title: Developing interventions for cancer-related cognitive dysfunction in childhood cancer survivors.
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.
authors: 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). scastell@wakehealth.edu.
authors: Sharon M
authors: SM
authors: Castellino
authors: 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).
authors: Nicole J
authors: NJ
authors: Ullrich
authors: 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).
authors: Megan J
authors: MJ
authors: Whelen
authors: 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).
authors: Beverly J
authors: BJ
authors: Lange
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D001288:Attention; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D015897:Comorbidity; D016371:Cranial Irradiation / Q000009:adverse effects; D000077265:Donepezil; D018479:Early Intervention, Educational / Q000379:methods; D004519:Education, Special; D006258:Head and Neck Neoplasms / Q000523:psychology; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D007223:Infant; D007278:Injections, Spinal; D008570:Memory, Short-Term; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008774:Methylphenidate / Q000627:therapeutic use; D000077408:Modafinil; D009369:Neoplasms / Q000523:psychology*; D019635:Neurosurgical Procedures / Q000009:adverse effects; D018697:Nootropic Agents / Q000627:therapeutic use; D010353:Patient Education as Topic / Q000379:methods; D010880:Piperidines / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000523:psychology; D011597:Psychomotor Performance; D011788:Quality of Life; D011879:Radiotherapy Dosage; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D017741:Survivors / Q000523:psychology*; D013850:Thinking; D064690:Wakefulness-Promoting Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D064690:Wakefulness-Promoting Agents; D019382:Human Growth Hormone; D008774:Methylphenidate; D000077265:Donepezil; D000077408:Modafinil; D008727:Methotrexate