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Braniecki S, Vichinsky E, Walters MC, Shenoy S, Shi Q, Moore TB, Talano JA, Parsons SK, Flower A, Panarella A, Fabricatore S, Morris E, Mahanti H, Milner J, McKinstry RC, Duncan CN, van de Ven C, Cairo MS. Neurocognitive outcome in children with sickle cell disease after myeloimmunoablative conditioning and haploidentical hematopoietic stem cell transplantation: a non-randomized clinical trial. Front Neurol 2024; 15:1263373. [PMID: 38841694 PMCID: PMC11151850 DOI: 10.3389/fneur.2024.1263373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
Background Due to the risk of cerebral vascular injury, children and adolescents with high-risk sickle cell disease (SCD) experience neurocognitive decline over time. Haploidentical stem cell transplantation (HISCT) from human leukocyte antigen-matched sibling donors may slow or stop progression of neurocognitive changes. Objectives The study is to determine if HISCT can ameliorate SCD-associated neurocognitive changes and prevent neurocognitive progression, determine which specific areas of neurocognitive functioning are particularly vulnerable to SCD, and determine if there are age-related differences in neurocognitive functioning over time. Methods We performed neurocognitive and neuroimaging in SCD recipients following HISCT. Children and adolescents with high-risk SCD who received parental HISCT utilizing CD34+ enrichment and mononuclear cell (T-cell) addback following myeloimmunoablative conditioning received cognitive evaluations and neuroimaging at three time points: pre-transplant, 1 and 2 years post-transplant. Results Nineteen participants (13.1 ± 1.2 years [3.3-20.0]) received HISCT. At 2 years post-transplant, neuroimaging and cognitive function were stable. Regarding age-related differences pre-transplantation, older children (≥13 years) had already experienced significant decreases in language functioning (p < 0.023), verbal intelligence quotient (p < 0.05), non-verbal intelligence quotient (p < 0.006), and processing speed (p < 0.05), but normalized post-HISCT in all categories. Conclusion Thus, HISCT has the potential to ameliorate SCD-associated neurocognitive changes and prevent neurocognitive progression. Further studies are required to determine if neurocognitive performance remains stable beyond 2 years post-HISCT.Clinical trial registration: The study was conducted under an investigator IND (14359) (MSC) and registered at clinicaltrials.gov (NCT01461837).
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Affiliation(s)
- Suzanne Braniecki
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Elliott Vichinsky
- Department of Pediatrics, UCSF Benioff Children’s Hospital, Oakland, CA, United States
| | - Mark C. Walters
- Department of Pediatrics, UCSF Benioff Children’s Hospital, Oakland, CA, United States
| | - Shalini Shenoy
- Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Qiuhu Shi
- Department of Epidemiology, New York Medical College, Valhalla, NY, United States
| | - Theodore B. Moore
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Julie-An Talano
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Susan K. Parsons
- Department of Medicine and Pediatrics, Tufts Medical Center, Boston, MA, United States
| | - Allyson Flower
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Anne Panarella
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Sandra Fabricatore
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Erin Morris
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Harshini Mahanti
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Jordan Milner
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Robert C. McKinstry
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Radiology, Washington University, St Louis, MO, United States
| | - Christine N. Duncan
- Dana-Faber/Children’s Cancer and Blood Disorders Center, Boston, MA, United States
| | - Carmella van de Ven
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Mitchell S. Cairo
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
- Department of Medicine, New York Medical College, Valhalla, NY, United States
- Department of Pathology, New York Medical College, Valhalla, NY, United States
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, United States
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, United States
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Turner EM, Wilkening G, Hutaff-Lee C, Wolfe KR. From Evidence-Based Guidelines to Clinical Practice: Pediatric Neuropsychology Care in Multidisciplinary Clinics. Arch Clin Neuropsychol 2024:acad099. [PMID: 38205830 DOI: 10.1093/arclin/acad099] [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: 04/21/2023] [Revised: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE High demand for pediatric neuropsychological care has highlighted the time- and resource-intensive nature of traditional comprehensive evaluations. Emerging care models address these constraints by facilitating tiered neuropsychological services provided in various contexts, including multidisciplinary clinics (MDCs). We aim to demonstrate feasibility and acceptability of tiered neuropsychological care in MDCs through examples from a single institution. METHODS A review of all current MDC practices at a tertiary pediatric care center was conducted to describe clinic workflow, services provided, and triage strategies. Pediatric neuropsychologists (n = 5) and other health care providers (n = 31) completed a survey focused on experience with neuropsychology consultation in MDCs. RESULTS Neuropsychologists provided care in 11 MDCs, including universal monitoring with consultative interviews and questionnaires, as well as targeted screening. Neuropsychologists (89%) and other health professionals (100%) reported that tiered neuropsychological services improved patient care within MDCs. Other health professionals reported utilizing results from neuropsychology MDC care to inform their clinical approach (48-90%), referrals (58%), and treatment or surveillance decisions (55-71%). CONCLUSION Tiered neuropsychological care in pediatric MDCs is feasible, and provider experience ratings indicate high acceptability. Practical steps for development of MDCs are provided, including identifying teams, clinic goals and outcomes, operational logistics, and billing.
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Affiliation(s)
- Elise M Turner
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Greta Wilkening
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Christa Hutaff-Lee
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Kelly R Wolfe
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
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Pereira L, Bono MH, Braniecki S, Giblin T, Lawton B. Are Young Adult Survivors of Pediatric Cancer Being Overlooked? Cognitive Testing Results and Referrals in Child, Adolescent, and Young Adult Survivors. J Adolesc Young Adult Oncol 2023; 12:782-786. [PMID: 36856489 DOI: 10.1089/jayao.2022.0080] [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: 03/02/2023] Open
Abstract
Treatment gaps in meeting the neuropsychological needs of young adult (YA) cancer survivors can be attributed to several clinical and systemic reasons. Access to neurocognitive care can be increased through the effective integration of neuropsychological monitoring and intervention in survivorship care. In this brief report, we aim to compare the efficacy of a brief neuropsychological screener (DIVERGT) in meeting the assessment and referral needs of pediatric and YA cancer survivors (n = 40) as part of a wellness and survivorship clinic. Participants (n = 40) were patients who presented to a pediatric oncology survivorship clinic over the span of 15 months.
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Affiliation(s)
- Lila Pereira
- Department of Pediatrics, New York Medical College, Valhalla, New York, USA
- The Pediatric Hematology, Oncology, and Stem Cell Transplantation, Maria Fareri Children's Hospital, Valhalla, New York, USA
- The Pediatric Hematology, Oncology, and Stem Cell Transplantation, Boston Children's Health Physicians, Hawthorne, New York, USA
| | - Madeline H Bono
- Department of Pediatrics, New York Medical College, Valhalla, New York, USA
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey
| | - Suzanne Braniecki
- Department of Pediatrics, New York Medical College, Valhalla, New York, USA
- The Pediatric Hematology, Oncology, and Stem Cell Transplantation, Maria Fareri Children's Hospital, Valhalla, New York, USA
- The Pediatric Hematology, Oncology, and Stem Cell Transplantation, Boston Children's Health Physicians, Hawthorne, New York, USA
| | - Tara Giblin
- The Pediatric Hematology, Oncology, and Stem Cell Transplantation, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Brittany Lawton
- Department of Pediatric Kidney Transplant, Lucille Packard Stanford Children's Hospital, Palo Alto, California, USA
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4
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Mochon A, Lippé S, Krajinovic M, Laverdière C, Marjerrison S, Michon B, Robaey P, Rondeau É, Sinnett D, Sultan S. Contribution of Fatigue to Cognitive Dysfunction in Childhood Acute Lymphoblastic Leukemia Survivors. Pediatr Hematol Oncol 2023; 40:554-567. [PMID: 37469296 DOI: 10.1080/08880018.2023.2215819] [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: 12/22/2022] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 07/21/2023]
Abstract
Late effects such as neurocognitive issues and fatigue have been reported in childhood acute lymphoblastic leukemia (cALL) survivors. Yet, their association is often poorly understood. In this study, we wished to (1) describe neurocognitive difficulties and fatigue in a well-characterized cohort of long-term cALL survivors and (2) explore the risk of having neurocognitive deficits as a function of fatigue. Childhood ALL survivors (N = 285) from three Canadian treatment centers completed the DIVERGT battery of cognitive tests and the PedsQL Multidimensional Fatigue Scale. We performed logistic regressions to assess the risk of a survivor to show cognitive deficits (<2.0 SD) depending on their fatigue levels. At least one cognitive deficit on the DIVERGT was present in 31% of participants. Domains primarily affected were working memory, fine motor skills, and verbal fluency. Sleep/rest fatigue in youths was higher than norms (d = 0.35). The risk for cognitive deficits increased independently with levels of fatigue in the domains of cognitive speed and flexibility, working memory, and verbal fluency. For every 10-point increase on general or sleep/rest fatigue on the 0-100 scale, there was a median +23-35% risk of showing a deficit among the 7 tasks significantly associated with fatigue. Fatigue may constitute a complementary target when searching to mitigate cognitive issues in this population.
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Affiliation(s)
- Alice Mochon
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Lippé
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Maja Krajinovic
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Caroline Laverdière
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Stacey Marjerrison
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Bruno Michon
- Department of Hematology-Oncology, Quebec University Health Center (QUHC), Montréal, Québec, Canada
| | - Philippe Robaey
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Émélie Rondeau
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Daniel Sinnett
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Serge Sultan
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
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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.
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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.
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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.
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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
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7
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Sedation Practices for Lumbar Punctures in Patients With Acute Lymphoblastic Leukemia: A Multicenter Retrospective Study Using Pediatric Health Information Systems. J Pediatr Hematol Oncol 2022; 44:e982-e987. [PMID: 35293881 DOI: 10.1097/mph.0000000000002446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sedation is often used to reduce pain and anxiety in pediatric patients with acute lymphoblastic leukemia (ALL) undergoing lumbar punctures (LPs). There is a potential for long-term effects on neurocognition with repeat sedative exposures in young children. The purpose of this study is to determine the practice habits regarding sedation for LPs in pediatric patients with ALL among multiple institutions. METHODS This is a retrospective study of 48 hospitals in the Pediatric Health Information Systems (PHIS) between October 2015 and December 2019. Children 1 to 18 years old with ALL who received intrathecal chemotherapy in an outpatient setting were included. We analyzed the prevalence of anesthesia usage and the types of anesthetics used. RESULTS Of the 16,785 encounters with documented use of anesthetic medications, intravenous and inhaled anesthetics were used in 16,486 (98.2%) and local anesthetics alone in 299 (1.8%). The most commonly used medications used for sedation were propofol (n=13,279; 79.1%), midazolam (n=4228; 25.2%), inhaled fluranes (n=3169; 18.9%), and ketamine (n=2100; 12.5%). CONCLUSION The majority of children's hospitals in the United States use intravenous and inhaled anesthetics for routine therapeutic LPs in pediatric patients with ALL. Propofol is one of the most common medications used for sedation.
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Abstract
OBJECTIVE The relationship between fatigue and cognition has not been fully elucidated in children and adolescent survivors of brain tumours. The aim of the present study was to investigate the potential relationship between fatigue and cognitive impairments in these survivors, as this group is at risk for both types of deficits. METHODS Survivors of paediatric brain tumours (n = 45) underwent a neuropsychological testing on average 4 years after diagnosis. Mean age at follow-up was 13.41 years. Cognition was assessed with neuropsychological tests, and fatigue with the Pediatric Quality of Life (PedsQL™) Multidimensional Fatigue Scale. Regression analysis, adjusted for cranial radiotherapy and age at diagnosis, was used to investigate the associations between cognitive variables and fatigue subscales. Cognitive variables associated with fatigue were subsequently exploratively assessed. RESULTS Significant associations were found for cognitive fatigue and measures of cognitive processing speed; Coding: p = .003, r = .583, 95% CI [9.61; 22.83] and Symbol Search: p = .001, r = .585, 95% CI [10.54; 24.87]. Slower processing speed was associated with poorer results for cognitive fatigue. Survivors with the largest decrease in processing speed from baseline to follow-up also experienced the most cognitive fatigue. Survivors expressed more cognitive fatigue compared to other types of fatigue. CONCLUSIONS The association between cognitive fatigue and cognitive processing speed in children and adolescents treated for brain tumours is in concordance with the results previously reported in adults. Some survivors experience fatigue without impairment in processing speed, indicating the need for comprehensive assessments. Moreover, the study supports that fatigue is a multidimensional concept which should be measured accordingly.
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Brief, Performance-Based Cognitive Screening in Youth Aged 12-25: A Systematic Review. J Int Neuropsychol Soc 2021; 27:835-854. [PMID: 33461647 DOI: 10.1017/s1355617720001241] [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: 11/07/2022]
Abstract
OBJECTIVE Cognitive screening is an efficient method of detecting cognitive impairment in adults and may signal need for comprehensive assessment. Cognitive screening is not, however, routinely used in youth aged 12-25, limiting clinical recommendations. The aims of this review were to describe performance-based cognitive screening tools used in people aged 12-25 and the contexts of use, review screening accuracy in detecting cognitive impairment relative to an objective reference standard, and evaluate the risk of bias of included studies. METHOD Electronic databases (Scopus, Medline, PsychINFO, and ERIC) were searched for relevant studies according to pre-determined criteria. Risk of bias was rated using the Quality Assessment of Diagnostic Accuracy Studies-2. Dual screening, extraction, and quality ratings occurred at each review phase. RESULTS Twenty studies met the review inclusion criteria. A diverse range of screening tools (length, format) were used in youth aged 12-25 with or without health conditions. Six studies investigating cognitive screening were conducted as primary accuracy studies and reported some relevant psychometric parameters (e.g., sensitivity and specificity). Fourteen studies presented correlational data to investigate the cognitive measure utility. Studies generally presented limited data on classification accuracy, which impacted full screening tool appraisal. Risk of bias was high (or unclear) in most studies with poor adherence to the Standards for Reporting Diagnostic Accuracy Studies (STARD) criteria. CONCLUSIONS Few, high quality studies have investigated the utility of cognitive screening in youth aged 12-25, with no screening measure emerging as superior at detecting cognitive impairment in this age group.
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Bava L, Freyer DR, Radbill LM, Johns AL. Association of language proficiency, sociodemographics, and neurocognitive functioning in dual-language Latino survivors of childhood acute lymphoblastic leukemia and lymphoma. Pediatr Blood Cancer 2021; 68:e29118. [PMID: 34019328 DOI: 10.1002/pbc.29118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukemia and lymphoma (ALL/LL) are at risk for cognitive dysfunction, but little is known about its relationship with language proficiency and sociodemographics. PROCEDURE In this cross-sectional cohort study of Latino survivors of childhood ALL/LL, English and Spanish language proficiency and cognitive and academic functioning were measured and their associations determined using paired t-tests, Pearson correlations, and linear regressions. RESULTS Participants (N = 57; 50.9% female) had mean ages (years ± SD) of 4.3 ± 2.6 at diagnosis and 10.6 ± 2.9 at testing (range 6-16); mean time post treatment was 3.7 ± 2.6 years. The majority (73.7%) had low socioeconomic status (SES). Most (78.8%) were dual-language learners in English and Spanish. English proficiency was graded as limited-to-fluent and was significantly higher than Spanish (p < .001). Higher SES was correlated with higher English proficiency (r = 0.31, p = .020). Males had higher Spanish proficiency (r = -0.32, p = .034). Controlling for SES and sex, English proficiency accounted for 43% of cognitive functioning variance (F = 14.86, p < .001), 55% of reading comprehension variance (F = 22.14, p < .001), and 21% of mathematics variance (F = 5.76, p = .002). CONCLUSIONS Low language proficiency correlated with SES but was independently associated with lower cognitive and academic functioning. Research and surveillance for neurocognitive late effects in Latino ALL/LL survivors should incorporate measures of language proficiency and SES to account for their effects on cognitive and academic functioning.
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Affiliation(s)
- Laura Bava
- Survivorship and Supportive Care Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - David R Freyer
- Survivorship and Supportive Care Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Linda M Radbill
- Survivorship and Supportive Care Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Alexis L Johns
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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11
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Elens I, Deprez S, Billiet T, Sleurs C, Labarque V, Uyttebroeck A, Van Gool S, Lemiere J, D’Hooge R. Methylene tetrahydrofolate reductase A1298C polymorphisms influence the adult sequelae of chemotherapy in childhood-leukemia survivors. PLoS One 2021; 16:e0250228. [PMID: 33930029 PMCID: PMC8087097 DOI: 10.1371/journal.pone.0250228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/03/2021] [Indexed: 11/23/2022] Open
Abstract
This retrospective correlation study investigated the putative link between methylene tetrahydrofolate reductase (MTHFR) A1298C mutations and chemotherapy-related brain function changes in adult childhood-leukemia survivors. To this end, we determined the relationship between the particular MTHFR1298 genotype (AA, AC or CC) of 31 adult childhood-leukemia survivors, and (1) their CSF Tau and phosphorylated Tau (pTau) levels at the time of treatment, (2) their adult performance intelligence quotient (PIQ), and (3) their regional brain connectivity using diffusion magnetic resonance imaging (dMRI) and resting-state functional MRI (rsfMRI). We confirmed that neuropathology markers Tau and pTau significantly increased in CSF of children after intrathecal methotrexate administration. Highest concentrations of these toxicity markers were found during the induction phase of the therapy. Moreover, CSF concentrations of Tau and pTau during treatment were influenced by the children’s particular MTHFR1298 genotype. CSF Tau (but not pTau) levels significantly dropped after folinic acid supplementation. At adult age (on average 13.1 years since the end of their treatment), their particular MTHFR1298 genotype (AA, AC or CC) influenced the changes in PIQ and cortical connectivity that we found to be related to their childhood exposure to chemotherapeutics. In summary, we suggest that homozygous MTHFR1298CC individuals are more vulnerable to the adult sequelae of antifolate chemotherapy.
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Affiliation(s)
- Iris Elens
- Laboratory of Biological Psychology, KU Leuven, Leuven, Belgium
- Department of Child and Adolescent Psychiatry, KU Leuven, University Psychiatric Centre Leuven, Leuven, Belgium
- Department of Psychiatry, AZ Delta, Roeselare, Belgium
| | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Thibo Billiet
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
- Icometrix, Leuven, Belgium
| | - Charlotte Sleurs
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
- Department of Pediatrics, Pediatric Hemato-Oncology, University Hospital Leuven, Leuven, Belgium
| | - Veerle Labarque
- Department of Pediatrics, Pediatric Hemato-Oncology, University Hospital Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, KU Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Pediatrics, Pediatric Hemato-Oncology, University Hospital Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, KU Leuven, Leuven, Belgium
| | | | - Jurgen Lemiere
- Department of Child and Adolescent Psychiatry, KU Leuven, University Psychiatric Centre Leuven, Leuven, Belgium
- Department of Pediatrics, Pediatric Hemato-Oncology, University Hospital Leuven, Leuven, Belgium
| | - Rudi D’Hooge
- Laboratory of Biological Psychology, KU Leuven, Leuven, Belgium
- * E-mail:
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Partanen M, Phipps S, Russell K, Anghelescu DL, Wolf J, Conklin HM, Krull KR, Inaba H, Pui CH, Jacola LM. Longitudinal Trajectories of Neurocognitive Functioning in Childhood Acute Lymphoblastic Leukemia. J Pediatr Psychol 2021; 46:168-178. [PMID: 33011782 PMCID: PMC7896273 DOI: 10.1093/jpepsy/jsaa086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Children with acute lymphoblastic leukemia (ALL) are at risk for neurocognitive deficits, and examining individual variability is essential to understand these risks. This study evaluated latent longitudinal trajectories and risk factors of neurocognitive outcomes in childhood ALL. METHODS There were 233 participants with ALL who were enrolled on a phase 3, risk-stratified chemotherapy-only clinical trial (NCT00137111) and who completed protocol-directed neurocognitive assessments [47.6% female, mean (SD) = 6.6 (3.7) years]. Measures of sustained attention, learning/memory, and parent ratings of attention were completed during and after treatment. Longitudinal latent class analyses were used to classify participants into distinct trajectories. Logistic regression was used to identify predictors of class membership. RESULTS Within the overall group, attention performance was below age expectations across time (Conners Continuous Performance Test detectability/variability, p < 0.01); memory performance and parent ratings were below expectations at later phases (California Verbal Learning Test learning slope, p < 0.05; Conners Parent Rating Scale, Revised attention/learning, p < 0.05). Most participants (80-89%) had stable neurocognitive profiles; smaller groups showed declining (3-6%) or improving (3-11%) trajectories. Older age (p = 0.020), female sex (p = 0.018), and experiencing sepsis (p = 0.047) were associated with greater attention problems over time. Lower baseline IQ was associated with improved memory (p = 0.035) and fewer ratings of attention problems (p = 0.013) over time. CONCLUSIONS Most patients with ALL have stable neurocognitive profiles. Smaller groups have significant impairments shortly after diagnosis or have worsening performance over time. A tiered assessment approach, which includes consideration of individual and clinical risk factors, may be useful for monitoring neurocognitive functioning during treatment and survivorship.
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13
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Al Ghriwati N, Stevens E, Velázquez-Martin B, Hocking MC, Schwartz LA, Barakat LP. Family factors and health-related quality of life within 6 months of completion of childhood cancer treatment. Psychooncology 2020; 30:408-416. [PMID: 33180350 DOI: 10.1002/pon.5592] [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] [Received: 05/04/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The transition from active cancer treatment to survivorship represents a period of uncertainty for youth and their families, but factors associated with adaptation during this period are understudied. We evaluated associations among cancer and treatment-related variables, family factors (family functioning, caregiver health-related quality of life [HRQL], and caregiver distress), and patient HRQL after treatment completion. We assessed the indirect effects of neurocognitive difficulties on youth HRQL through family factors. METHODS One hundred fifty-four caregivers (of patients' ages 0-18 years) and 52 youth (ages 7-18 years) completed questionnaires assessing family factors, neurocognitive difficulties, and HRQL for patients within 6 months following treatment completion. Electronic health records were reviewed for cancer and treatment-related information. Bootstrapping analyses assessed whether neurocognitive function had indirect effects on HRQL through family factors. RESULTS Family factors were associated with self- and caregiver reports of children's HRQL. Controlling for demographic, cancer, and treatment covariates, caregiver reports of their child's neurocognitive difficulties had an indirect effect on their reports of child physical HRQL through family functioning. Caregiver reports of their child's neurocognitive difficulties indirectly related to caregiver reports of child psychosocial HRQL through family functioning and caregiver HRQL. Indirect effects for self-reported neurocognitive difficulties and HRQL were not supported. CONCLUSIONS Findings highlight the need for routine psychosocial screening for youth and caregiver reports of family adjustment and HRQL during the transition off treatment. Providers are encouraged to offer interventions matched to specific needs for families at risk for poor family functioning to improve patient outcomes as they transition off treatment.
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Affiliation(s)
| | | | | | - Matthew C Hocking
- The Children's Hospital of Philadelphia.,Perelman School of Medicine at the University of Pennsylvania
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia.,Perelman School of Medicine at the University of Pennsylvania
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia.,Perelman School of Medicine at the University of Pennsylvania
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14
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van der Plas E, Qiu W, Nieman BJ, Yasui Y, Liu Q, Dixon SB, Kadan-Lottick NS, Weldon CB, Weil BR, Jacola LM, Gibson TM, Leisenring W, Oeffinger K, Hudson MM, Robison LL, Armstrong GT, Krull KR. Sex-Specific Associations Between Chemotherapy, Chronic Conditions, and Neurocognitive Impairment in Acute Lymphoblastic Leukemia Survivors: A Report From the Childhood Cancer Survivor Study. J Natl Cancer Inst 2020; 113:588-596. [PMID: 32882041 PMCID: PMC8096369 DOI: 10.1093/jnci/djaa136] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The purpose was to examine associations between treatment and chronic health conditions with neurocognitive impairment survivors of acute lymphoblastic leukemia (ALL) treated with chemotherapy only. METHODS This cross-sectional study included 1207 ALL survivors (54.0% female; mean age 30.6 years) and 2273 siblings (56.9% female; mean age 47.6 years), who completed the Childhood Cancer Survivor Study Neurocognitive Questionnaire. Multivariable logistic regression compared prevalence of neurocognitive impairment between survivors and siblings by sex. Associations between neurocognitive impairment with treatment exposures and chronic conditions (graded according to Common Terminology Criteria for Adverse Events) were also examined. Statistical tests were 2-sided. RESULTS Relative to same-sex siblings, male and female ALL survivors reported increased prevalence of impaired task efficiency (males: 11.7% vs 16.9%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.31 to 2.74; females: 12.5% vs 17.6%; OR = 1.50, 95% CI = 1.07 to 2.14), as well as impaired memory (males: 11.6% vs 19.9%, OR = 1.89, CI = 1.31 to 2.74; females: 14.78% vs 25.4%, OR = 1.96, 95% CI = 1.43 to 2.70, respectively). Among male survivors, impaired task efficiency was associated with 2-4 neurologic conditions (OR = 4.33, 95% CI = 1.76 to 10.68) and with pulmonary conditions (OR = 4.99, 95% CI = 1.51 to 16.50), and impaired memory was associated with increased cumulative dose of intrathecal methotrexate (OR = 1.68, 95% CI = 1.16 to 2.46) and with exposure to dexamethasone (OR = 2.44, 95% CI = 1.19 to 5.01). In female survivors, grade 2-4 endocrine conditions were associated with higher risk of impaired task efficiency (OR = 2.19, 95% CI = 1.20 to 3.97) and memory (OR = 2.26, 95% CI = 1.31 to 3.92). CONCLUSION Neurocognitive impairment is associated with methotrexate, dexamethasone, and chronic health conditions in a sex-specific manner, highlighting the need to investigate physiological mechanisms and monitor impact through survivorship.
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Affiliation(s)
- Ellen van der Plas
- University of Iowa Hospital & Clinics, Department of Psychiatry, Iowa City, IA, USA
| | - Weiyu Qiu
- University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Brian J Nieman
- The Hospital for Sick Children, Translational Medicine, Toronto, Ontario, Canada
| | - Yutaka Yasui
- St Jude Children's Research Hospital, Epidemiology and Cancer Control Department, Memphis, TN, USA
| | - Qi Liu
- University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Stephanie B Dixon
- St Jude Children's Research Hospital, Oncology Department, Memphis, TN, USA
| | - Nina S Kadan-Lottick
- Yale University School of Medicine, Pediatric Hematology & Oncology, New Haven, CT, USA
| | | | - Brent R Weil
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | - Lisa M Jacola
- St Jude Children's Research Hospital, Psychology Department, Memphis, TN, USA
| | - Todd M Gibson
- National Institutes of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Wendy Leisenring
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA
| | | | - Melissa M Hudson
- St Jude Children's Research Hospital, Oncology Department, Memphis, TN, USA
| | - Leslie L Robison
- St Jude Children's Research Hospital, Epidemiology and Cancer Control Department, Memphis, TN, USA
| | - Gregory T Armstrong
- St Jude Children's Research Hospital, Epidemiology and Cancer Control Department, Memphis, TN, USA
| | - Kevin R Krull
- St Jude Children's Research Hospital, Psychology Department, Memphis, TN, USA
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15
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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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16
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Tanner L, Keppner K, Lesmeister D, Lyons K, Rock K, Sparrow J. Cancer Rehabilitation in the Pediatric and Adolescent/Young Adult Population. Semin Oncol Nurs 2020; 36:150984. [DOI: 10.1016/j.soncn.2019.150984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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17
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Padgett LS, Van Dyk K, Kelly NC, Newman R, Hite S, Asher A. Addressing Cancer-Related Cognitive Impairment in Cancer Survivorship. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/10463356.2020.1692601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Phelan R, Eissa H, Becktell K, Bhatt N, Kudek M, Nuechterlein B, Pommert L, Tanaka R, Baker KS. Upfront Therapies and Downstream Effects: Navigating Late Effects in Childhood Cancer Survivors in the Current Era. Curr Oncol Rep 2019; 21:104. [PMID: 31768799 DOI: 10.1007/s11912-019-0861-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW As survival rates of those diagnosed with childhood cancer improve over time, the number of long-term survivors continues to grow. Advances have not only been made in the upfront treatment of childhood cancer, but also in the identification and treatment of late complications that may arise as a result of the chemotherapy, radiotherapy, or surgical interventions required to provide a cure. RECENT FINDINGS As new therapies emerge that are often more targeted to cancerous cells while sparing healthy tissues, the hope is that cure can be achieved without the same long-term side effects for survivors. However, much is unknown regarding how these novel interventions will impact patients in the years to come. It is critical that we continue to follow patients treated with new modalities in order to identify and treat the long-term complications that may arise in future childhood cancer survivors.
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Affiliation(s)
- Rachel Phelan
- Children's Hospital of Wisconsin/Medical College of Wisconsin, 8701 Watertown Plank Rd, MFRC 3018, Milwaukee, WI, 53122, USA.
| | - Hesham Eissa
- The University of Colorado, School of Medicine, Blood and Marrow Transplant and Cellular Therapeutics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, 13123 East 16th Avenue, Box B115, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Kerri Becktell
- Children's Hospital of Wisconsin/Medical College of Wisconsin, 8701 Watertown Plank Rd, MFRC 3018, Milwaukee, WI, 53122, USA
| | - Neel Bhatt
- Seattle Children's Hospital/University of Washington, 1100 Fairview Ave N, D5-390, Seattle, WA, 98109, USA
| | - Matthew Kudek
- Children's Hospital of Wisconsin/Medical College of Wisconsin, 8701 Watertown Plank Rd, MFRC 3018, Milwaukee, WI, 53122, USA
| | - Brandon Nuechterlein
- The University of Colorado, School of Medicine, Blood and Marrow Transplant and Cellular Therapeutics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, 13123 East 16th Avenue, Box B115, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Lauren Pommert
- Children's Hospital of Wisconsin/Medical College of Wisconsin, 8701 Watertown Plank Rd, MFRC 3018, Milwaukee, WI, 53122, USA
| | - Ryuma Tanaka
- Children's Hospital of Wisconsin/Medical College of Wisconsin, 8701 Watertown Plank Rd, MFRC 3018, Milwaukee, WI, 53122, USA
| | - K Scott Baker
- Seattle Children's Hospital/University of Washington, 1100 Fairview Ave N, D5-390, Seattle, WA, 98109, USA
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19
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Prevention of Long-term Adverse Health Outcomes With Cardiorespiratory Fitness and Physical Activity in Childhood Acute Lymphoblastic Leukemia Survivors. J Pediatr Hematol Oncol 2019; 41:e450-e458. [PMID: 30688830 DOI: 10.1097/mph.0000000000001426] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most childhood acute lymphoblastic leukemia (ALL) survivors develop chronic treatment-related adverse effects several years after the end of therapy. A regular practice of physical activity and a good cardiorespiratory fitness have the potential to reduce the risk of chronic disease and improve quality of life. The aim of this study was to evaluate in a cohort of ALL survivors, the association between a good cardiorespiratory fitness or the respect of physical activity guidelines and major long-term health outcomes. METHODS In total, 247 ALL survivors underwent a cardiopulmonary exercise test, completed a physical activity questionnaire and a battery of clinical examinations. We calculated the odds ratio to obtain the preventive fraction (PF) to evaluate the effects of the cardiorespiratory fitness and physical activity levels on health outcomes (ie, obesity, metabolic health, cardiac health, cognitive health and mood, bone health). RESULTS Despite their young age, 88% of the participants presented at least one adverse health outcome, and 46% presented ≥3. Their cardiorespiratory fitness was also lower than expected with a median VO2 peak reaching 84% of the predicted value. In the analyses using cardiorespiratory fitness, statistically significant PFs were observed for obesity (0.30), low-high-density lipoprotein-cholesterol (0.21) and depression (0.26). In the physical activity level analyses, statistically significant PFs were observed for obesity, depression, and low bone mineral density, with a PF of 0.55, 0.81, and 0.60, respectively. CONCLUSIONS Our results indicate that a good cardiorespiratory fitness and physical activity level induced a preventive action for most health outcomes studied and was associated with a lower late adverse effects prevalence in ALL survivors.
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20
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Boulet‐Craig A, Robaey P, Barlaam F, Laniel J, Oswald V, Jerbi K, Sultan S, Affret‐Bertout L, Drouin S, Krajinovic M, Laverdière C, Sinnett D, Jolicoeur P, Lippé S. Visual short‐term memory activation patterns in adult survivors of childhood acute lymphoblastic leukemia. Cancer 2019; 125:3639-3648. [DOI: 10.1002/cncr.32374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Aubree Boulet‐Craig
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Psychology University of Montreal Montreal Quebec Canada
| | - Philippe Robaey
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Psychology University of Montreal Montreal Quebec Canada
- Department of Psychiatry University of Montreal Montreal Quebec Canada
- Department of Psychiatry University of Ottawa Ottawa Ontario Canada
- Children's Hospital of Eastern Ontario Ottawa Ontario Canada
| | - Fanny Barlaam
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
| | - Julie Laniel
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Psychology University of Montreal Montreal Quebec Canada
| | - Victor Oswald
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
| | - Karim Jerbi
- Department of Psychology University of Montreal Montreal Quebec Canada
| | - Serge Sultan
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Psychology University of Montreal Montreal Quebec Canada
| | | | - Simon Drouin
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
| | - Maja Krajinovic
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Pediatrics University of Montreal Montreal Quebec Canada
| | - Caroline Laverdière
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Pediatrics University of Montreal Montreal Quebec Canada
| | - Daniel Sinnett
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Pediatrics University of Montreal Montreal Quebec Canada
| | - Pierre Jolicoeur
- Department of Psychology University of Montreal Montreal Quebec Canada
| | - Sarah Lippé
- CHU Sainte‐Justine Research Center Montreal Quebec Canada
- Department of Psychology University of Montreal Montreal Quebec Canada
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21
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Petrykey K, Lippé S, Robaey P, Sultan S, Laniel J, Drouin S, Bertout L, Beaulieu P, St-Onge P, Boulet-Craig A, Rezgui A, Yasui Y, Sapkota Y, Krull KR, Hudson MM, Laverdière C, Sinnett D, Krajinovic M. Influence of genetic factors on long-term treatment related neurocognitive complications, and on anxiety and depression in survivors of childhood acute lymphoblastic leukemia: The Petale study. PLoS One 2019; 14:e0217314. [PMID: 31181069 PMCID: PMC6557490 DOI: 10.1371/journal.pone.0217314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/08/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A substantial number of survivors of childhood acute lymphoblastic leukemia suffer from treatment-related late adverse effects including neurocognitive impairment. While multiple studies have described neurocognitive outcomes in childhood acute lymphoblastic leukemia (ALL) survivors, relatively few have investigated their association with individual genetic constitution. METHODS To further address this issue, genetic variants located in 99 genes relevant to the effects of anticancer drugs and in 360 genes implicated in nervous system function and predicted to affect protein function, were pooled from whole exome sequencing data of childhood ALL survivors (PETALE cohort) and analyzed for an association with neurocognitive complications, as well as with anxiety and depression. Variants that sustained correction for multiple testing were genotyped in entire cohort (n = 236) and analyzed with same outcomes. RESULTS Common variants in MTR, PPARA, ABCC3, CALML5, CACNB2 and PCDHB10 genes were associated with deficits in neurocognitive tests performance, whereas a variant in SLCO1B1 and EPHA5 genes was associated with anxiety and depression. Majority of associations were modulated by intensity of treatment. Associated variants were further analyzed in an independent SJLIFE cohort of 545 ALL survivors. Two variants, rs1805087 in methionine synthase, MTR and rs58225473 in voltage-dependent calcium channel protein encoding gene, CACNB2 are of particular interest, since associations of borderline significance were found in replication cohort and remain significant in combined discovery and replication groups (OR = 1.5, 95% CI, 1-2.3; p = 0.04 and; OR = 3.7, 95% CI, 1.25-11; p = 0.01, respectively). Variant rs4149056 in SLCO1B1 gene also deserves further attention since previously shown to affect methotrexate clearance and short-term toxicity in ALL patients. CONCLUSIONS Current findings can help understanding of the influence of genetic component on long-term neurocognitive impairment. Further studies are needed to confirm whether identified variants may be useful in identifying survivors at increased risk of these complications.
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Affiliation(s)
- Kateryna Petrykey
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Laniel
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Laurence Bertout
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Patrick Beaulieu
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Pascal St-Onge
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Aubrée Boulet-Craig
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Aziz Rezgui
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Yutaka Yasui
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Yadav Sapkota
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Kevin R. Krull
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Melissa M. Hudson
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
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22
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Tom MC, Cahill DP, Buckner JC, Dietrich J, Parsons MW, Yu JS. Management for Different Glioma Subtypes: Are All Low-Grade Gliomas Created Equal? Am Soc Clin Oncol Educ Book 2019; 39:133-145. [PMID: 31099638 DOI: 10.1200/edbk_238353] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Following the identification of key molecular alterations that provided superior prognostication and led to the updated 2016 World Health Organization (WHO) Central Nervous System (CNS) Tumor Classification, the understanding of glioma behavior has rapidly evolved. Mutations in isocitrate dehydrogenase (IDH) 1 and 2 are present in the majority of adult grade 2 and 3 gliomas, and when used in conjunction with 1p/19q codeletion for classification, the prognostic distinction between grade 2 versus grade 3 is diminished. As such, the previously often used term of "low-grade glioma," which referred to grade 2 gliomas, has now been replaced by the phrase "lower-grade glioma" to encompass both grade 2 and 3 tumors. Additional molecular characterization is ongoing to even further classify this heterogeneous group of tumors. With such a colossal shift in the understanding of lower-grade gliomas, management of disease is being redefined in the setting of emerging molecular-genetic biomarkers. In this article, we review recent progress and future directions regarding the surgical, radiotherapeutic, chemotherapeutic, and long-term management of adult lower-grade gliomas.
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Affiliation(s)
- Martin C Tom
- 1 Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel P Cahill
- 2 Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jan C Buckner
- 3 Department of Oncology, Mayo Clinic, Rochester, MN
| | - Jörg Dietrich
- 4 Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Michael W Parsons
- 4 Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Jennifer S Yu
- 1 Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.,5 Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
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23
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Lofstad GE, Reinfjell T, Weider S, Diseth TH, Hestad K. Neurocognitive Outcome and Compensating Possibilities in Children and Adolescents Treated for Acute Lymphoblastic Leukemia With Chemotherapy Only. Front Psychol 2019; 10:1027. [PMID: 31156497 PMCID: PMC6532365 DOI: 10.3389/fpsyg.2019.01027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/17/2019] [Indexed: 11/29/2022] Open
Abstract
Aim: To examine the neurocognitive outcomes in children and adolescents with acute lymphoblastic leukemia (ALL) in remission who were treated with systemic chemotherapy only (CTO). Methods: Neurocognitive performances in 36 children and adolescents, aged 8.4-15.3 years, in long-term remission from ALL 4.3-12.4 years post diagnosis, without relapse, and with no pre-diagnosis history of neurodevelopmental disorder were compared with 36 healthy controls matched for gender, age, and parents' socio-economic status. The former patients and the healthy controls completed an extensive battery of standardized neuropsychological tests. Results: Survivors who were treated by CTO obtained significantly lower scores than did healthy controls on the domains of Copy and drawing (p = 0.001; Cohen's d 0.85; after controlling for Type 1 errors q = 0.006), Arithmetic (p = 0.001; Cohen's d 0.80; after controlling for Type 1 errors, q = 0.006), and Tactile sensory functions (p = 0.008; Cohen's d 0.65; after controlling for Type 1 errors, q = 0.03). Fifty percent of the ALL group were more than 1 SD below the control groups mean on Copy and drawing. There was an interaction between age and group (ALL vs. Control, p = 0.042) on Copy and drawing, indicating that the youngest ALL patients exhibited the worst performance. The oldest ALL patients performed equal to or better than the controls. A tendency in the same direction was seen for Arithmetic and Tactile sensory functions. The ALL survivors exhibited a steeper rising learning slope on repeated tests, with lower scores on a tactile problem-solving task, tactile sensory tests, verbal memory, and visual attention, but they performed as well as the controls when stimuli were repeated. Conclusion: The results indicate that neurocognitive long-term sequelae in ALL survivors are limited to specific domains - particularly complex drawing, arithmetic, and tactile processing, and novelty processing. Cognitive deficits are shown among the youngest ALL patients. Intervention programs and school programs should account for difficulties with processing new information and taking advantage of repetitions as a strength, which may prevent survivors from falling behind their peers.
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Affiliation(s)
| | - Trude Reinfjell
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Siri Weider
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trond H. Diseth
- Division of Paediatric and Adolescent Medicine, Department of Child and Adolescent Mental Health in Hospitals, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Hestad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Health and Nursing Science, Inland Norway University of Applied Sciences, Elverum, Norway
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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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25
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Chiou S, Lin P, Liao Y, Yang P. A cross‐sectional follow‐up study of physical morbidities, neurocognitive function, and attention problems in post‐treatment childhood acute lymphoblastic leukemia survivors. Kaohsiung J Med Sci 2019; 35:373-378. [DOI: 10.1002/kjm2.12061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/04/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Shyh‐Shin Chiou
- Department of Pediatrics, College of MedicineKaohsiung Medical University and Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University and Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - Pei‐Chin Lin
- Department of Pediatrics, College of MedicineKaohsiung Medical University and Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University and Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - Yu‐Mei Liao
- Department of Pediatrics, College of MedicineKaohsiung Medical University and Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University and Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - Pinchen Yang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University and Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Psychiatry, College of MedicineKaohsiung Medical University and Kaohsiung Medical University Hospital Kaohsiung Taiwan
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26
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Richard AE, Hodges EK, Heinrich KP. Visual Attention and Math Performance in Survivors of Childhood Acute Lymphoblastic Leukemia. Arch Clin Neuropsychol 2018; 33:1015-1023. [PMID: 29373636 DOI: 10.1093/arclin/acy002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
Objective Attentional and academic difficulties, particularly in math, are common in survivors of childhood acute lymphoblastic leukemia (ALL). Of cognitive deficits experienced by survivors of childhood ALL, attention deficits may be particularly responsive to intervention. However, it is unknown whether deficits in particular aspects of attention are associated with deficits in math skills. The current study investigated relationships between math calculation skills, performance on an objective measure of sustained attention, and parent- and teacher-reported attention difficulties. Method Twenty-four survivors of childhood ALL (Mage = 13.5 years, SD = 2.8 years) completed a computerized measure of sustained attention and response control and a written measure of math calculation skills in the context of a comprehensive clinical neuropsychological evaluation. Parent and teacher ratings of inattention and impulsivity were obtained. Results Visual response control and visual attention accounted for 26.4% of the variance observed among math performance scores after controlling for IQ (p < .05). Teacher-rated, but not parent-rated, inattention was significantly negatively correlated with math calculation scores. Conclusions Consistency of responses to visual stimuli on a computerized measure of attention is a unique predictor of variance in math performance among survivors of childhood ALL. Objective testing of visual response control, rather than parent-rated attentional problems, may have clinical utility in identifying ALL survivors at risk for math difficulties.
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Affiliation(s)
- Annette E Richard
- Department of Psychiatry, Neuropsychology Section, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elise K Hodges
- Department of Psychiatry, Neuropsychology Section, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kimberley P Heinrich
- Department of Psychiatry, Neuropsychology Section, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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27
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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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28
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Abstract
Over the last 50 years, the survival rates in children with acute lymphoblastic leukemia (ALL) have increased remarkably. The optimal use of antileukemic agents in cooperative group protocols, central nervous system-directed treatment, improvements in supportive care, and recognition of biological, clinical, and treatment response characteristics that predict patients with a higher or a lower risk of treatment failure have improved 5-year event-free survival rates, reaching more than 85%, and 5-year overall survival rates, reaching more than 90%. Consequently, it has become increasingly important to characterize the occurrence of long-term late effects. ALL treatments have been associated with increased risks for adverse outcomes such as late mortality, secondary malignancies, and neurological, cardiac, endocrine, and social/psychological disorders. In recent decades, cooperative groups in Europe and in the United States have provided essential information about the long-term effects of ALL therapy, giving recommendations for screening as well as facilitating new approaches for reducing late-term morbidity and mortality. Current frontline protocols continue to examine ways to lower the intensity and amount of therapy to reduce late effects, whereas survivorship studies attempt to predict such adverse effects precisely and develop targeted prevention and treatment strategies.
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Affiliation(s)
- Hande Kızılocak
- Istanbul University-Cerrahpaşa Faculty of Medicine, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Fatih Okcu
- Texas Children’s Hematology and Oncology Centers, Baylor College of Medicine, Department of Pediatrics, Division of Hematology and Oncology, Houston, TX, USA
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29
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Asor E, Ben-Shachar D. Gene expression dynamics following mithramycin treatment: A possible model for post-chemotherapy cognitive impairment. Clin Exp Pharmacol Physiol 2018; 45:1028-1037. [PMID: 29851136 DOI: 10.1111/1440-1681.12975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 12/20/2022]
Abstract
Chemotherapy-induced cognitive changes is a major burden on a substantial number of cancer survivors. The mechanism of this sequel is unknown. In this study, we followed long-term effects of early in life mithramycin (MTR) treatment on behaviour and on the normal course of alterations of gene expression in brain. Between post-natal days (PND) 7 and 10, male rats were divided into 2 groups, 1 receiving MTR (0.1 mg/kg s.c. per day) and the other receiving saline. At PND11, frontal cortex tissue samples were dissected from 4 rats from each group. At PND 65 the remaining rats underwent behavioural tests after which all the rats were decapitated and their prefrontal cortex incised. Rats treated transiently with MTR early in life, showed impairments in spatial working memory and anxious-like behaviour in adulthood. The immediate molecular effect of MTR was expressed in a limited number of altered genes of different unconnected trajectories, which were simultaneously distorted by the drug. In contrast, 3 months later we observed a change in the expression of more than 1000 genes that converged into specific cellular processes. Time-dependent gene expression dynamics of several genes was significantly different between treated and untreated rats. The differences in the total number of altered genes and in gene expression trends, immediately and long after MTR treatment cessation, suggest the evolution of a new cellular homeostatic set point, which can lead to behavioural abnormalities following chemotherapy treatment.
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Affiliation(s)
- Eyal Asor
- Laboratory of Psychobiology, Department of Psychiatry, Rambam Medical Center, Haifa, Israel.,B. Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel
| | - Dorit Ben-Shachar
- Laboratory of Psychobiology, Department of Psychiatry, Rambam Medical Center, Haifa, Israel.,B. Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel.,The Rappaport Family Institute for Research in Medical Sciences, Technion-IIT, Haifa, Israel
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30
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Sleurs C, Lemiere J, Christiaens D, Billiet T, Peeters R, Sunaert S, Uyttebroeck A, Deprez S. Advanced MR diffusion imaging and chemotherapy-related changes in cerebral white matter microstructure of survivors of childhood bone and soft tissue sarcoma? Hum Brain Mapp 2018; 39:3375-3387. [PMID: 29675944 DOI: 10.1002/hbm.24082] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
With the increase of survival rates of pediatric cancer patients, the number of children facing potential cognitive sequelae has grown. Previous adult studies suggest that white matter (WM) microstructural changes may contribute to cognitive impairment. This study aims to investigate WM microstructure in childhood bone and soft tissue sarcoma. Differences in (micro-)structure can be investigated using diffusion MRI (dMRI). The typically used diffusion tensor model (DTI) assumes Gaussian diffusion, and lacks information about fiber populations. In this study, we compare WM structure of childhood bone and soft tissue sarcoma survivors (n = 34) and matched controls (n = 34), combining typical and advanced voxel-based models (DTI and NODDI model, respectively), as well as recently developed fixel-based models (for estimations of intra-voxel differences, apparent fiber density [AFD] and fiber cross-section [FC]). Parameters with significant findings were compared between treatments, and correlated with subscales of the WAIS-IV intelligence test, age at diagnosis, age at assessment and time since diagnosis. We encountered extensive regions showing lower fractional anisotropy, overlapping with both significant NODDI parameters and fixel-based parameters. In contrast to these diffuse differences, the fixel-based measure of AFD was reduced in the cingulum and corpus callosum only. Furthermore, AFD of the corpus callosum was significantly predicted by chemotherapy treatment and correlated positively with time since diagnosis, visual puzzles and similarities task scores. This study suggests altered WM structure of childhood bone and soft tissue sarcoma survivors. We conclude global chemotherapy-related changes, with particular vulnerability of centrally located WM bundles. Finally, such differences could potentially recover after treatment.
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Affiliation(s)
- Charlotte Sleurs
- Department of Pediatrics, University Hospitals Leuven, UZ Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, UZ Leuven, Belgium.,Department of Oncology, UZ Leuven, Belgium
| | - Jurgen Lemiere
- Department of Pediatrics, University Hospitals Leuven, UZ Leuven, Belgium
| | - Daan Christiaens
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Thibo Billiet
- Imaging Biomarker Experts, Icometrix, Leuven, Belgium
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, UZ Leuven, Belgium
| | - Stefan Sunaert
- Department of Radiology, University Hospitals Leuven, UZ Leuven, Belgium.,Department of Imaging and Pathology, UZ Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Pediatrics, University Hospitals Leuven, UZ Leuven, Belgium.,Department of Oncology, UZ Leuven, Belgium
| | - Sabine Deprez
- Department of Radiology, University Hospitals Leuven, UZ Leuven, Belgium.,Department of Imaging and Pathology, UZ Leuven, Belgium
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31
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Irestorm E, Perrin S, Tonning Olsson I. Pretreatment Cognition in Patients Diagnosed With Pediatric Brain Tumors. Pediatr Neurol 2018; 79:28-33. [PMID: 29249552 DOI: 10.1016/j.pediatrneurol.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/30/2017] [Accepted: 11/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a large body of literature identifying risk factors for the long-term cognitive alterations found in survivors of pediatric brain tumors. Less is known about baseline cognitive functioning in this population, but studies suggest that cognitive dysfunctions are often present at the time of diagnosis. This study aimed to identify potential risk factors for lower cognitive function at the time of pediatric brain tumor diagnosis. METHODS Participants were children and adolescents (n = 101) diagnosed with a pediatric brain tumor between 2006 and 2015, who underwent a pretreatment neuropsychologic assessment. Multivariate regression models were used to estimate the association between gender, age at diagnosis, tumor size and location, increased intracranial pressure, epilepsy, and six different indicators of cognitive functioning. RESULTS Overall, cognitive performance was relatively intact, with results close to norm means, but impairments were found in memory and cognitive processing speed. Male gender, older age, epilepsy, increased intracranial pressure, and larger tumors were all associated with lower cognitive function at the time of brain tumor diagnosis; whereas tumor location was not. CONCLUSIONS Pretreatment neuropsychologic assessments, with some adjustments, can be carried out with children and adolescents with brain tumors. Our study adds to a small but growing body of literature documenting cognitive impairments at the time of diagnosis; these impairments may partly explain the longer-term deficits that commonly occur in pediatric brain tumor survivors. Consistent with previous research, pretreatment impairments were more common among boys, older children, and those with increased intracranial pressure, epilepsy, and larger tumors. The relationship between baseline and longer-term cognitive deficits requires further examination.
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Affiliation(s)
- Elin Irestorm
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden.
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Ingrid Tonning Olsson
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden; Department of Psychology, Lund University, Lund, Sweden
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Hardy KK, Olson K, Cox SM, Kennedy T, Walsh KS. Systematic Review: A Prevention-Based Model of Neuropsychological Assessment for Children With Medical Illness. J Pediatr Psychol 2017; 42:815-822. [PMID: 28369473 PMCID: PMC7328686 DOI: 10.1093/jpepsy/jsx060] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective Many pediatric chronic illnesses have shown increased survival rates, leading to greater focus on cognitive and psychosocial issues. Neuropsychological services have traditionally been provided only after significant changes in the child's cognitive or adaptive functioning have occurred. This model of care is at odds with preventative health practice, including early identification and intervention of neuropsychological changes related to medical illness. We propose a tiered model of neuropsychological evaluation aiming to provide a preventative, risk-adapted level of assessment service to individuals with medical conditions impacting the central nervous system based on public health and clinical decision-making care models. Methods Elements of the proposed model have been used successfully in various pediatric medical populations. We summarize these studies in association with the proposed evaluative tiers in our model. Results and Conclusions This model serves to inform interventions through the various levels of assessment, driven by evidence of need at the individual level in real time.
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Affiliation(s)
- Kristina K. Hardy
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children’s National Health System
- Departments of Psychiatry & Behavioral Science and Pediatrics, The George Washington University School of Medicine
| | - Katie Olson
- Division of Hematology and Oncology, Center for Cancer and Blood Disorders, Children’s National Health System
| | - Stephany M. Cox
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children’s National Health System
| | - Tess Kennedy
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children’s National Health System
| | - Karin S. Walsh
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children’s National Health System
- Departments of Psychiatry & Behavioral Science and Pediatrics, The George Washington University School of Medicine
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33
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Baum KT, Powell SK, Jacobson LA, Gragert MN, Janzen LA, Paltin I, Rey-Casserly CM, Wilkening GN. Implementing guidelines: Proposed definitions of neuropsychology services in pediatric oncology. Pediatr Blood Cancer 2017; 64. [PMID: 28121073 DOI: 10.1002/pbc.26446] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/10/2016] [Indexed: 11/06/2022]
Abstract
Several organizations have published guidelines for the neuropsychological care of survivors of childhood cancer. However, there is limited consensus in how these guidelines are applied. The model of neuropsychology service delivery is further complicated by the variable terminology used to describe recommended services. In an important first step to translate published guidelines into clinical practice, this paper proposes definitions for specific neuropsychological processes and services, with the goal of facilitating consistency across sites to foster future clinical program development and to clarify clinical practice guidelines.
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Affiliation(s)
- Katherine T Baum
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology and University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio
| | - Stephanie K Powell
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Child & Adolescent Psychiatry, Northwestern University, Feinberg School of Medicine, Department of Psychiatry ' Behavioral Science, Chicago, Illinois
| | - Lisa A Jacobson
- Kennedy Krieger Institute, Department of Neuropsychology, Johns Hopkins School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD, 21231
| | - Marsha N Gragert
- Texas Children's Hospital and Baylor College of Medicine Department of Pediatrics, Section of Psychology Houston, Texas
| | - Laura A Janzen
- Department of Psychology/Division of Heamatology/Oncology, The Hospital for Sick Children, Toronto, ON
| | - Iris Paltin
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia
| | | | - Greta N Wilkening
- Children's Hospital Colorado and the University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado
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34
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Marcoux S, Drouin S, Laverdière C, Alos N, Andelfinger GU, Bertout L, Curnier D, Friedrich MG, Kritikou EA, Lefebvre G, Levy E, Lippé S, Marcil V, Raboisson MJ, Rauch F, Robaey P, Samoilenko M, Séguin C, Sultan S, Krajinovic M, Sinnett D. The PETALE study: Late adverse effects and biomarkers in childhood acute lymphoblastic leukemia survivors. Pediatr Blood Cancer 2017; 64. [PMID: 27917589 DOI: 10.1002/pbc.26361] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/27/2016] [Accepted: 10/17/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Childhood cancer survivorship issues represent an established public health challenge. Most late adverse effects (LAEs) have been demonstrated to be time and treatment dependent. The PETALE study is a multidisciplinary research project aiming to comprehensively characterize LAEs and identify associated predictive biomarkers in childhood acute lymphoblastic leukemia (cALL) survivors. METHODS cALL survivors treated at Sainte-Justine University Health Center with Dana-Farber Cancer Institution-ALL protocols 87-01 through 2005-01 were eligible. During Phase I of the study, the participants underwent comprehensive clinical, biologic, and psychosocial investigation targeting metabolic syndrome, cardiotoxicity, bone morbidity, neurocognitive problems, and quality of life issues. Whole-exome sequencing was performed for all participants. Subjects identified with an extreme phenotype during Phase I were recalled for additional testing (Phase II). RESULTS Phase I included 246 survivors (recall rate 71.9%). Of those, 85 participants completed Phase II (recall rate 88.5%). Survivors agreeing to participate in Phase I (n = 251) were similar to those who refused (n = 31) in terms of relapse risk profile, radiotherapy exposure, and age at the time of study. Participants, however, tended to be slightly older at diagnosis (6.1 vs. 4.7 years old, P = 0.08), with a higher proportion of female agreeing to participate compared with males (93.2 vs. 86.5%, P = 0.07). CONCLUSION The PETALE study will contribute to comprehensively characterize clinical, psychosocial, biologic, and genomic features of cALL survivors using an integrated approach. Expected outcomes include LAE early detection biomarkers, long-term follow-up guidelines, and recommendations for physicians and health professionals.
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Affiliation(s)
- Sophie Marcoux
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Caroline Laverdière
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Nathalie Alos
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Gregor U Andelfinger
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Laurence Bertout
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Daniel Curnier
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | | | | | | | - Emile Levy
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Sarah Lippé
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Valérie Marcil
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Marie-Josée Raboisson
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Frank Rauch
- Shriners Hospitals for Children, Montréal, Québec, Canada
| | - Philippe Robaey
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | | | - Chantal Séguin
- McGill University Health Center Research Institute, Montréal, Québec, Canada
| | - Serge Sultan
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Maja Krajinovic
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Daniel Sinnett
- Université de Montréal, Montréal, Québec, Canada.,Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
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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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Lai JS, Bregman C, Zelko F, Nowinski C, Cella D, Beaumont JJ, Goldman S. Parent-reported cognitive function is associated with leukoencephalopathy in children with brain tumors. Qual Life Res 2017; 26:2541-2550. [PMID: 28447250 DOI: 10.1007/s11136-017-1583-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 10/10/2023]
Abstract
PURPOSE Cognitive dysfunction is a major concern for children with brain tumors. A valid, user-friendly screening tool could facilitate prompt referral for comprehensive neuropsychological assessments and therefore early intervention. Applications of the pediatric perceived cognitive function item bank (pedsPCF) such as computerized adaptive testing can potentially serve as such a tool given its brevity and user-friendly nature. This study aimed to evaluate whether pedsPCF was a valid indicator of cerebral compromise using the criterion of structural brain changes indicated by leukoencephalopathy grades. METHODS Data from 99 children (mean age = 12.6 years) with brain tumors and their parents were analyzed. Average time since diagnosis was 5.8 years; time since last treatment was 4.3 years. Leukoencephalopathy grade (range 0-4) was based on white matter damage and degree of deep white matter volume loss shown on MRI. Parents of patients completed the pedsPCF. Scores were based on the US general population-based T-score metric (mean = 50; SD = 10). Higher scores reflect better function. RESULTS Leukoencephalopathy grade distributions were as follows: 36 grade 0, 27 grade 1, 22 grade 2, 13 grade 3, and 1 grade 4. The mean pedsPCF T-score was 48.3 (SD = 8.3; range 30.5-63.7). The pedsPCF scores significantly discriminated patients with different leukoencephalopathy grades, F = 4.14, p = 0.0084. Effect sizes ranged from 0.09 (grade 0 vs. 1) to 1.22 (grade 0 vs. 3/4). CONCLUSION This study demonstrates that the pedsPCF is a valid indicator of leukoencephalopathy and provides support for its use as a screening tool for more comprehensive neurocognitive testing.
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Affiliation(s)
- Jin-Shei Lai
- Medical Social Sciences and Pediatrics, Feinberg School of Medicine at Northwestern University, 633 N St Clair, #19-039, Chicago, IL, 60611, USA.
| | - Corey Bregman
- Medical Imaging (Radiology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL, 60611, USA
| | - Frank Zelko
- Pediatric Neuropsychology Service, Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Cindy Nowinski
- Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, USA
| | - David Cella
- Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, USA
| | - Jennifer J Beaumont
- Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, USA
| | - Stewart Goldman
- Hematology/Oncology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
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Moore IM(K, Merkle CJ, Byrne H, Ross A, Hawkins AM, Ameli SS, Montgomery DW. Effects of Intraventricular Methotrexate on Neuronal Injury and Gene Expression in a Rat Model. Biol Res Nurs 2016; 18:505-14. [DOI: 10.1177/1099800416644780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Central nervous system (CNS)-directed treatment for acute lymphoblastic leukemia, used to prevent disease recurrence in the brain, is essential for survival. Systemic and intrathecal methotrexate, commonly used for CNS-directed treatment, have been associated with cognitive problems during and after treatment. The cortex, hippocampus, and caudate putamen, important brain regions for learning and memory, may be involved in methotrexate-induced brain injury. Objectives of this study were to (1) quantify neuronal degeneration in selected regions of the cortex, hippocampus, and caudate putamen and (2) measure changes in the expression of genes with known roles in oxidant defense, apoptosis/inflammation, and protection from injury. Male Sprague Dawley rats were administered 2 or 4 mg/kg of methotrexate diluted in artificial cerebrospinal fluid (aCSF) or aCSF only into the left cerebral lateral ventricle. Gene expression changes were measured using customized reverse transcription (RT)2 polymerase chain reaction arrays. The greatest percentage of degenerating neurons in methotrexate-treated animals was in the medial region of the cortex; percentage of degenerating neurons in the dentate gyrus and cornu ammonis 3 regions of the hippocampus was also greater in rats treated with methotrexate compared to perfusion and vehicle controls. There was a greater percentage of degenerating neurons in the inferior cortex of control versus methotrexate-treated animals. Eight genes involved in protection from injury, oxidant defense, and apoptosis/inflammation were significantly downregulated in different brain regions of methotrexate-treated rats. To our knowledge, this is the first study to investigate methotrexate-induced injury in selected brain regions and gene expression changes using a rat model of intraventricular drug administration.
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Affiliation(s)
| | | | | | - Adam Ross
- College of Nursing, The University of Arizona, Tucson AZ, USA
| | | | - Sara S. Ameli
- College of Nursing, The University of Arizona, Tucson AZ, USA
| | - David W. Montgomery
- College of Nursing, The University of Arizona, Tucson AZ, USA
- Southern Arizona VA Healthcare System, Tucson AZ, USA
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Hockenberry MJ, Krull KR, Insel KC, Harris LL, Gundy PM, Adkins KB, Pasvogel AE, Taylor OA, Koerner KM, Montgomery DW, Ross AK, Hill A, Moore IM. Oxidative Stress, Motor Abilities, and Behavioral Adjustment in Children Treated for Acute Lymphoblastic Leukemia. Oncol Nurs Forum 2016; 42:542-9. [PMID: 26302283 DOI: 10.1188/15.onf.542-549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine associations among oxidative stress, fine and visual-motor abilities, and behavioral adjustment in children receiving chemotherapy for acute lymphoblastic leukemia (ALL)
. DESIGN A prospective, repeated-measures design
. SETTING Two pediatric oncology settings in the southwestern United States. SAMPLE 89 children with ALL were followed from diagnosis to the end of chemotherapy. METHODS Serial cerebrospinal fluid samples were collected during scheduled lumbar punctures and analyzed for oxidative stress biomarkers. Children completed fine motor dexterity, visual processing speed, and visual-motor integration measures at three time points. Parents completed child behavior ratings at the same times. MAIN RESEARCH VARIABLES Oxidative stress, fine motor dexterity, visual processing, visual-motor integration, and behavioral adjustment
. FINDINGS Children with ALL had below-average fine motor dexterity, visual processing speed, and visual-motor integration following the induction phase of ALL therapy. By end of therapy, visual processing speed normalized, and fine motor dexterity and visual-motor integration remained below average. Oxidative stress measures correlated with fine motor dexterity and visual-motor integration. Decreased motor functioning was associated with increased hyperactivity and anxiety
. CONCLUSIONS Oxidative stress occurs following chemo-therapy for childhood ALL and is related to impaired fine motor skills and visual symptoms
. IMPLICATIONS FOR NURSING Early intervention should be considered to prevent fine motor and visual-spatial deficits, as well as behavioral problems.
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Walsh KS, Noll RB, Annett RD, Patel SK, Patenaude AF, Embry L. Standard of Care for Neuropsychological Monitoring in Pediatric Neuro-Oncology: Lessons From the Children's Oncology Group (COG). Pediatr Blood Cancer 2016; 63:191-5. [PMID: 26451963 PMCID: PMC5222571 DOI: 10.1002/pbc.25759] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022]
Abstract
As the mortality of pediatric cancers has decreased, focus on neuropsychological morbidities of treatment sequelae have increased. Neuropsychological evaluations are essential diagnostic tools that assess cognitive functioning and neurobiological integrity. These tests provide vital information to support ongoing medical care, documenting cognitive morbidity and response to interventions. We frame standards for neuropsychological monitoring of pediatric patients with CNS malignancy or who received cancer-directed therapies involving the CNS and discuss billing for these services in the United States in the context of clinical research. We describe a cost-effective, efficient model of neuropsychological monitoring that may increases access to neuropsychological care.
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Affiliation(s)
- KS Walsh
- Children’s National Health System & The George Washington University School of Medicine, Washington, DC
| | - RB Noll
- University of Pittsburgh, Pittsburgh, PA
| | - RD Annett
- University of Colorado Denver; Children’s Hospital of Colorado
| | - SK Patel
- City of Hope Medical Center, Duarte, California
| | - AF Patenaude
- Dana-Farber Cancer Institute, Harvard Medical School, Boston MA
| | - L Embry
- University of Texas Health Science Center at San Antonio, San Antonio, TX
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40
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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.
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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
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41
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Bull KS, Liossi C, Peacock JL, Yuen HM, Kennedy CR. Screening for cognitive deficits in 8 to 14-year old children with cerebellar tumors using self-report measures of executive and behavioral functioning and health-related quality of life. Neuro Oncol 2015. [PMID: 26203065 DOI: 10.1093/neuonc/nov129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to identify a brief screening measure for detection of cognitive deficit in children treated for cerebellar tumors that would be useful in clinical practice. METHODS A sample of 72 children, aged 8-14 years, and within 3 years post diagnosis for standard-risk medulloblastoma (n = 37) or low-grade cerebellar astrocytoma (n = 35) and 38 children in a nontumor group were assessed using teacher-, parent-, and child-report of the Behavior Rating Inventory of Executive Function (BRIEF), Strengths and Difficulties Questionnaire (SDQ), and Pediatric Quality of Life Inventory (PedsQL). The accuracy of these scores as a screen for a full-scale Intelligence Quotient (FSIQ) < 80 on the Wechsler Intelligence Scale for Children (WISC-IV UK) was assessed using their receiver operating characteristic (ROC) curves. RESULTS The questionnaires with the highest areas under the ROC curves were the child- and parent-report PedsQL, the teacher-report BRIEF, and the SDQ. At optimal cutoff scores, their sensitivities (95% CIs) to cases of FSIQ < 80 were 84 (60-96)%, 65 (41-84)%, 79 (54-93)%, and 84 (60-96)%, and their specificities (95% CIs) were 79 (68-86)%, 87 (77-93)%, 77 (66-86)%, and 71 (64-84)% respectively. All cases of FSIQ < 80 screened positive on either teacher-report SDQ or self-report PedsQL. CONCLUSIONS The PedsQL child- and parent-report and the teacher-report BRIEF and SDQ have moderately good accuracy for discriminating between children with and without a FSIQ < 80. The PedsQL could be used in a clinical setting, and the BRIEF and SDQ in an educational setting, to screen for cases with FSIQ < 80 in children treated for brain tumors.
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Affiliation(s)
- Kim S Bull
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK (K.S.B., H.M.Y, C.R.K.); University Hospital Southampton NHS Foundation Trust, Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK (C.L.); Division of Health and Social Care Research, King's College London, London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK (J.L.P.)
| | - Christina Liossi
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK (K.S.B., H.M.Y, C.R.K.); University Hospital Southampton NHS Foundation Trust, Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK (C.L.); Division of Health and Social Care Research, King's College London, London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK (J.L.P.)
| | - Janet L Peacock
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK (K.S.B., H.M.Y, C.R.K.); University Hospital Southampton NHS Foundation Trust, Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK (C.L.); Division of Health and Social Care Research, King's College London, London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK (J.L.P.)
| | - Ho Ming Yuen
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK (K.S.B., H.M.Y, C.R.K.); University Hospital Southampton NHS Foundation Trust, Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK (C.L.); Division of Health and Social Care Research, King's College London, London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK (J.L.P.)
| | - Colin R Kennedy
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK (K.S.B., H.M.Y, C.R.K.); University Hospital Southampton NHS Foundation Trust, Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK (C.L.); Division of Health and Social Care Research, King's College London, London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK (J.L.P.)
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Raiker JS, Manning E, Herrington B, May AC, Haynes S, Graves PE, Karlson CW. Brief neurocognitive screening in youth with brain tumours: A preliminary investigation of the Lebby-Asbell Neurocognitive Screening Examination (LANSE). Brain Inj 2015; 29:1192-1198. [DOI: 10.3109/02699052.2015.1035331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ottensmeier H, Zimolong B, Wolff JE, Ehrich J, Galley N, von Hoff K, Kuehl J, Rutkowski S. Neuropsychological short assessment of disease- and treatment-related intelligence deficits in children with brain tumours. Eur J Paediatr Neurol 2015; 19:298-307. [PMID: 25617910 DOI: 10.1016/j.ejpn.2014.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 12/26/2014] [Accepted: 12/30/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The Wuerzburger Psychologische Kurz-Diagnostik (WUEP-KD) is a short screening battery for cognitive deficits in children with brain tumour. We report on its psychometric quality and testing efficiency. MATERIAL AND METHODS WUEP-KD was founded on Cattell-Horn-Carroll (CHC) framework of cognitive abilities. We assessed the construct validity of the short battery by conducting factor analysis and the concurrent validity by multiple linear regressions with Kaufman Assessment Battery for Children (K-ABC). The concurrent validity was explored by multiple linear regressions with Wechsler Intelligence Scale for Children (WISC). The discriminant validity was examined by a reanalysis of harmful effects of brain tumour treatments in a medulloblastoma cohort. RESULTS The construct validity assessment revealed three neuropsychological domains: cognitive operations, executive abilities, and psychomotor abilities. The retest reliabilities for individual testing and the convergent coefficients of the WUEP-KD with K-ABC and WISC yielded satisfactory results. The cognitive effects of different treatment modalities in the medulloblastoma cohort matched exactly previously reported data on the decline of general intelligence scores and delivered the details for the harmful effects. An in-depth analysis based on Hedges' g effect sizes confirmed specific harmful late effects on all abilities of cognitive operations, on the executive ability of perceptual speed and on psychomotor ability of movement steadiness. CONCLUSION WUEP-KD is a valid and efficient short test instrument, which may be especially useful in larger cohorts, multicenter settings or if patients do not tolerate longer tests. Due to its foundation on the CHC framework, our findings provide a rationale to create a common data set along with scores from other factor-based tests in international studies.
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Affiliation(s)
- Holger Ottensmeier
- Department of Oncology and Hematology, Children's University Hospital Wuerzburg, Wuerzburg, Germany.
| | | | - Johannes E Wolff
- Department of Pediatric Hematology Oncology Cleveland Clinic Children's, Cleveland, OH, USA
| | - Jochen Ehrich
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Niels Galley
- Department of Psychology, University of Cologne, Cologne, Germany
| | - Katja von Hoff
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Kuehl
- Department of Oncology and Hematology, Children's University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Increase in oxidative stress as measured by cerebrospinal fluid lipid peroxidation during treatment for childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2015; 37:e86-93. [PMID: 25222054 PMCID: PMC4423740 DOI: 10.1097/mph.0000000000000258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Five-year survival from childhood acute lymphoblastic leukemia (ALL) approaches 90%, but 40% of survivors experience central nervous system (CNS) treatment-related cognitive problems. Despite considerable evidence for cognitive problems, less is known about mechanisms of neurological injury. Our purpose was to investigate oxidative stress, measured by lipid peroxidation, as a mechanism of CNS treatment-related neurological injury. The sample included 55 children (mean age at diagnosis=6.84 y, SD=3.40) who received intrathecal and intravenous chemotherapy for CNS-directed treatment according to Children's Oncology Group protocols. Glycerophospholipids were extracted from cerebrospinal fluid samples obtained at diagnosis and during intrathecal chemotherapy administration. Unoxidized and oxidized phosphatidylcholine (PC) and phosphatidylinositol (PI) were measured by normal phase high-performance liquid chromatography with diode array detection, and analyzed with a general linear model for repeated measures analysis of variance. Compared with the diagnostic cerebrospinal fluid sample, unoxidized and oxidized PC and PI increased significantly across treatment phases. Amount of intravenous methotrexate received was significantly correlated with oxidized PI, and age at time of ALL diagnosis was significantly associated with oxidized PC. These findings support our hypothesis that oxidative stress is a mechanism of neurological injury associated with CNS-directed treatment for ALL.
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Abstract
Treatment for childhood cancer with chemotherapy, radiation and/or hematopoietic cell transplant can result in adverse sequelae that may not become evident for many years. A clear understanding of the association between therapeutic exposures and specific long-term complications, and an understanding of the magnitude of the burden of morbidity borne by childhood cancer survivors, has led to the development of guidelines to support lifelong risk-based follow up for this population. It is important to develop interventions to reduce the impact of treatment-related late effects on morbidity and mortality and to continue research regarding the etiopathogenesis of therapy-related cancers and other late effects.
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Affiliation(s)
- Wendy Landier
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd., DPS-173, Duarte, CA 91010, USA
| | - Saro Armenian
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd., DPS-173, Duarte, CA 91010, USA
| | - Smita Bhatia
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd., DPS-173, Duarte, CA 91010, USA.
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Barnes MA, Raghubar KP. Mathematics development and difficulties: the role of visual-spatial perception and other cognitive skills. Pediatr Blood Cancer 2014; 61:1729-33. [PMID: 24510838 DOI: 10.1002/pbc.24909] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/26/2013] [Indexed: 11/08/2022]
Abstract
Several neurocognitive abilities, including visual-spatial and language-based processes, attention, and fine motor/finger skills, are thought to play important roles in mathematical development and disability. Evidence for relations of specific neurocognitive skills and mathematical development and disability is presented, with a particular emphasis on findings from longitudinal studies. Why these particular neurocognitive skills are related to math is also discussed. We suggest that mathematics learning in children with congenital and acquired neurodevelopmental disorders, including children treated for cancer, is particularly vulnerable to disruption because these disorders often affect one or more of the neurocognitive systems that support math learning and performance. Implications for assessment of and interventions for math difficulties are discussed. The article ends with implications for mathematical functioning in children treated for acute lymphoblastic leukemia and brain tumors.
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Affiliation(s)
- Marcia A Barnes
- Department of Special Education, University of Texas, Austin, Texas; Children's Learning Institute, Department of Pediatrics, University of Texas Health Science Center, Houston, Texas
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Luxton J, Brinkman TM, Kimberg C, Robison LL, Hudson MM, Krull KR. Utility of the N-back task in survivors of childhood acute lymphoblastic leukemia. J Clin Exp Neuropsychol 2014; 36:944-55. [PMID: 25252969 PMCID: PMC4355950 DOI: 10.1080/13803395.2014.957168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The N-back task is often used in functional brain imaging studies to activate working memory networks; however, limited information is available on its association to clinical outcomes in children or cancer survivors. A total of 137 survivors of acute lymphoblastic leukemia (ALL; mean current age = 14.3 years, SD = 4.8; time since diagnosis = 7.6 years, SD = 1.6) completed the N-back task and comprehensive neurocognitive testing, including standardized measures of attention, processing speed, and working memory. Results indicated that females demonstrated significantly slower reaction times (0-back p = .02; 1-back p = .03) than males. Survivors <15 years old at the time of testing demonstrated a significant decrease in accuracy as working memory load increased compared to survivors ≥15 years old (p < .001). Performance on the N-back task was associated with nonverbal working memory (rs = .56, p < .001) in survivors ≥15 years of age. For younger survivors, N-back performance was more strongly associated with attention skills. Results suggest the N-back assesses different cognitive constructs at younger compared to older childhood ages. These age differences should be considered in interpreting functional brain imaging results.
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Affiliation(s)
- Joshua Luxton
- a Department of Epidemiology and Cancer Control , St. Jude Children's Research Hospital , TN , USA
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Bull KS, Liossi C, Culliford D, Peacock JL, Kennedy CR. Child-related characteristics predicting subsequent health-related quality of life in 8- to 14-year-old children with and without cerebellar tumors: a prospective longitudinal study. Neurooncol Pract 2014; 1:114-122. [PMID: 26034623 DOI: 10.1093/nop/npu016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We identified child-related determinants of health-related quality of life (HRQoL) in children aged 8-14 years who were treated for 2 common types of pediatric brain tumors. METHODS Questionnaire measures of HRQoL and psychometric assessments were completed by 110 children on 3 occasions over 24 months. Of these 110, 72 were within 3 years of diagnosis of a cerebellar tumor (37 standard-risk medulloblastoma, 35 low-grade cerebellar astrocytoma), and 38 were in a nontumor group. HRQoL, executive function, health status, and behavioral difficulties were also assessed by parents and teachers as appropriate. Regression modeling was used to relate HRQoL z scores to age, sex, socioeconomic status, and 5 domains of functioning: Cognition, Emotion, Social, Motor and Sensory, and Behavior. RESULTS HRQoL z scores were significantly lower after astrocytoma than those in the nontumor group and significantly lower again in the medulloblastoma group, both by self-report and by parent-report. In regression modeling, significant child-related predictors of poorer HRQoL z scores by self-report were poorer cognitive and emotional function (both z scores) and greater age (years) at enrollment (B = 0.038, 0.098, 0.136, respectively). By parent-report, poorer cognitive, emotional and motor or sensory function (z score) were predictive of lower subsequent HRQoL of the child (B = 0.043, 0.112, 0.019, respectively), while age at enrollment was not. CONCLUSIONS Early screening of cognitive and emotional function in this age group, which are potentially amenable to change, could identify those at risk of poor HRQoL and provide a rational basis for interventions to improve HRQoL.
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Affiliation(s)
- Kim S Bull
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - Christina Liossi
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - David Culliford
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - Janet L Peacock
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - Colin R Kennedy
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
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Castellino SM, Ullrich NJ, Whelen MJ, Lange BJ. Developing interventions for cancer-related cognitive dysfunction in childhood cancer survivors. J Natl Cancer Inst 2014; 106:dju186. [PMID: 25080574 DOI: 10.1093/jnci/dju186] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Survivors of childhood cancer frequently experience cancer-related cognitive dysfunction, commonly months to years after treatment for pediatric brain tumors, acute lymphoblastic leukemia (ALL), or tumors involving the head and neck. Risk factors for cancer-related cognitive dysfunction include young age at diagnosis, treatment with cranial irradiation, use of parenteral or intrathecal methotrexate, female sex, and pre-existing comorbidities. Limiting use and reducing doses and volume of cranial irradiation while intensifying chemotherapy have improved survival and reduced the severity of cognitive dysfunction, especially in leukemia. Nonetheless, problems in core functional domains of attention, processing speed, working memory and visual-motor integration continue to compromise quality of life and performance. We review the epidemiology, pathophysiology and assessment of cancer-related cognitive dysfunction, the impact of treatment changes for prevention, and the broad strategies for educational and pharmacological interventions to remediate established cognitive dysfunction following childhood cancer. The increased years of life saved after childhood cancer warrants continued study toward the prevention and remediation of cancer-related cognitive dysfunction, using uniform assessments anchored in functional outcomes.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL).
| | - Nicole J Ullrich
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Megan J Whelen
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Beverly J Lange
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
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Hamidah A, Sham Marina M, Tamil AM, Loh CK, Zarina LA, Jamal R, Tuti Iryani MD, Ratnam VC. Parental reports of behavioural outcome among paediatric leukaemia survivors in Malaysia: a single institution experience. Trop Med Int Health 2014; 19:1177-84. [PMID: 25047756 DOI: 10.1111/tmi.12358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the behavioural impact of chemotherapy in survivors of acute lymphoblastic leukaemia (ALL) treated with chemotherapy only and to identify treatment-related or sociodemography-related factors that might be associated with behavioural outcome. METHODS We examined 57 survivors of childhood ALL, who were off treatment for at least 2 years and were in remission, aged 4-18 years, and 221 unrelated healthy controls. The Child Behaviour Checklist (CBCL) parent report was used either in English or in Bahasa Malaysia (the national language of Malaysia) to assess the behavioural outcome. RESULTS Childhood ALL survivors had significantly higher scores on externalising behaviour on the CBCL parent report than did controls. Higher problem scores were found in ALL survivors with single parents on 'total problems' (P = 0.03) and subscales 'withdrawn' (P = 0.03), 'social problems' (P < 0.01) and 'delinquent behaviour' (P = 0.03) than in survivors with married parents. Significant associations were seen between a lower education level of the father and the variables representing internalising (withdrawn, anxious/depressed) and externalising (aggressive behaviour). We observed trends on higher scores in all scales in ALL survivors with single parents than in controls with single parents or with fathers with low education level, especially primary education only. CONCLUSIONS Malaysian childhood ALL survivors had a significantly increased risk for externalising behavioural problems, and there was a trend towards increased risk of problems in many other behavioural scales. Understanding the sociocultural dimension of patients' health is important to be able to design the most appropriate remedy for problem behaviours detected in this multi-ethnic population.
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Affiliation(s)
- Alias Hamidah
- Department of Pediatrics, National University of Malaysia, Kuala Lumpur, Malaysia
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