medicine, University of California, San Francisco, CA, USA
| | - Sabine Mueller
- Department of Neurology, University of California, San Francisco, CA, USA Department of Pediatrics, University of California, San Francisco, CA, USA Department of Neurosurgery, University of California, San Francisco, CA, USA
| |
Collapse
|
30
|
Sands SA. Proton Beam Radiation Therapy: The Future May Prove Brighter for Pediatric Patients With Brain Tumors. J Clin Oncol 2016; 34:1024-6. [PMID: 26811526 DOI: 10.1200/jco.2015.65.4350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
31
|
Associations among treatment-related neurological risk factors and neuropsychological functioning in survivors of childhood brain tumor. J Neurooncol 2016; 127:137-44. [DOI: 10.1007/s11060-015-2021-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/13/2015] [Indexed: 10/22/2022]
|
32
|
Willard VW, Allen TM, Hardy KK, Bonner MJ. Social functioning in survivors of pediatric brain tumors: Contribution of neurocognitive and social-cognitive skills. CHILDRENS HEALTH CARE 2015. [DOI: 10.1080/02739615.2015.1124769] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
33
|
Annett RD, Patel SK, Phipps S. Monitoring and Assessment of Neuropsychological Outcomes as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S460-513. [PMID: 26700917 DOI: 10.1002/pbc.25749] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/13/2015] [Indexed: 11/07/2022]
Abstract
Central nervous system cancers or exposure to CNS-directed therapies increase risk for neuropsychological deficits. There are no accepted guidelines for assessment of neuropsychological functioning in this population. A multifaceted literature search was conducted and relevant literature reviewed to inform the guidelines. Studies of neuropsychological outcomes are widely documented in the pediatric oncology literature. There is strong evidence of need for neuropsychological assessment, but insufficient evidence to guide the timing of assessment, nor to recommend specific interventions. Children with brain tumors and others at high risk for neuropsychological deficits should be monitored and assessed for neuropsychological deficits.
Collapse
Affiliation(s)
- Robert D Annett
- Universityof Mississippi Medical Center, Jackson, Mississippi
| | - Sunita K Patel
- City of Hope Medical Center and Beckman Research Institute, Duarte, California
| | - Sean Phipps
- St. Jude Children's Hospital, Memphis, Tennessee
| |
Collapse
|
34
|
de Ruiter MA, Grootenhuis MA, van Mourik R, Maurice-Stam H, Breteler MHM, Gidding C, Beek LR, Granzen B, van Vuurden DG, Schouten-van Meeteren AYN, Oosterlaan J. Timed performance weaknesses on computerized tasks in pediatric brain tumor survivors: A comparison with sibling controls. Child Neuropsychol 2015; 23:208-227. [DOI: 10.1080/09297049.2015.1108395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
35
|
Conklin HM, Ogg RJ, Ashford JM, Scoggins MA, Zou P, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, Jeha S, Huang L, Zhang H. Computerized Cognitive Training for Amelioration of Cognitive Late Effects Among Childhood Cancer Survivors: A Randomized Controlled Trial. J Clin Oncol 2015; 33:3894-902. [PMID: 26460306 DOI: 10.1200/jco.2015.61.6672] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Children receiving CNS-directed therapy for cancer are at risk for cognitive problems, with few available empirically supported interventions. Cognitive problems indicate neurodevelopmental disruption that may be modifiable with intervention. This study evaluated short-term efficacy of a computerized cognitive training program and neural correlates of cognitive change. PATIENT AND METHODS A total of 68 survivors of childhood acute lymphoblastic leukemia (ALL) or brain tumor (BT) with identified cognitive deficits were randomly assigned to computerized cognitive intervention (male, n = 18; female, n = 16; ALL, n = 23; BT, n = 11; mean age ± standard deviation, 12.21 ± 2.47 years) or waitlist (male, n = 18; female, n = 16; ALL, n = 24; BT, n = 10; median age ± standard deviation, 11.82 ± 2.42 years). Intervention participants were asked to complete 25 training sessions at home with weekly, telephone-based coaching. Cognitive assessments and functional magnetic resonance imaging scans (intervention group) were completed pre- and postintervention, with immediate change in spatial span backward as the primary outcome. RESULTS Survivors completing the intervention (n = 30; 88%) demonstrated greater improvement than controls on measures of working memory (mean ± SEM; eg, Wechsler Intelligence Scale for Children [fourth edition; WISC-IV] spatial span backward, 3.13 ± 0.58 v 0.75 ± 0.43; P = .002; effect size [ES], 0.84), attention (eg, WISC-IV spatial span forward, 3.30 ± 0.71 v 1.25 ± 0.39; P = .01; ES, 0.65), and processing speed (eg, Conners' Continuous Performance Test hit reaction time, -2.10 ± 1.47 v 2.54 ± 1.25; P = .02; ES, .61) and showed greater reductions in reported executive dysfunction (eg, Conners' Parent Rating Scale III, -6.73 ± 1.51 v 0.41 ± 1.53; P = .002; ES, 0.84). Functional magnetic resonance imaging revealed significant pre- to post-training reduction in activation of left lateral prefrontal and bilateral medial frontal areas. CONCLUSION Study findings show computerized cognitive training is feasible and efficacious for childhood cancer survivors, with evidence for training-related neuroplasticity.
Collapse
Affiliation(s)
- Heather M Conklin
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC.
| | - Robert J Ogg
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Jason M Ashford
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Matthew A Scoggins
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Ping Zou
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Kellie N Clark
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Karen Martin-Elbahesh
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Kristina K Hardy
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Thomas E Merchant
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Sima Jeha
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Lu Huang
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Hui Zhang
- Heather M. Conklin, Robert J. Ogg, Jason M. Ashford, Matthew A. Scoggins, Ping Zou, Kellie N. Clark, Karen Martin-Elbahesh, Thomas E. Merchant, Sima Jeha, Lu Huang, and Hui Zhang, St Jude Children's Research Hospital, Memphis, TN; and Kristina K. Hardy, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| |
Collapse
|
36
|
Law N, Smith ML, Greenberg M, Bouffet E, Taylor MD, Laughlin S, Malkin D, Liu F, Moxon-Emre I, Scantlebury N, Mabbott D. Executive function in paediatric medulloblastoma: The role of cerebrocerebellar connections. J Neuropsychol 2015; 11:174-200. [DOI: 10.1111/jnp.12082] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 06/12/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Nicole Law
- Program in Neuroscience and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; Collaborative Program in Neuroscience; University of Toronto; Ontario Canada
| | - Mary Lou Smith
- Department of Psychology; Collaborative Program in Neuroscience; University of Toronto; Ontario Canada
- Department of Psychology; Hospital for Sick Children; Toronto Ontario Canada
| | - Mark Greenberg
- Pediatric Oncology Group of Ontario; Toronto Ontario Canada
- Division of Hematology/Oncology; Hospital for Sick Children; Toronto Ontario Canada
| | - Eric Bouffet
- Division of Hematology/Oncology; Hospital for Sick Children; Toronto Ontario Canada
| | - Michael D. Taylor
- Division of Neurosurgery; Arthur and Sonia Labatt Brain Tumor Research Centre; Hospital for Sick Children; Toronto Ontario Canada
- Program in Developmental and Stem Cell Biology; Hospital for Sick Children; Toronto Ontario Canada
| | - Suzanne Laughlin
- Diagnostic Imaging; Hospital for Sick Children; Toronto Ontario Canada
| | - David Malkin
- Pediatric Oncology Group of Ontario; Toronto Ontario Canada
- Division of Hematology/Oncology; Hospital for Sick Children; Toronto Ontario Canada
- Genetics and Genome Biology Program; Hospital for Sick Children; Toronto Ontario Canada
- Department of Pediatrics; University of Toronto; Ontario Canada
| | - Fang Liu
- Program in Neuroscience and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
| | - Iska Moxon-Emre
- Program in Neuroscience and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; Collaborative Program in Neuroscience; University of Toronto; Ontario Canada
- Pediatric Oncology Group of Ontario; Toronto Ontario Canada
| | - Nadia Scantlebury
- Program in Neuroscience and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
| | - Donald Mabbott
- Program in Neuroscience and Mental Health; Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; Collaborative Program in Neuroscience; University of Toronto; Ontario Canada
- Division of Hematology/Oncology; Hospital for Sick Children; Toronto Ontario Canada
| |
Collapse
|
37
|
Wengenroth L, Rueegg CS, Michel G, Gianinazzi ME, Essig S, von der Weid NX, Grotzer M, Kuehni CE. Concentration, working speed and memory: cognitive problems in young childhood cancer survivors and their siblings. Pediatr Blood Cancer 2015; 62:875-82. [PMID: 25645276 PMCID: PMC5916869 DOI: 10.1002/pbc.25396] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 11/19/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cognitive problems can have a negative effect on a person's education, but little is known about cognitive problems in young childhood cancer survivors (survivors). This study compared cognitive problems between survivors and their siblings, determined if cognitive problems decreased during recent treatment periods and identified characteristics associated with the presence of a cognitive problem in survivors. METHODS As part of the Swiss Childhood Cancer Survivor Study, a questionnaire was sent to all survivors, aged 8-20 years, registered in the Swiss Childhood Cancer Registry, diagnosed at age <16 years, who had survived ≥ 5 years. Parent-reported (aged 8-15 years) and self-reported (aged 16-20 years) cognitive problems (concentration, working speed, memory) were compared between survivors and siblings. Multivariable logistic regression was used to identify characteristics associated with cognitive problems in survivors. RESULTS Data from 840 survivors and 247 siblings were analyzed. More often than their siblings, survivors reported problems with concentration (12% vs. 6%; P = 0.020), slow working speed (20% vs. 8%; P = 0.001) or memory (33% vs. 15%; P < 0.001). Survivors from all treatment periods were more likely to report a cognitive problem than were siblings. Survivors of CNS tumors (OR = 2.82 compared to leukemia survivors, P < 0.001) and those who had received cranial irradiation (OR = 2.10, P = 0.010) were most severely affected. CONCLUSION Childhood cancer survivors, even those treated recently (2001-2005), remain at risk to develop cognitive problems, suggesting a need to improve therapies. Survivors with cognitive problems should be given the opportunity to enter special education programs.
Collapse
Affiliation(s)
- L Wengenroth
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Cox LE, Ashford JM, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, Ogg RJ, Jeha S, Willard VW, Huang L, Zhang H, Conklin HM. Feasibility and acceptability of a remotely administered computerized intervention to address cognitive late effects among childhood cancer survivors. Neurooncol Pract 2015; 2:78-87. [PMID: 27054041 DOI: 10.1093/nop/npu036] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Childhood cancer survivors frequently develop working memory (WM) deficits as a result of disease and treatment. Medication-based and therapist-delivered interventions are promising but have limitations. Computerized interventions completed at home may be more appealing for survivors. We evaluated the feasibility and acceptability of a remotely administered, computerized WM intervention (Cogmed) for pediatric cancer survivors using a single-blind, randomized, wait-list control design. METHODS Of 80 qualifying patients, 12 were excluded or declined to participate. Participants randomized to intervention (n = 34/68) included survivors of childhood brain tumors (32%) or acute lymphoblastic leukemia (ALL; 68%) between the ages of 8 and 16 years ([Formula: see text] = 12.2) who were at least 1 year post therapy ([Formula: see text] = 5.0). The majority of brain tumor participants were treated with cranial radiation therapy (72.7%), whereas most of the ALL participants were treated with chemotherapy only (87%). Participants completed 25 WM training sessions over 5-9 weeks at home with weekly phone-based coaching. RESULTS Participants lived in 16 states. Compliance was strong, with 30 of the 34 participants (88%) completing intervention. Almost all participants completed pre- and postintervention neuroimaging exams (91% and 93%, respectively). Families had the necessary skills to utilize the computer program successfully. Caregivers reported they were generally able to find time to complete training (63%), viewed training as beneficial (70%), and would recommend this intervention to others (93%). CONCLUSIONS Cogmed is a feasible and acceptable intervention for childhood cancer survivors. It is a viable option for survivors who do not live in close proximity to cancer care centers. Efficacy and neural correlates of change are currently being evaluated.
Collapse
Affiliation(s)
- Lauren E Cox
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Jason M Ashford
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Kellie N Clark
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Karen Martin-Elbahesh
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Kristina K Hardy
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Thomas E Merchant
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Robert J Ogg
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Sima Jeha
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Victoria W Willard
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Lu Huang
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Hui Zhang
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Heather M Conklin
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| |
Collapse
|
39
|
Willard VW, Leung W, Huang Q, Zhang H, Phipps S. Cognitive outcome after pediatric stem-cell transplantation: impact of age and total-body irradiation. J Clin Oncol 2014; 32:3982-8. [PMID: 25385724 DOI: 10.1200/jco.2014.56.2223] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the influence of age and conditioning with total-body irradiation (TBI) on the trajectory of cognitive functioning after treatment with pediatric hematopoietic stem-cell transplantation (SCT). PATIENTS AND METHODS Pediatric patients who were scheduled to undergo a SCT were eligible for the study, with 315 patients completing a baseline assessment. Of these, 183 patients (58.1%) were alive at 1 year after SCT and completed additional assessments at 1, 3, and 5 years after SCT. Half of the long-term sample (52.1%) received TBI during conditioning. Cognitive functioning was assessed via age-appropriate standardized measures. RESULTS At baseline, there were no differences in intelligence quotient (IQ) based on age. At 5 years after SCT, the youngest patients (< 3 years old at baseline) who received TBI demonstrated a significantly lower IQ than those who did not receive TBI (P = .05). Longitudinal analyses (piecewise linear mixed-effects models with a knot at 1 year after SCT) revealed a significant impact of age and TBI over time. The youngest patients evidenced declines in cognitive functioning during the first year; however, patients who did not receive TBI largely recovered their functioning in subsequent years. In contrast, young patients who received TBI failed to recover the losses experienced during the first year after SCT, demonstrating stability in their functioning, but at a lower level. CONCLUSION Our findings clarify the relationship between TBI and age on cognitive outcomes in pediatric SCT survivors. Young patients who receive TBI may benefit from early intervention efforts to minimize cognitive losses during the first year after SCT and to maximize potential recovery.
Collapse
Affiliation(s)
| | - Wing Leung
- All authors: St Jude Children's Research Hospital, Memphis, TN
| | - Qinlei Huang
- All authors: St Jude Children's Research Hospital, Memphis, TN
| | - Hui Zhang
- All authors: St Jude Children's Research Hospital, Memphis, TN
| | - Sean Phipps
- All authors: St Jude Children's Research Hospital, Memphis, TN.
| |
Collapse
|
40
|
Wochos GC, Semerjian CH, Walsh KS. Differences in parent and teacher rating of everyday executive function in pediatric brain tumor survivors. Clin Neuropsychol 2014; 28:1243-57. [PMID: 25343533 DOI: 10.1080/13854046.2014.971875] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We aimed to compare executive function (EF) outcomes in pediatric brain tumor (BT) survivors compared with healthy children (HC) across multiple settings. This retrospective cross-sectional study of BT survivors and age- and gender-matched HC analyzed scale patterns of parent and teacher ratings of EF (Behavior Ratings of Executive Function; BRIEF). We also analyzed relationships between groups and raters (parent/teacher) and clinical elevations across EF domains on the BRIEF. Group differences in aspects of EF emerged from parent ratings in working memory (WM), while significant interactions from teacher ratings emerged on nearly all EF scales. Parents reported impaired cognitive/behavioral flexibility in the BT group four times more than parents of HC. Teachers rated survivors significantly more poorly as a group on the majority of EF domains, and indicated clinical impairment in cognitive/behavioral flexibility, emotional regulation, self-starting/initiation, WM, and planning and organization (P/O) four to ten times more often than the teachers of HC. Overall, teacher ratings of EF impairment in pediatric BT survivors were significantly greater than parent ratings, who reported far fewer EF problems. Possible explanations for inter-rater discrepancies include potential reporting bias/response shift in parents and/or differences in EF demands across settings.
Collapse
Affiliation(s)
- G C Wochos
- a Children'sNational Medical Center , Washington , DC 20010 , USA
| | | | | |
Collapse
|
41
|
Winter AL, Conklin HM, Tyc VL, Stancel H, Hinds PS, Hudson MM, Kahalley LS. Executive function late effects in survivors of pediatric brain tumors and acute lymphoblastic leukemia. J Clin Exp Neuropsychol 2014; 36:818-30. [PMID: 25126830 DOI: 10.1080/13803395.2014.943695] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Survivors of pediatric brain tumors (BT) and acute lymphoblastic leukemia (ALL) are at risk for neurocognitive late effects related to executive function. PROCEDURE Survivors of BT (48) and ALL (50) completed neurocognitive assessment. Executive function was compared to estimated IQ and population norms by diagnostic group. RESULTS Both BT and ALL demonstrated relative executive function weaknesses. As a group, BT survivors demonstrated weaker executive functioning than expected for age. Those BT survivors with deficits exhibited a profile suggestive of global executive dysfunction, while affected ALL survivors tended to demonstrate specific rapid naming deficits. CONCLUSION Findings suggest that pediatric BT and ALL survivors may exhibit different profiles of executive function late effects, which may necessitate distinct intervention plans.
Collapse
Affiliation(s)
- Amanda L Winter
- a Department of Pediatrics, Section of Psychology , Baylor College of Medicine , Houston , TX , USA
| | | | | | | | | | | | | |
Collapse
|
42
|
Jacola LM, Ashford JM, Reddick WE, Glass JO, Ogg RJ, Merchant TM, Conklin HM. The relationship between working memory and cerebral white matter volume in survivors of childhood brain tumors treated with conformal radiation therapy. J Neurooncol 2014; 119:197-205. [PMID: 24847967 PMCID: PMC4133306 DOI: 10.1007/s11060-014-1476-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/03/2014] [Indexed: 10/25/2022]
Abstract
Survivors of childhood brain tumors (BTs) treated with CNS-directed therapy show changes in cerebral white matter that are related to neurocognitive late effects. We examined the association between white matter volume and working memory ability in survivors treated with conformal radiation therapy (CRT). Fifty survivors (25 males, age at assessment = 13.14 ± 2.88, age at CRT = 7.41 ± 3.41 years) completed Digit Span from the Wechsler Intelligence Scales for Children, 4th Edition and experimental Self-Ordered Search (SOS) tasks as measures of working memory. Caregiver ratings were obtained using the Behavior Rating Inventory of Executive Function. MRI exams were acquired on a 1.5 T scanner. Volumes of normal appearing white matter (NAWM) were quantified using a well-validated automated segmentation and classification program. Correlational analyses demonstrated that NAWM volumes were significantly larger in males and participants with tumors located in the infratentorial space. Correlations between NAWM volume and Digit Span Backward were distributed across anterior and posterior regions, with evidence for greater right hemisphere involvement (r = .32-.34, p ≤ .05). Correlations between NAWM volume with Digit Span Backward (r = .44-.52; p ≤ .05) and NAWM volume with SOS-Object Total (r = .45-.52, p ≤ .05) were of greater magnitude in females. No relationship was found between NAWM volume and caregiver report. Working memory performance in survivors of pediatric BTs treated with CRT are related to regionally specific NAWM volume. Developmental differences in cerebral myelination may explain findings of greater risk for neurocognitive late effects in female survivors. Future studies are needed to better isolate vulnerable white matter pathways, thus facilitating the development of neuroprotective interventions.
Collapse
Affiliation(s)
- Lisa M. Jacola
- Department of Psychology, St. Jude Children's Research Hospital
| | | | - Wilburn E. Reddick
- Division of Translational Imaging, St. Jude Children's Research Hospital
| | - John O. Glass
- Division of Translational Imaging, St. Jude Children's Research Hospital
| | - Robert J. Ogg
- Division of Translational Imaging, St. Jude Children's Research Hospital
| | | | | |
Collapse
|
43
|
Crom DB, Li Z, Brinkman TM, Hudson MM, Armstrong GT, Neglia J, Ness KK. Life satisfaction in adult survivors of childhood brain tumors. J Pediatr Oncol Nurs 2014; 31:317-26. [PMID: 25027187 DOI: 10.1177/1043454214534532] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Adult survivors of childhood brain tumors experience multiple, significant, lifelong deficits as a consequence of their malignancy and therapy. Current survivorship literature documents the substantial impact such impairments have on survivors' physical health and quality of life. Psychosocial reports detail educational, cognitive, and emotional limitations characterizing survivors as especially fragile, often incompetent, and unreliable in evaluating their circumstances. Anecdotal data suggest some survivors report life experiences similar to those of healthy controls. The aim of our investigation was to determine whether life satisfaction in adult survivors of childhood brain tumors differs from that of healthy controls and to identify potential predictors of life satisfaction in survivors. This cross-sectional study compared 78 brain tumor survivors with population-based matched controls. Chi-square tests, t tests, and linear regression models were used to investigate patterns of life satisfaction and identify potential correlates. Results indicated that life satisfaction of adult survivors of childhood brain tumors was similar to that of healthy controls. Survivors' general health expectations emerged as the primary correlate of life satisfaction. Understanding life satisfaction as an important variable will optimize the design of strategies to enhance participation in follow-up care, reduce suffering, and optimize quality of life in this vulnerable population.
Collapse
Affiliation(s)
| | - Zhenghong Li
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | | | | | | |
Collapse
|
44
|
Knight SJ, Conklin HM, Palmer SL, Schreiber JE, Armstrong CL, Wallace D, Bonner M, Swain MA, Evankovich KD, Mabbott DJ, Boyle R, Huang Q, Zhang H, Anderson VA, Gajjar A. Working memory abilities among children treated for medulloblastoma: parent report and child performance. J Pediatr Psychol 2014; 39:501-11. [PMID: 24627465 DOI: 10.1093/jpepsy/jsu009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We investigated the 5-year postsurgical developmental trajectory of working memory (WM) in children with medulloblastoma using parent and performance-based measures. METHOD This study included 167 patients treated for medulloblastoma. Serial assessments of WM occurred at predetermined time points for 5 years. RESULTS There was a subtle, statistically significant increase in parental concern about WM, coupled with a statistically significant decrease in age-standardized scores on performance-based measures. However, whole-group mean scores on both parent and performance-based measures remained in the age-expected range. Posterior fossa syndrome was consistently associated with poorer WM. Younger age at treatment and higher treatment intensity were associated with greater negative change in WM performance only. CONCLUSIONS Most children treated for medulloblastoma display WM within the age-appropriate range according to parent report and performance. However, the subtle negative changes over time and identified subgroups at increased risk highlight the need for ongoing monitoring of this population.
Collapse
Affiliation(s)
- Sarah J Knight
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research HospitalClinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research HospitalClinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, D
| | - Heather M Conklin
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Shawna L Palmer
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Jane E Schreiber
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Carol L Armstrong
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Dana Wallace
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Melanie Bonner
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Michelle A Swain
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Karen D Evankovich
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Donald J Mabbott
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Robyn Boyle
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Qinlei Huang
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Hui Zhang
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Vicki A Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research HospitalClinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| | - Amar Gajjar
- Clinical Sciences, Murdoch Childrens Research Institute, Children's Cancer Centre and Psychology Department, Royal Children's Hospital, Victorian Paediatric Rehabilitation Service, Monash Children's, Department of Paediatrics, The University of Melbourne, Department of Psychology, St. Jude Children's Research Hospital, Neuro-Oncology Program, Children's Hospital of Philadelphia, Department of Psychiatry, Duke University Medical Center, Royal Children's Hospital, Department of Pediatric Medicine, Texas Children's Hospital, Department of Psychology, The Hospital for Sick Children, Psychology Service, Sydney Children's Hospital, Department of Biostatistics St. Jude Children's Research Hospital, and Department of Oncology, St. Jude Children's Research Hospital
| |
Collapse
|
45
|
Howarth RA, Adamson AM, Ashford JM, Merchant TE, Ogg RJ, Schulenberg SE, Ogg S, Li J, Wu S, Xiong X, Conklin HM. Investigating the relationship between COMT polymorphisms and working memory performance among childhood brain tumor survivors. Pediatr Blood Cancer 2014; 61:40-5. [PMID: 23956130 PMCID: PMC4101980 DOI: 10.1002/pbc.24649] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 05/22/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Survivors of childhood brain tumors are at increased risk for neurocognitive impairments, including deficits in abilities supported by frontal brain regions. Catechol-O-methyltransferase (COMT) metabolizes dopamine in the prefrontal cortex, with the Met allele resulting in greater dopamine availability and better performance on frontally mediated tasks compared to the Val allele. Given the importance of identifying resiliency factors against the emergence of cognitive late effects, the current study examined the relationship between COMT genotype and working memory performance among childhood brain tumor survivors. PROCEDURE Children treated for a brain tumor with conformal radiation therapy (N = 50; mean age at irradiation = 7.41 ± 3.41; mean age at assessment = 13.18 ± 2.88) were administered two computerized measures of working memory (self-ordered search verbal and object tasks). Buccal (cheek) swabs were used to provide tissue from which DNA was extracted. RESULTS Findings revealed an association between COMT genotype and performance on the self-ordered verbal (P = 0.03) but not object task (P = 0.33). Better performance was found for the Met/Val group compared to either Met/Met or Val/Val. CONCLUSIONS COMT may indicate a potential resiliency factor against neurocognitive effects of cancer and its treatment; however, there is a need for replication with larger samples of childhood brain tumor survivors.
Collapse
Affiliation(s)
| | - Amanda M. Adamson
- The Center for Pediatric Neuropsychology, Palm Beach Gardens, Florida
| | | | | | - Robert J. Ogg
- Division of Translational Imaging Research, St. Jude Children’s Research Hospital
| | | | - Susan Ogg
- Department of Epidemiology & Cancer Control, St. Jude Children’s Research Hospital
| | - Jiang Li
- Department of Psychiatry & Behavioral Sciences, Northwestern University
| | - Shengjie Wu
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Xiaoping Xiong
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Heather M. Conklin
- Department of Psychology, St. Jude Children’s Research Hospital,Corresponding Author: Heather M. Conklin, Department of Psychology, Mail Stop #740, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105. Telephone: 901-595-3585. Fax: 901-595-4701.
| |
Collapse
|
46
|
Greenberg-Kushnir N, Freedman S, Eshel R, Zwerdling N, Elhasid R, Dvir R, Yalon M, Kulkarni AV, Constantini S. Screening tool for late-effect pediatric neuro-oncological clinics: a treatment-oriented questionnaire. Pediatr Blood Cancer 2013; 60:1369-74. [PMID: 23418062 DOI: 10.1002/pbc.24495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 01/10/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Many survivors of pediatric brain tumors (SPBTs) suffer from long-term late effects (LEs). Our aim was to create a practical screening tool for detecting LEs in this population. Such a screening tool will improve our ability to identify those patients who may benefit from treatment in LE clinics while focusing on individual relevant issues. PROCEDURE We developed the Treatment-Oriented Screening Questionnaire (TOSQ); a self-reported, risk-based questionnaire that addresses all LEs SPBTs can potentially suffer. As a basis for the TOSQ design we used the Long-Term Follow-Up Guidelines published by the Children's Oncology Group. Output includes individual recommendations for further treatment. We prospectively assessed whether the TOSQ can accurately detect treatment targets in SPBTs by comparing patient and caregiver questionnaire scores with physician evaluations. Data are presented from 41 SPBTs. RESULTS The TOSQ is a precise screening tool for identifying LEs in SPBTs based on the significant correlation (P < 0.05) that was found between parental scores and physician evaluations. Statistical testing proved that parents are a good source of information about child's health status, and that TOSQ accurately reflects the correlation between patient difficulties and quality of life. CONCLUSIONS The TOSQ is the first described screening tool for identification of LEs designed specifically for SPBTs. It is simple to use and provides a valid, comprehensive and economic assessment followed by targeted treatment plan for each patient. By repeatedly using the TOSQ over the years, we can improve our ability to detect and give focused treatment to those who require assistance.
Collapse
Affiliation(s)
- Noa Greenberg-Kushnir
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Computerized assessment of cognitive late effects among adolescent brain tumor survivors. J Neurooncol 2013; 113:333-40. [PMID: 23525951 DOI: 10.1007/s11060-013-1123-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/16/2013] [Indexed: 10/27/2022]
Abstract
Advantages of computerized assessment of neuropsychological functions include improved standardization and increased reliability of response time variables. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized battery developed for monitoring recovery following mild brain injuries that assesses attention, memory and processing speed. Despite evidence that core areas of deficit among cancer survivors are those assessed by ImPACT, it has not previously been used with this population. Twenty four childhood brain tumor (BT) survivors treated with conformal radiation therapy (mean age = 15.7 ± 1.6; mean age at irradiation = 9.8 ± 2.5), twenty solid tumor (ST) survivors treated without CNS-directed therapy (mean age = 16.2 ± 1.8) and twenty healthy siblings (mean age = 15.1 ± 1.6 years) were administered an age modified version of ImPACT. Additional computerized measures of working memory and recognition memory were administered. Univariate ANOVAs revealed group differences (p < 0.05) on measures of recognition memory, spatial working memory, processing speed and reaction time, with BT survivors performing significantly worse than ST survivors and siblings. Pearson correlation coefficients revealed significant associations between ImPACT memory tasks and computerized forced choice recognition tasks (rs = 0.30-0.33, p < 0.05). Multiple surgical resections, hydrocephalus and CSF shunt placement most consistently predicted worse ImPACT performance using linear mixed models (p < 0.05). The ImPACT test battery demonstrated sensitivity to cognitive late effects experienced by some BT survivors with clinical predictors of performance consistent with the pediatric oncology literature. Correlations with measures of similar constructs provide evidence for convergent validity. Findings offer initial support for the utility of ImPACT for monitoring of cognitive late effects.
Collapse
|
48
|
The utility of parent report in the assessment of working memory among childhood brain tumor survivors. J Int Neuropsychol Soc 2013; 19:380-9. [PMID: 23351399 DOI: 10.1017/s1355617712001567] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Childhood brain tumor survivors are at increased risk for neurocognitive impairments, including working memory (WM) problems. WM is typically assessed using performance measures. Little is known about the value of parent ratings for identifying WM difficulties, the relationship between rater and performance measures, or predictors of parent-reported WM problems in this population. Accordingly, the current study examined the utility of parent report in detecting WM difficulties among childhood brain tumor survivors treated with conformal radiation therapy (n = 50) relative to siblings (n = 40) and solid tumor survivors not receiving central nervous system-directed therapy (n = 40). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF). Participants were administered WM measures (digit span, self-ordered search tasks). Findings revealed parents rated brain tumor survivors as having significantly more WM problems (p < .01) compared to controls. However, the BRIEF-WM scale demonstrated poor sensitivity and specificity for detecting performance-based problems. Significant, albeit modest, correlations were found between the BRIEF-WM scale and performance measures (r = -.24-.22; p < .05) for the combined group. Age at testing, socioeconomic status, and IQ were significant predictors of parent reported WM problems. Rater and performance measures offer complimentary yet different information in assessing WM, which reiterates the importance of using both within the context of clinical assessment.
Collapse
|