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Alias H, Mohd Ranai N, Lau SCD, de Sonneville LMJ. Neuropsychological task outcomes among survivors of childhood acute lymphoblastic leukemia in Malaysia. Sci Rep 2024; 14:7915. [PMID: 38575744 PMCID: PMC10995164 DOI: 10.1038/s41598-024-58128-1] [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: 05/18/2023] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
This study intended to explore the neuropsychological ramifications in childhood acute lymphoblastic leukemia (ALL) survivors in Malaysia and to examine treatment-related sequelae. A case-control study was conducted over a 2-year period. Seventy-one survivors of childhood ALL who had completed treatment for a minimum of 1 year and were in remission, and 71 healthy volunteers were enlisted. To assess alertness (processing speed) and essential executive functioning skills such as working memory capacity, inhibition, cognitive flexibility, and sustained attention, seven measures from the Amsterdam Neuropsychological Tasks (ANT) program were chosen. Main outcome measures were speed, stability and accuracy of responses. Mean age at diagnosis was 4.50 years (SD ± 2.40) while mean age at study entry was 12.18 years (SD ± 3.14). Survivors of childhood ALL underperformed on 6 out of 7 ANT tasks, indicating poorer sustained attention, working memory capacity, executive visuomotor control, and cognitive flexibility. Duration of treatment, age at diagnosis, gender, and cumulative doses of chemotherapy were not found to correlate with any of the neuropsychological outcome measures. Childhood ALL survivors in our center demonstrated significantly poorer neuropsychological status compared to healthy controls.
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Affiliation(s)
- Hamidah Alias
- Department of Pediatrics, Faculty of Medicine, The National University of Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Norashikin Mohd Ranai
- Department of Pediatrics, Faculty of Medicine, Universiti Teknologi Mara (UiTM), 47000, Shah Alam, Selangor, Malaysia
| | - Sie Chong Doris Lau
- Department of Pediatrics, Faculty of Medicine, The National University of Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Leo M J de Sonneville
- Clinical Neurodevelopmental Sciences, Faculty of Social Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
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Grewal A, Bansal B, Mittal C, Gupta H, Sasi A, Ganesan P, Dabas A, Sahi P, Ramamoorthy L, Lalthanthuami HT, Ramamoorthy J, Sindhu A, Arora S, Bhukya A, Hepzibah M, Devi K, Krishnamurthy K, Rai SK, Mehta N, Antil K, Bakhshi S, Ganguly S. Knowledge and attitude on childhood cancer survivorship among healthcare trainees: a multicentre study from India. Fam Med Community Health 2024; 12:e002618. [PMID: 38575353 PMCID: PMC11002353 DOI: 10.1136/fmch-2023-002618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The proportion of childhood cancer survivors (CCS) in low/middle-income countries (LMICs) is rising. CCS often develop several physical and psycho-social long-term adverse effects, with unique healthcare needs. Primary healthcare providers (primary care physicians (PCPs)), especially in LMICs, are often not equipped to handle survivorship care. This study aimed to assess knowledge, and attitude among trainee healthcare providers concerning major issues of paediatric survivorship care. METHODS A multi-centre, cross-sectional, questionnaire-based study was conducted among nursing and medical undergraduate students, and postgraduate medical residents across three tertiary-care teaching hospitals in India-All India Institute of Medical Sciences, New Delhi; Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry; and Maulana Azad Medical College, New Delhi. A questionnaire with total of 24 questions (14 knowledge-based and 10 attitude-based) was finalised after validation by expert review and piloting. The major domains covered in the questionnaire included knowledge and attitude regarding long-term adverse effects and psychosocial, employment-related issues faced by the survivors. It was administered to the study participants electronically. The knowledge-based questions had true/false responses (scored as 0 or 1 if incorrect or correct, respectively). Attitude-based questions were scored as 5-point Likert scale. RESULTS Total 898 responses were collected (median age: 21 years, 64% (576/898) female). Among the respondents, 44% were undergraduate medical students, 42% were nursing students and 14% were postgraduate medical residents. The mean (SD) of knowledge score was 8.72 (2.04) (out of 14). On multivariable analysis, only discipline of training predicted knowledge scores regarding survivorship care. Postgraduate medical residents (9.08) as well as undergraduate medical students (8.85), had significantly higher mean knowledge scores than nursing students (8.47) (p=0.004).Two questions were answered incorrectly by the majority; children and siblings of CCS need additional genetic screening (79% incorrectly answered true), and CCS face intimacy issues in relation to normal sexual functioning (59% incorrectly answered false).Nearly half (48%) of respondents believed that their knowledge of cancer survivorship issues was inadequate. Majority of respondents (84%) suggested that oncologists should handle long-term survivorship care rather than PCPs. CONCLUSION Trainee healthcare providers in India reported inadequate knowledge regarding survivorship care. Improving awareness by incorporating survivorship in teaching curriculum is imperative to equip future PCPs to provide survivorship care across the country.
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Affiliation(s)
- Amritesh Grewal
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Bhavik Bansal
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Chetanya Mittal
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Hardik Gupta
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Aashima Dabas
- Department of Pediatrics, Lok Nayak Hospital, New Delhi, Delhi, India
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Puneet Sahi
- Department of Pediatrics, Lok Nayak Hospital, New Delhi, Delhi, India
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Lakshmi Ramamoorthy
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Hmar Thiak Lalthanthuami
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Jaikumar Ramamoorthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Arwachi Sindhu
- Medical Student, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Suyash Arora
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Anumeha Bhukya
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Muthumani Hepzibah
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Kanchana Devi
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Karthick Krishnamurthy
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Sanjeet K Rai
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Nikhil Mehta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Komal Antil
- College of Nursing, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Davies MR, Greenberg Z, van Vuurden DG, Cross CB, Zannettino ACW, Bardy C, Wardill HR. More than a small adult brain: Lessons from chemotherapy-induced cognitive impairment for modelling paediatric brain disorders. Brain Behav Immun 2024; 115:229-247. [PMID: 37858741 DOI: 10.1016/j.bbi.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023] Open
Abstract
Childhood is recognised as a period of immense physical and emotional development, and this, in part, is driven by underlying neurophysiological transformations. These neurodevelopmental processes are unique to the paediatric brain and are facilitated by augmented rates of neuroplasticity and expanded neural stem cell populations within neurogenic niches. However, given the immaturity of the developing central nervous system, innate protective mechanisms such as neuroimmune and antioxidant responses are functionally naïve which results in periods of heightened sensitivity to neurotoxic insult. This is highly relevant in the context of paediatric cancer, and in particular, the neurocognitive symptoms associated with treatment, such as surgery, radio- and chemotherapy. The vulnerability of the developing brain may increase susceptibility to damage and persistent symptomology, aligning with reports of more severe neurocognitive dysfunction in children compared to adults. It is therefore surprising, given this intensified neurocognitive burden, that most of the pre-clinical, mechanistic research focuses exclusively on adult populations and extrapolates findings to paediatric cohorts. Given this dearth of age-specific research, throughout this review we will draw comparisons with neurodevelopmental disorders which share comparable pathways to cancer treatment related side-effects. Furthermore, we will examine the unique nuances of the paediatric brain along with the somatic systems which influence neurological function. In doing so, we will highlight the importance of developing in vitro and in vivo paediatric disease models to produce age-specific discovery and clinically translatable research.
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Affiliation(s)
- Maya R Davies
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Supportive Oncology Research Group, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
| | - Zarina Greenberg
- South Australian Health and Medical Research Institute (SAHMRI), Laboratory of Human Neurophysiology and Genetics, Adelaide, SA, Australia
| | - Dannis G van Vuurden
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the weNetherlands
| | - Courtney B Cross
- Supportive Oncology Research Group, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Andrew C W Zannettino
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Cedric Bardy
- South Australian Health and Medical Research Institute (SAHMRI), Laboratory of Human Neurophysiology and Genetics, Adelaide, SA, Australia; Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Hannah R Wardill
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Supportive Oncology Research Group, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
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Sullivan AW, Johnson MK, Boes AD, Tranel D. Implications of age at lesion onset for neuropsychological outcomes: A systematic review focusing on focal brain lesions. Cortex 2023; 163:92-122. [PMID: 37086580 PMCID: PMC10192019 DOI: 10.1016/j.cortex.2023.03.002] [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: 08/09/2022] [Revised: 02/10/2023] [Accepted: 03/19/2023] [Indexed: 04/24/2023]
Abstract
Theories of the relation between age at lesion onset and outcomes posit different views of the young brain: resilient and plastic (i.e., the so-called "Kennard Principle"), or vulnerable (i.e., the Early Vulnerability Hypothesis). There is support for both perspectives in previous research and questions about the "best" or "worst" times to sustain brain injury remain. Here, we present a systematic review investigating the influence of age at focal brain lesion onset on cognitive functioning. This systematic review identifies and qualitatively synthesizes empirical studies from 1985 to 2021 that investigated age at lesion onset as a variable of interest associated with neuropsychological outcomes. A total of 45 studies were identified from PubMed, PsycINFO, and CINAHL databases. Almost all studies indicated that brain injury earlier in the developmental period predicts worse cognitive outcomes when compared to onset either later in the developmental period or in adulthood. More specifically, the overwhelming majority of studies support an "earlier is worse" model for domains of intellect, processing speed, attention and working memory, visuospatial and perceptual skills, and learning and memory. Relatively more variability in outcomes exists for domains of language and executive functioning. Outcomes for all domains are influenced by various other age and injury variables (e.g., lesion size, lesion laterality, chronicity, a history of epilepsy). Continued interdisciplinary understanding and communication about the influence of age at lesion onset on neuropsychological outcomes will aid in promoting the best possible outcomes for patients.
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Affiliation(s)
- Alyssa W Sullivan
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
| | - Marcie K Johnson
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
| | - Aaron D Boes
- Department of Neurology, University of Iowa, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Iowa City, IA, USA; Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
| | - Daniel Tranel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA; Department of Neurology, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA.
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Kobayashi K, Ishida Y, Gunji M, Nagase K, Yoshimoto-Suzuki Y, Hosoya Y, Hasegawa D, Manabe A, Ohde S, Ozawa M. Factors related to employment in childhood cancer survivors in Japan: A preliminary study. Front Pediatr 2022; 10:961935. [PMID: 36545671 PMCID: PMC9760961 DOI: 10.3389/fped.2022.961935] [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: 06/05/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Previous research has revealed vocational and academic difficulties in childhood cancer survivors, and explored impact of survivors' medical history and physical function on vocational and academic status. However, we often encounter survivors with similar diagnoses and late effects but different academic or employment statuses. This raises the question of what affects academic attainment and employment other than treatment or late effects. This study aimed to explore factors associated with childhood cancer survivors' employment status and academic achievement. METHODS Comprehensive health check-up and questionnaire survey were conducted for 69 survivors who were over the age of 18 and participated in St. Luke's Lifetime cohort study. We obtained survivors' biological function using comprehensive health check-up, neurocognitive states, quality of life, transition readiness, and family function. We conducted univariate analysis (Mann-Whitney U tests or chi-square tests) to compare the differences between the regular workers/students and non-regular workers/unemployed groups. The variables with p-values <0.1 were used as independent variables multivariate logistic regression to explore predictors of employment status and academic attainment. RESULTS Result of the univariate analysis, intelligence quotient, SF-8 PCS, transition readiness, family function were used for multivariate logistic regression as independent variables. The stepwise likelihood method was conducted; intelligence quotient (odds ratio [OR] = 1.100; 95% confidence interval [CI] 1.015-1.193; p = 0.021), transition readiness (OR = 0.612; 95% CI 0.396-0.974; p = 0.038), and family function (OR = 2.337; 95% CI 1.175-4.645; p = 0.015) were found to be associated with survivors' regular workers/students in the final regression model. CONCLUSION Long-term follow-up of pediatric cancer survivors requires the provision of total care, which supports physical, psychological, and social functions to improve health, readiness for transition to self-management, and family functioning.
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Affiliation(s)
- Kyoko Kobayashi
- Department of Child & Family Health Nursing, St. Luke's International University, Tokyo, Japan
| | - Yasushi Ishida
- Department of Pediatrics, Ehime Prefectural Hospital, Ehime, Japan
| | - Michiyo Gunji
- Department of Nursing, St. Luke's International Hospital, Tokyo, Japan
| | - Kyoko Nagase
- Department of Nursing, St. Luke's International Hospital, Tokyo, Japan
| | - Yuri Yoshimoto-Suzuki
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan.,Course of Advanced and Specialized Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yosuke Hosoya
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University, Hokkaido, Japan
| | - Sachiko Ohde
- Division of Epidemiology, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Miwa Ozawa
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
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Al-Kaylani HM, Reasoner EE, Loeffler BT, Mott SL, Madasu S, Liu A, Langbehn K, Conrad AL, Dickens D, Grafft A, Harshman L, Modi AJ, van der Plas E. Characterizing academic performance in pediatric acute lymphoblastic leukemia with population-based achievement tests. Cancer Rep (Hoboken) 2021; 5:e1560. [PMID: 34596316 PMCID: PMC9458490 DOI: 10.1002/cnr2.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/09/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent shifts from radiation to chemotherapy-based treatment for acute lymphoblastic leukemia (ALL) have contributed to reduced long-term morbidity. Despite this, ALL survivors remain at increased risk for long-term cognitive impairments. AIM To identify demographic and treatment factors associated with school performance in pediatric survivors of ALL. METHODS We collected standardized test scores for reading, math, and science obtained in a school setting from grades 3-11 in 63 ALL survivors (46.0% boys). Most participants were assessed across multiple grades (median number of grades n = 5, range 1-7), and 269 observations were considered in the analyses. Treatment exposures were extracted from medical records. Socio-economic status was estimated using participation in free/reduced lunch programs at school. Mixed effects linear regression models were conducted to determine factors associated with school performance. RESULTS ALL survivors' scores were comparable to state norms on reading, math, and science performances. On multivariable analysis, participation in free/reduced lunch programs was significantly associated with lower reading scores (β = -12.52; 95% CI -22.26:-2.77, p = .01). Exposure to radiation during treatment was also associated with lower reading test scores (β = -30.81, 95% CI -52.00:-9.62, p = .01). No significant associations between demographics and treatment parameters were observed for math and science test scores. CONCLUSIONS We utilized population-based achievement tests conducted from grades 3-11 to characterize school performance in ALL survivors. Our results imply that survivors with low socio-economic status and those exposed to radiation during treatment could benefit from early monitoring and intervention to maximize academic success.
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Affiliation(s)
- Hend M Al-Kaylani
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Erin E Reasoner
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Bradley T Loeffler
- Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Susan Madasu
- Stead Family Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Audrey Liu
- Stead Family Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Kathleen Langbehn
- Department of Health Education and Behavior, University of Florida, Gainesville, Florida, USA
| | - Amy L Conrad
- Stead Family Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - David Dickens
- Stead Family Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Amanda Grafft
- Stead Family Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Lyndsay Harshman
- Stead Family Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Arunkumar J Modi
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
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7
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van der Plas E, Noakes TLS, Butcher DT, Weksberg R, Galin-Corini L, Wanstall EA, Te P, Hopf L, Guger S, Hitzler J, Schachar RJ, Ito S, Nieman BJ. Cognitive and behavioral risk factors for low quality of life in survivors of childhood acute lymphoblastic leukemia. Pediatr Res 2021; 90:419-426. [PMID: 33203967 PMCID: PMC9014848 DOI: 10.1038/s41390-020-01230-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND With high survival rates for pediatric acute lymphoblastic leukemia (ALL), long-term quality of life is a prominent consideration in treatment. We concurrently evaluated cognition, behavior, and quality of life in child and adolescent ALL survivors and determined associations between them. METHODS The sample included 83 controls (mean age: 12.5 years) and 71 ALL survivors (mean age: 11.9 years, mean age at diagnosis: 3.8 years). Participants completed measures of general intellectual abilities, math achievement, and fine motor skills. Parents and teachers completed a survey assessing child participants' cognitive, behavioral, and emotional function. Parents additionally completed a survey about their child's quality of life. RESULTS Survivors had lower scores on measures of working memory, processing speed, timed math, and fine motor skills (effect size 0.5-1, p < 0.001). Parents identified more problems with executive function and learning in survivors than controls (effect size > 0.7, p < 0.001), and indicated a lower quality of life in all categories evaluated (effect size > 0.7, p < 10-4). Reduced quality of life was associated with lower math achievement scores and with inattention and executive function problems. CONCLUSIONS ALL survivors experience diffuse cognitive, behavioral, and motor impairments, which are associated with reduced quality of life. These findings underscore the need to address these challenges in ALL survivors. IMPACT Compared with cancer-free peers, parents of childhood acute lymphoblastic leukemia survivors treated with chemotherapy only reported reduced quality of life. Math difficulties and behavioral problems increased the risk for reduced quality of life. Reduced quality of life is associated with mild cognitive and behavioral difficulties, suggesting that even relatively mild impairments have broad implications for ALL survivors. Screening and early intervention targeting cognitive and behavioral function may enhance quality of life for ALL survivors.
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Affiliation(s)
- Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital & Clinics, Iowa City, IA
| | - T. Leigh Spencer Noakes
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, ON, Canada,Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Darci T. Butcher
- Genetics & Genome Biology, Hospital for Sick Children Research Institute, Toronto, ON, Canada,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Rosanna Weksberg
- Genetics & Genome Biology, Hospital for Sick Children Research Institute, Toronto, ON, Canada,Clinical and Metabolic Genetics, Hospital for Sick Children Research Institute, Toronto, ON, Canada,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | | | - Elizabeth A. Wanstall
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Psychology, York University, Toronto, ON, Canada
| | - Patrick Te
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada,Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
| | - Laura Hopf
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Guger
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Johann Hitzler
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, ON, Canada,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J. Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada,Psychiatry Research, Hospital for Sick Children, Toronto, ON, Canada
| | - Shinya Ito
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada,Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada,Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brian J. Nieman
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, ON, Canada,Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada,Ontario Institute for Cancer Research, Toronto, ON, Canada,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada,Corresponding Author: Brian J. Nieman, Hospital for Sick Children, Centre for Phenogenomics25 Orde Street, Toronto, ON, Canada, M5T 3H7; 416-813-7654 ext. 309555;
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8
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Karlson CW, Sarver DE, Raiker JS, Espil FM, Cox AD, Elkin TD, Annett RD. The contribution of neurocognitive functions to academic and psychological outcomes in pediatric cancer: A latent profile analysis. Child Neuropsychol 2020; 26:881-899. [PMID: 32157961 DOI: 10.1080/09297049.2020.1734553] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This study aimed to identify the impact of neurocognitive functioning on academic and psychological domains using a novel person-centered latent profile analysis approach. We further examined the contribution of identified risk factors (e.g., age at diagnosis, treatment) on latent class membership. 101 pediatric oncology patients and survivors (M age = 11.2, 35.6% female; 47.5% African American; M time since diagnosis = 3.4 years) completed neuropsychological evaluations at a university medical center between February 2004 and June 2017. Neurocognitive, academic, and emotional-behavioral functioning were examined using validated measures. Discreet, homogenous neurocognitive subgroups (latent classes) were identified using latent profile analysis. Demographic and medical factors were evaluated as predictors of latent class. A 3-class model indicated excellent class separation (range: .00-.04) and homogeneity (range: .94-.99). Classes were distinguished by differential cognitive patterns. Class 2 (52%) and Class 3 (25%) displayed overall normative functioning; however, Class 3 displayed significantly poorer attention than the other two classes. Class 1 (23%) demonstrated Borderline neurocognitive, low average academic, and poorer emotional-behavioral and inhibition/executive control functioning. Class membership was predicted by race and whole brain radiation dose. Latent profile analysis identified discrete groups in neurocognitive functioning in this heterogeneous pediatric cancer population. Class membership was predicted by race, whole brain radiation dose, and referral source. Other medical variables (e.g., diagnosis, age at diagnosis) were not significant predictors of neurocognitive function in our sample.
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Affiliation(s)
- Cynthia W Karlson
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA.,Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA
| | - Dustin E Sarver
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center , Jackson, MS, USA
| | - Joseph S Raiker
- Department of Psychology, Florida International University , Miami, FL, USA
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, CA, USA
| | - Amanda D Cox
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA
| | - T David Elkin
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center , Jackson, MS, USA
| | - Robert D Annett
- Center for Advancement of Youth, Department of Pediatrics, University of Mississippi Medical Center , Jackson, MS, USA
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Gummersall T, Skaczkowski G, Wilson C. Childhood cancer, age at diagnosis and educational attainment: A meta-analysis. Crit Rev Oncol Hematol 2020; 145:102838. [DOI: 10.1016/j.critrevonc.2019.102838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/25/2019] [Accepted: 11/20/2019] [Indexed: 12/23/2022] Open
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10
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Balsamo LM, Mitchell HR, Ross W, Metayer C, Hardy KK, Kadan-Lottick NS. Monitoring neurocognitive functioning in childhood cancer survivors: evaluation of CogState computerized assessment and the Behavior Rating Inventory of Executive Function (BRIEF). BMC Psychol 2019; 7:26. [PMID: 31046815 PMCID: PMC6498488 DOI: 10.1186/s40359-019-0302-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/15/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many childhood cancer survivors develop neurocognitive impairment, negatively affecting education and psychosocial functioning. Recommended comprehensive neuropsychological testing can be time- and cost- intensive for both institutions and patients and their families. It is important to find quick and easily administered surveillance measures to identify those in need of evaluation. METHODS We evaluated, individually and in combination, the sensitivity and specificity of the 1) Behavior Rating Inventory of Executive Functioning-Metacognition Index (BRIEF-MCI), and 2) CogState Composite Index (computerized assessment of cognition) in identifying below grade-level performance on state-administered tests of reading and mathematics among childhood cancer survivors. RESULTS The 45 participants (39% female) were a mean age of 7.1 ± 4.4 years at diagnosis, 14.0 ± 3.0 at evaluation, with a history of leukemia (58%), lymphoma (9%), central nervous system tumors (20%), and other tumors (13%). Impairment on the BRIEF-MCI was associated with low sensitivity (26% reading, 41% mathematics) but stronger specificity (88% reading, 96% mathematics). We found similar associations for the CogState Composite Index with sensitivity of 26% for reading and 29% for mathematics and specificity of 92% for both reading and mathematics. Combining the two measures did not improve sensitivity appreciably (47% reading, 59% mathematics) while reducing specificity (84% reading, 88% mathematics). CONCLUSIONS While individuals identified from the BRIEF-MCI or CogState Composite would likely benefit from a full neuropsychological evaluation given the strong specificity, use of these measures as screening tools is limited. With poor sensitivity, they do not identify many patients with academic difficulties and in need of a full neuropsychological evaluation. Continued effort is required to find screening measures that have both strong sensitivity and specificity.
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Affiliation(s)
- Lyn M Balsamo
- Yale University School of Medicine, 15 PO Box 208064, 16 333 Cedar Street, LMP-2073 (for courier mail), 17, New Haven, CT, 06520-8064, USA.
| | | | - Wilhelmenia Ross
- Yale University School of Medicine, 15 PO Box 208064, 16 333 Cedar Street, LMP-2073 (for courier mail), 17, New Haven, CT, 06520-8064, USA
| | - Catherine Metayer
- School of Public Health, University of California, Berkeley, California, USA
| | - Kristina K Hardy
- Center for Neuroscience and Behavioral Medicine, Neuropsychology Division, Children's National Medical Center, Washington, DC, USA
- Department of Psychiatry and Behavioral Science, George Washington University School of Medicine, Washington, DC, USA
| | - Nina S Kadan-Lottick
- Yale University School of Medicine, 15 PO Box 208064, 16 333 Cedar Street, LMP-2073 (for courier mail), 17, New Haven, CT, 06520-8064, USA
- Yale Cancer Center, New Haven, CT, USA
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11
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An H, Lee S. Difficulty in returning to school among adolescent leukemia survivors: A qualitative descriptive study. Eur J Oncol Nurs 2019; 38:70-75. [DOI: 10.1016/j.ejon.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 12/04/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
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12
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Boulet-Craig A, Robaey P, Laniel J, Bertout L, Drouin S, Krajinovic M, Laverdière C, Sinnett D, Sultan S, Lippé S. DIVERGT screening procedure predicts general cognitive functioning in adult long-term survivors of pediatric acute lymphoblastic leukemia: A PETALE study. Pediatr Blood Cancer 2018; 65:e27259. [PMID: 29797640 DOI: 10.1002/pbc.27259] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/24/2018] [Accepted: 05/06/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Because of major improvements in treatment protocols, the survival rate now exceeds 80%. However, ALL treatments can cause long-term neurocognitive sequelae, which negatively impact academic achievement and quality of life. Therefore, cognitive sequelae need to be carefully evaluated. The DIVERGT is a battery of tests proposed as a screening tool, sensitive to executive function impairments in children and adolescent cancer survivors. Our study aimed at verifying the predictive value of the DIVERGT on general cognitive functioning in adult long-term survivors of ALL. METHODS ALL survivors completed the DIVERGT 13.4 years, on average, after remission (N = 247). In addition, 49 of these survivors (equally selected amongst those with low, average, and high DIVERGT scores) as well as 29 controls completed a more comprehensive neuropsychological evaluation within a 3-year period from DIVERGT administration. Multivariate regression analysis was used to assess the predictive value of the DIVERGT on general intelligence, mathematics, verbal memory, and working memory. As a follow-up analysis, three performance groups were created based on the DIVERGT results. Multivariate analysis of variance (MANOVA) assessed neuropsychological differences between groups. RESULTS The DIVERGT accurately predicted General Ability Index (GAI) (P < 0.0001), mathematics (P < 0.0001) and verbal memory (P = 0.045). Moreover, the low-performance group consistently had poorer performance than the high-performance and control groups on the neuropsychological tests. CONCLUSION The DIVERGT is a useful, time-effective screening battery for broader neurocognitive impairments identification in long-term adult ALL survivors. It could be implemented as routine examination in cancer follow-up clinics.
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Affiliation(s)
- Aubree Boulet-Craig
- Sainte-Justine University Health Center, Research Center, Montréal, Québec, Canada.,Université de Montréal, Department of Psychology, Montréal, Québec, Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center, Research Center, Montréal, Québec, Canada.,Université de Montréal, Department of Pediatrics, Montréal, Québec, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Department of Psychiatry, Ottawa, Ontario, Canada
| | - Julie Laniel
- Sainte-Justine University Health Center, Research Center, Montréal, Québec, Canada.,Université de Montréal, Department of Psychology, Montréal, Québec, Canada
| | - Laurence Bertout
- Sainte-Justine University Health Center, Research Center, Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center, Research Center, Montréal, Québec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center, Research Center, Montréal, Québec, Canada.,Université de Montréal, Department of Pediatrics, Montréal, Québec, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center, Research Center, Montréal, Québec, Canada.,Université de Montréal, Department of Pediatrics, Montréal, Québec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Research Center, Montréal, Québec, Canada.,Université de Montréal, Department of Pediatrics, Montréal, Québec, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center, Research Center, Montréal, Québec, Canada.,Université de Montréal, Department of Psychology, Montréal, Québec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center, Research Center, Montréal, Québec, Canada.,Université de Montréal, Department of Psychology, Montréal, Québec, Canada
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13
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Abstract
BACKGROUND Acute lymphoblastic leukemia is the most common pediatric cancer, and survival approaches 90%. Acute lymphoblastic leukemia survivors are more likely than healthy peers or siblings to experience academic underachievement, yet little is known about neurocognitive predictors of academic outcomes. OBJECTIVES Objectives were to compare neurocognitive abilities to age-adjusted standardized norms, examine change over time in neurocognitive abilities, and establish neurocognitive predictors of academic outcomes. METHODS Seventy-one children were followed over the course of therapy. Cognitive abilities were assessed during induction when the child was in remission (baseline) and annually for 3 years (years 1, 2, and 3). Reading and mathematics abilities were assessed at year 3. RESULTS Fine motor dexterity was significantly below age-adjusted norms at all data points but showed improvement over time. Baseline visual-motor integration was within the reference range but significantly declined by year 3, and mean scores at years 2 and 3 were significantly below age-adjusted norms. Verbal short-term memory was significantly below age-adjusted norms at all assessments. Visual-motor integration predicted reading and mathematics abilities. Verbal short-term memory predicted reading abilities, and visual short-term memory predicted mathematics abilities. CONCLUSIONS Central nervous system-directed therapy is associated with specific neurocognitive problems. Visual-spatial skills and verbal and visual short-term memory predict academic outcomes. IMPLICATIONS FOR PRACTICE Early assessment of visual-spatial perception and short-term memory can identify children at risk of academic problems. Children who are at risk of academic problems could benefit from a school-based individual educational program and/or educational intervention.
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14
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Bava L, Johns A, Freyer DR, Ruccione K. Development of a Culturally Competent Service to Improve Academic Functioning for Latino Survivors of Acute Lymphoblastic Leukemia: Methodological Considerations. J Pediatr Oncol Nurs 2016; 34:222-229. [PMID: 27889691 DOI: 10.1177/1043454216676837] [Citation(s) in RCA: 7] [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
Many survivors of childhood acute lymphoblastic leukemia (ALL) develop neurocognitive deficits that compromise academic functioning, especially in the presence of sociodemographic risk factors. The extent to which these risk factors coexist for Latino ALL survivors is not well described, but with shifts in U.S. demographics and improved survival in ALL, culturally competent interventions are needed. The Achieving Best Cognitive Successes after Cancer service was designed and implemented by a team representing nursing, medicine, psychology, and social work. Service components include neurocognitve assessment and individualized intervention for treatment-related risks and improving academic success for school-aged ALL survivors. Interventions are child-focused and parent-directed, recognizing that parents are major sources of support and advocates for their children within school systems. The service was designed to be culturally appropriate for the predominantly Latino patient population at our center, based on (1) linguistic competency of children and parents; (2) multicultural and ecological considerations for urban, low socioeconomic status, and migrant populations; (3) literacy barriers; and (4) contextual factors. This report describes methodological considerations and practice implications relevant to the design and implementation of similar culturally competent services for Latino pediatric cancer survivors.
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Affiliation(s)
- Laura Bava
- 1 Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alexis Johns
- 1 Children's Hospital Los Angeles, Los Angeles, CA, USA.,2 University of Southern California, Los Angeles, CA, USA
| | - David R Freyer
- 1 Children's Hospital Los Angeles, Los Angeles, CA, USA.,2 University of Southern California, Los Angeles, CA, USA
| | - Kathleen Ruccione
- 2 University of Southern California, Los Angeles, CA, USA.,3 Azusa Pacific University, Azusa, CA, USA
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15
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Tougas AM, Jutras S, Bigras M. Types and Influence of Social Support on School Engagement of Young Survivors of Leukemia. J Sch Nurs 2016; 32:281-93. [DOI: 10.1177/1059840516635711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The present study aimed to describe and explore the influence of social support on the school engagement of young survivors of pediatric leukemia. Fifty-three young Quebecers, previously diagnosed and treated for leukemia, completed a questionnaire measuring their school engagement and participated in an interview focusing on the support offered by four groups of relations with regard to school: parents, siblings, friends, and other nonprofessional relations. The interview responses revealed that parents were perceived to be the primary source of informational and emotional support, with support also provided to a lesser extent by friends, siblings, and members of the extended family. Inferential analyses indicated that young survivors report a higher school engagement score when they perceive themselves as receiving support from a greater number of groups of relations, especially from friends or siblings.
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Affiliation(s)
| | - Sylvie Jutras
- Université du Québec à Montréal, Montréal, QC, Canada
| | - Marc Bigras
- Université du Québec à Montréal, Montréal, QC, Canada
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16
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Stingone JA, McVeigh KH, Claudio L. Association between prenatal exposure to ambient diesel particulate matter and perchloroethylene with children's 3rd grade standardized test scores. ENVIRONMENTAL RESEARCH 2016; 148:144-153. [PMID: 27058443 PMCID: PMC4874864 DOI: 10.1016/j.envres.2016.03.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/07/2016] [Accepted: 03/25/2016] [Indexed: 05/06/2023]
Abstract
UNLABELLED The objective of this research was to determine if prenatal exposure to two common urban air pollutants, diesel and perchloroethylene, affects children's 3rd grade standardized test scores in mathematics and English language arts (ELA). Exposure estimates consisted of annual average ambient concentrations of diesel particulate matter and perchloroethylene obtained from the Environmental Protection Agency's 1996 National Air Toxics Assessment for the residential census tract at birth. Outcome data consisted of linked birth and educational records for 201,559 singleton, non-anomalous children born between 1994 and 1998 who attended New York City public schools. Quantile regression models were used to estimate the effects of these exposures on multiple points within the continuous distribution of standardized test scores. Modified Poisson regression models were used to calculate risk ratios (RR) and 95% confidence intervals (CI) of failing to meet curricula standards, an indicator derived from test scores. Models were adjusted for a number of maternal, neighborhood and childhood factors. Results showed that math scores were approximately 6% of a standard deviation lower for children exposed to the highest levels of both pollutants as compared to children with low levels of both pollutants. Children exposed to high levels of both pollutants also had the largest risk of failing to meet math test standards when compared to children with low levels of exposure to the pollutants (RR 1.10 95%CI 1.07,1.12 RR high perchloroethylene only 1.03 95%CI 1.00,1.06; RR high diesel PM only 1.02 95%CI 0.99,1.06). There was no association observed between exposure to the pollutants and failing to meet ELA standards. This study provides preliminary evidence of associations between prenatal exposure to urban air pollutants and lower academic outcomes. Additionally, these findings suggest that individual pollutants may additively impact health and point to the need to study the collective effects of air pollutant mixtures. KEY WORDS air toxics, academic outcomes, urban health, tetrachloroethylene, air pollutant mixtures.
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Affiliation(s)
- Jeanette A Stingone
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1057, New York, NY 10029, United States.
| | - Katharine H McVeigh
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, Queens, NY United States
| | - Luz Claudio
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1057, New York, NY 10029, United States
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17
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Balsamo LM, Sint KJ, Neglia JP, Brouwers P, Kadan-Lottick NS. The Association Between Motor Skills and Academic Achievement Among Pediatric Survivors of Acute Lymphoblastic Leukemia. J Pediatr Psychol 2016; 41:319-28. [PMID: 26514641 PMCID: PMC4852216 DOI: 10.1093/jpepsy/jsv103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Assess the association between fine motor (FM) and visual-motor integration (VMI) skills and academic achievement in pediatric acute lymphoblastic leukemia (ALL) survivors. METHODS In this 28-site cross-sectional study of 256 children in first remission, a mean of 8.9 ± 2.2 years after treatment for standard-risk precursor-B ALL, validated measures of FM, VMI, reading, math, and intelligence were administered at mean follow-up age of 12.8 ± 2.5 years. RESULTS VMI was significantly associated with written math calculation ability (p < .0069) after adjusting for intelligence (p < .0001). VMI was more strongly associated with math in those with lower intelligence (p = .0141). Word decoding was also significantly associated with VMI but with no effect modification by intelligence. FM skills were not associated with either reading or math achievement. CONCLUSION These findings suggest that VMI is associated with aspects of math and reading achievement in leukemia survivors. These skills may be amenable to intervention.
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Affiliation(s)
- Lyn M Balsamo
- Section of Pediatric Hematology/Oncology, Yale University School of Medicine
| | | | | | - Pim Brouwers
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Nina S Kadan-Lottick
- Section of Pediatric Hematology/Oncology, Yale University School of Medicine Yale Comprehensive Cancer Center, New Haven, CT, USA
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18
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Tougas AM, Jutras S, Bigras M, Tourigny M. The potential role of benefit and burden finding in school engagement of young leukaemia survivors: an exploratory study. Child Care Health Dev 2016; 42:68-75. [PMID: 25824576 DOI: 10.1111/cch.12245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Childhood cancer may radically change the daily lives of young survivors, particularly in school. Depending on the sense they derive from the experience of illness, survivors may go through profound transformations in the way they approach life. METHODS This exploratory study reports on school engagement of cancer survivors by examining their perceptions of benefits and burdens in relation to their illness. Forty-nine young Quebecers, previously diagnosed and treated for leukaemia, completed a questionnaire measuring their school engagement and participated in an interview focusing on the impact of cancer on their lives. Perceptions with regard to the presence and types of benefits and burdens were described and examined in light of participants' characteristics. An analysis of variance explored whether the presence/absence of benefits and burdens were associated with participants' scores regarding school engagement. RESULTS Most participants mentioned benefits from having had cancer, and in particular benefits at an interpersonal level. Half of the participants mentioned burdens, mainly of a physical and psychological nature. Significant correlations indicated that (i) the older the survivors were, the more likely they were to report benefits in terms of qualities and strengths of character; (ii) the more time had elapsed since their diagnosis, the more survivors were likely to report psychological types of burdens; and (iii) children from single-parent families reported more frequently having appreciated social or recreational activities compared with children from two-parent families. One main effect indicated that school engagement was greater for survivors who perceived the presence of benefits. An interaction effect revealed that the perception of both benefits and burdens predicts the highest scores of school engagement. CONCLUSIONS While the results reveal the promising potential that an optimistic yet realistic disposition has in regard to school engagement, more research is necessary to further our understanding of such a disposition.
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Affiliation(s)
- A-M Tougas
- Psychoéducation, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - S Jutras
- Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - M Bigras
- Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - M Tourigny
- Psychoéducation, Université de Sherbrooke, Sherbrooke, QC, Canada
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19
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Educational attainment among long-term survivors of cancer in childhood and adolescence: a Norwegian population-based cohort study. J Cancer Surviv 2015; 10:87-95. [PMID: 25929213 DOI: 10.1007/s11764-015-0453-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The number of young cancer survivors has increased over the past few decades due to improvement in treatment regimens, and understanding of long-term effects among the survivors has become even more important. Educational achievements and choice of educational fields were explored here. METHODS Five-year cancer survivors born in Norway during 1965-1985 (diagnosed <19 years) were included in our analysis by linking Norwegian population-based registries. Cox regression was applied to study the educational attainment among survivors of central nervous system (CNS) tumours, those assumed to have received CNS-directed therapy, and other cancer survivors relative to the cancer-free population. Logistic regression was used to compare the choice of educational fields between the cancer survivors at undergraduate and graduate level and the cancer-free population. RESULTS Overall, a lower proportion of the cancer survivors completed intermediate (67 vs. 70 %), undergraduate (31 vs. 35 %) and graduate education (7 vs. 9 %) compared with the cancer-free population. Deficits in completion of an educational level were mainly observed among survivors of CNS-tumours and those assumed to have received CNS-directed therapy. Choices of educational fields among cancer survivors were in general similar with the cancer-free population at both undergraduate and graduate levels. CONCLUSION Survivors of CNS-tumours and those assumed to have received CNS-directed therapy were at increased risk for educational impairments compared with the cancer-free population. Choices of educational fields were in general similar. IMPLICATIONS FOR CANCER SURVIVORS Careful follow-up of the survivors of CNS-tumours and those assumed to have received CNS-directed therapy is important at each level of education.
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