Learning problems in childhood cancer

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

According to the National Cancer Institute, the incidence of childhood cancers has increased over the past 20 years. New medical treatments and technologies are improving the survival rate of childhood cancers however, late effects of cancer and its treatments, particularly those involving learning and cognition, require further study.

Effect of cancer on brain development

Research shows that children with cancer are at risk for developing various cognitive or learning problems. These difficulties may be related to brain injury stemming from the cancer itself, such as a brain tumor or central nervous system metastasis or from side effects of cancer treatments such as chemotherapy and radiation therapy. Studies have shown that chemo and radiation therapies may damage brain white matter and disrupt brain activity.

Cognitive problems that have been associated with cancer and its treatments in children include deficits in attention, working memory, processing speed, mental flexibility, persistence, verbal fluency, memory, motor skills, academic achievement and social function. These deficits have been shown to occur irrespective of age, socioeconomic status, months since onset or cessation of treatment, anxiety, fatigue and dosage schedule.

Cognitive rehabilitation

Some clinicians and research groups in neuropsychology are developing programs to help treat the cognitive problems associated with childhood cancer. Treatment typically involves a program of cognitive rehabilitation which aims to help improve cognitive function either by restoring capacities that were impaired and/or helping the patient learn ways to compensate for the impairment(s). Cognitive rehabilitation usually involves evaluation to determine the specific impairments involved, an individualized program of specific skills training and practice and metacognitive strategies. Metacognitive strategies include helping the patient increase self-awareness regarding problem solving skills by learning how to better monitor the effectiveness of these skills and self-correct when necessary. Cognitive rehabilitation is conducted under the supervision of a neuropsychologist or other trained professional.

References

• Butler RW, Haser JK (2006). "Neurocognitive effects of treatment for childhood cancer". Ment Retard Dev Disabil Res Rev. 12 (3): 184–191.
• Mulhern RK, Butler RW (2004). "Neurocognitive sequelae of childhood cancers and their treatment". Pediatr Rehabil. 7 (1): 1–14.
• Zou P, Mulhern RK, Butler RW, Li CS, Langston JW, Ogg RJ (2005). "BOLD responses to visual stimulation in survivors of childhood cancer". Neuroimage. 24 (1): 61–69.CS1 maint: Multiple names: authors list (link)
• Cetingul N, Aydinok Y, Kantar M; et al. (1999). "Neuropsychologic sequelae in the long-term survivors of childhood acute lymphoblastic leukemia". Pediatr Hematol Oncol. 16 (3): 213–220.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
• Duffner PK (2006). "Long-term effects of radiation therapy on cognitive and endocrine function in children with leukemia and brain tumors". Neurologist. 10 (6): 293–310.
• Langer T, Martus P, Ottensmeier H, Hertzberg H, Beck JD, Meier W (2002). "CNS late-effects after ALL therapy in childhood. Part III: neuropsychological performance in long-term survivors of childhood ALL: impairments of concentration, attention, and memory. Medical and pediatric oncology". Medical and pediatric oncology. 38 (5): 320–328.CS1 maint: Multiple names: authors list (link)

Resources

Cognitive rehabilitation for children with cancer

• Stanford Medical Center
• Doernbecher Children's Hospital
• MD Anderson Cancer Center
• Memorial Sloan-Kettering

Other

• Leukemia
• Neuroblastoma
• Pediatric Oncology Group
• Children's Oncology Group

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