1
|
Nigro SE, Hall LP, Harman J, Willard VW, Conklin HM, Pui CH, Jeha S, Jacola LM. The association of environmental factors with neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia (ALL). Support Care Cancer 2023; 32:1. [PMID: 38047975 PMCID: PMC10762952 DOI: 10.1007/s00520-023-08212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To investigate the association of environmental factors, rehabilitation services during therapy and socioeconomic status (SES - insurance type), with neurocognitive outcomes at the end of therapy for survivors of childhood acute lymphoblastic leukemia (ALL). METHODS Survivors (n = 236) treated on the St. Jude Total Therapy Study 16 completed end of therapy testing with performance measures (IQ, attention, processing speed, fine motor skills, academics) and caregiver ratings (attention, executive function, adaptive skills). Environmental factors were abstracted from the medical record. RESULTS Distribution of sex (47.3% female, p = 0.399), treatment arm (45.5% low risk, 54.5% standard/high risk p = 0.929), insurance type (47.7% private, 52.3% public/none, p = 0.117), and mean age at diagnosis (7.7 vs. 6.8 years, p = 0.143) were similar for groups with (n = 110; 46.6%) and without (n = 126; 53.6%) rehabilitation services during therapy. Compared to those without rehabilitation, the rehabilitation group (n = 110; 46.4%) had more caregiver reported problems with attention (Z = -0.28 vs. 0.43, p = 0.022), executive function (Z = -0.50 vs. -0.08, p = 0.003), and adaptive skills (Z = -0.41 vs.-0.13, p = 0.031). Among the rehabilitation group, there was no difference in outcomes by insurance status. Among those without rehabilitation, those with public insurance had worse neurocognitive outcomes than those with private insurance in IQ (Z = -0.04 vs. -0.45, p = 0.0115), processing speed (Z = -0.10 vs. -0.75, p = 0.0030), reading (Z = 0.18 vs. -0.59, p < 0.0001), and math (Z = -0.04 vs. -0.50, p = 0.0021). CONCLUSION Participation in rehabilitation services during early intensive therapy is associated with end of therapy caregiver-reported neurocognitive outcomes in daily life.
Collapse
Affiliation(s)
- S E Nigro
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - L P Hall
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - J Harman
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - V W Willard
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - H M Conklin
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - C-H Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - S Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - L M Jacola
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
| |
Collapse
|
2
|
Sparrow J, Dagen H, Harris A, Schwartzberg S, Weathers L, Kibby M, Harman JL, Jacola LM. Occupational Therapy: An Essential Component of Support for Young Children With Cancer. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:211-217. [PMID: 35929023 DOI: 10.1177/15394492221115060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We established a multidisciplinary early childhood clinic to support infants and toddlers receiving cancer treatment. The access to occupational therapy (OT) in this population is unknown. To describe the access to OT for infants and toddlers with cancer. We retrospectively reviewed medical records to determine the frequency and characteristics of children with cancer who were referred to OT. Demographic data, medical information, and frequency of referrals were extracted from September 2015 to September 2018. Of the 134 patients, 112 (83.6%) received an OT evaluation: 88.4% were referred for hospital-based OT services; 42.0% were recommended for services upon returning home. Between-group comparisons revealed significant differences in referrals for home- or community-based OT services based on age and disease. OT is crucial to treatment plans that address the developmental needs of young pediatric oncology patients during hospitalization and thereafter. Recommendations for monitoring this vulnerable population are provided.
Collapse
Affiliation(s)
| | - Hannah Dagen
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Lucy Weathers
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Megan Kibby
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Lisa M Jacola
- St. Jude Children's Research Hospital, Memphis, TN, USA
| |
Collapse
|
3
|
Trapani JA, Murdaugh DL. Processing efficiency in pediatric cancer survivors: A review and operationalization for outcomes research and clinical utility. Brain Behav 2022; 12:e2809. [PMID: 36330565 PMCID: PMC9759139 DOI: 10.1002/brb3.2809] [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: 01/13/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Childhood cancer and cancer-related treatments disrupt brain development and maturation, placing survivors at risk for cognitive late effects. Given that assessment tools vary widely across researchers and clinicians, it has been daunting to identify distinct patterns in outcomes across diverse cancer types and to implement systematic neurocognitive screening tools. This review aims to operationalize processing efficiency skill impairment-or inefficient neural processing as measured by working memory and processing speed abilities-as a worthwhile avenue for continued study within the context of childhood cancer. METHODS A comprehensive literature review was conducted to examine the existing research on cognitive late effects and biopsychosocial risk factors in order to conceptualize processing efficiency skill trends in childhood cancer survivors. RESULTS While a frequently reported pattern of neurobiological (white matter) and cognitive (working memory and processing speed) disruption is consistent with processing efficiency skill impairment, these weaknesses have not yet been fully operationalized in this population. We offer a theoretical model that highlights the impacts of a host of biological and environmental factors on the underlying neurobiological substrates of cancer survivors that precede and may even predict long-term cognitive outcomes and functional abilities following treatment. CONCLUSION The unified construct of processing efficiency may be useful in assessing and communicating neurocognitive skills in both outcomes research and clinical practice. Deficits in processing efficiency may serve as a possible indicator of cognitive late effects and functional outcomes due to the unique relationship between processing efficiency skills and neurobiological disruption following cancer treatment. Continued research along these lines is crucial for advancing childhood cancer outcomes research and improving quality of life for survivors.
Collapse
Affiliation(s)
- Julie A Trapani
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Donna L Murdaugh
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
4
|
Trpchevska A, Longoria J, Okhomina V, Raches D, Potter B, Kang G, Heitzer AM, Hankins JS. Adaptive Functioning in Children and Adolescents With Sickle Cell Disease. J Pediatr Psychol 2022; 47:939-951. [PMID: 35380685 DOI: 10.1093/jpepsy/jsac024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Risk for neurocognitive deficits in sickle cell disease (SCD) is well established, yet minimal research has evaluated the risk for deficits in adaptive functioning. We assessed adaptive functioning in pediatric patients with SCD to test the hypothesis that disease, treatment, and demographic factors were associated with adaptive outcomes. METHODS Two hundred fifty-six patients (57% HbSS/HbSß0-thalassemia and 43% HbSC/HbSß+-thalassemia), ages 8-18, received routine neuropsychological assessments as part of a larger prospective lifetime cohort study. Adaptive functioning was measured using the Behavior Assessment System for Children, Second or Third Edition. Adaptive scores were compared with normative values using t-test or Wilcoxon signed rank test and linear regression models were used to measure associations between adaptive functioning and age, hydroxyurea (HU) use, sickle genotype, and socioeconomic status. Furthermore, we examined the influence of intellectual and executive functioning on adaptive behavior using hierarchical linear regression analyses. RESULTS Parent ratings of adaptive functioning skills did not differ from normative expectations (all false discovery rate [FDR] adjusted p-value [pFDR] > 0.05). Social vulnerability was negatively associated with adaptive scores on most adaptive scales in both genotypes (pFDR < 0.05). HU treatment was not significantly associated with any adaptive scale. Overall IQ was positively associated with Functional Communication and Leadership only for those with HbSS/HbSß0-thalassemia. Higher parent ratings of executive difficulties were correlated with lower adaptive scores (estimate = -0.64, standard error = 0.051, p < .001). CONCLUSIONS Poorer parent-rated adaptive skills were associated with increased social vulnerability, lower Full-Scale IQ, and parent-rated executive difficulties. Most adaptive scores were in the normal range; however, parent ratings may not fully capture the impact of disease complications and neurocognitive deficits on daily functioning.
Collapse
Affiliation(s)
- Ana Trpchevska
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Victoria Okhomina
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Darcy Raches
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Brian Potter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew M Heitzer
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| |
Collapse
|
5
|
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]
|
6
|
Di Lorenzo M, Desrocher M, Westmacott R. The clinical utility of the behavior rating inventory of executive function in preschool children with a history of perinatal stroke. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:429-437. [PMID: 33535801 DOI: 10.1080/21622965.2021.1875828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The current study examined the utility of the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P) in capturing emerging deficits in executive function in preschool children with a history of perinatal stroke. Parents and teachers of 55 clinically referred preschool children (3-5 years of age) provided ratings using the BRIEF-P. Both parent (M = 56.02, p = .001) and teacher ratings (M = 58.61, p = .002) indicated significant scale elevations for working memory compared to the normative sample, albeit below the clinically elevated range. Parent and teacher ratings were low-to-moderately correlated (r = .05-.55). Greater deficits in working memory (r = -.58), inhibition (r = -.45), and planning/organization (r = -.51), as rated by teachers, were associated with lower intellectual functioning. Parents' ratings were not associated with intellectual functioning. Further, no neurological or personal characteristics were associated with ratings of executive function. The current study demonstrates children with a history of perinatal stroke are, on average, following a normal trajectory of executive function development according to BRIEF-P ratings. The needs for multi-informant ratings and performance-based measures to comprehensively assess executive functioning in preschoolers with a history of stroke are discussed.
Collapse
Affiliation(s)
| | - Mary Desrocher
- Department of Psychology, York University, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology and Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
7
|
Boles J, Daniels S. Researching the Experiences of Children with Cancer: Considerations for Practice. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E93. [PMID: 31426332 PMCID: PMC6721372 DOI: 10.3390/children6080093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 11/16/2022]
Abstract
Children and adolescents with cancer often participate in medical and psychosocial research throughout their diagnosis and treatment. Furthermore, this involvement frequently extends into the survivorship period. Sometimes referred to as "doubly vulnerable" research participants, children and adolescents with cancer are not only minors, but also minors facing significant medical, developmental, and psychosocial stressors associated with chronic illness. Thus, it is important to exercise care in designing and conducting research with this population; however, these considerations have not been adequately addressed in pediatric healthcare literature. Therefore, the purpose of this review is to describe the research preferences and experiences of children and adolescents with cancer to identify techniques for supporting this population as research participants. By incorporating developmentally appropriate, context-specific, and child-centered adjustments, researchers can help children and adolescents with cancer effectively and meaningfully describe their illness experiences while also developing a positive outlook on future research participation.
Collapse
Affiliation(s)
- Jessika Boles
- Child Life Services, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN 37232, USA.
| | - Sarah Daniels
- Child Life Program, St. Jude Children's Research Hospital, Memphis, TN 38163, USA
| |
Collapse
|