Long Term Cognitive Sequelae

Neurocognitive problems are seen in up to 40% of childhood cancer survivors (Krull et al. 2008). Survivors of childhood lymphoblastic leukemia and brain tumors, who have often been treated with chemotherapy or radiation that targets the central nervous system or is toxic to the developing brain, are at particular risk of later onset of long-term cognitive and learning deficits. Specific screening techniques (Krull et al. 2008) and guidelines have been developed for assessment and follow-up of later neurocognitive effects in childhood cancer survivors to ensure that early and specific intervention can be offered (Nathan et al. 2007). Problems of attention, memory, and information processing that occur after treatment for cancers in the central nervous system have been found to impact the child's psychological adjustment and quality of life (Peterson and Drotar 2006). Treatment with methylphenidate has been found to have at least some short-term efficacy for those survivors with problems of attention (Mulhern et al. 2004).

In the Childhood Cancer Survivor Study, 12,430 young adults who were at least 5 years postdiagnosis for pediatric cancer and 3,410 full siblings of the survivors were compared regarding use of special education services and educational attainment. Survivors were significantly more likely than siblings to require special education services. Survivors of tumors of the central nervous system, leukemia, non-Hodgkin's lymphoma, and neuroblastoma who did not receive special education services were significantly less likely to complete high school than were their siblings (Mitby et al. 2003). Another large study of childhood cancer survivors used parental reports to compare 800 survivors with 923 matched controls on educational outcomes. They found that survivors were more likely to have repeated a grade (21% vs. 9%), to have educational problems (46% vs. 23%), and to attend learning disability (19% vs. 7%) or special education (20% vs. 8%) programs than were controls. Survivors who had cranial radiation were more likely than other survivors to have had educational difficulties (Barrera et al. 2005).

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