Screening for neurocognitive impairment in pediatric cancer long-term survivors.
OBJECTIVE
Recent studies suggest that up to 40% of childhood cancer survivors may experience neurocognitive problems, a finding that has led the Children's Oncology Group to recommend regular evaluation. However, for a variety of reasons, including costs, time restraints, health insurance, and access to professional resources, these guidelines are often difficult to implement. We report reliability and validity data on a brief neurocognitive screening method that could be used to routinely screen patients in need of comprehensive follow-up.


METHODS
Two hundred forty consecutive patients were screened during their annual visits to a long-term survivor clinic using standard neurocognitive measures and brief parent rating. From this total, 48 patients had a second screening, and 52 patients had a comprehensive follow-up evaluation. Test-retest reliability and predictive and discriminative validity were examined.


RESULTS
Good test-retest reliability was demonstrated, with an overall r = 0.72 and all individual subtest correlations greater than r = 0.40. Although means tended to improve from first to second testing, no significant changes were detected (all P > .10). The screen accurately predicted global intellect (F(6,45) = 11.81, P < .0001), reading skills (F(6,45) = 4.74, P < .001), and mathematics (F(6,45) = 3.35, P < .008). Parent rating was a marginal indicator of global intellect only.


CONCLUSIONS
The brief neurocognitive screening was a better predictor of child functioning than specific parent rating. This brief measure, which can be completed in 30 minutes, is a practical and reliable method to identify cancer survivors in need of further neurocognitive follow-up.
Krull
Kevin R
KR
Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 332 N Lauderdale St, MS 735, Memphis, TN 38105-2794, USA. kevin.krull@stjude.org
Okcu
M Fatih
MF
Potter
Brian
B
Jain
Neelam
N
Dreyer
ZoAnn
Z
Kamdar
Kala
K
Brouwers
Pim
P