LATE COGNITIVE, ACADEMIC, AND BEHAVIORAL FUNCTIONING IN CHILDHOOD CANCER SURVIVORS TREATED BEFORE AGE FIVE WITH NON-CNS-DIRECTED THERAPY

Open Access
- Author:
- FitzGerald, Julie L.
- Graduate Program:
- School Psychology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- October 24, 2007
- Committee Members:
- Barbara Schaefer, Committee Chair/Co-Chair
James Clyde Diperna, Committee Member
Paul Morgan, Committee Member
Rick Owen Gilmore, Committee Member - Keywords:
- memory
attention
intelligence
pediatric oncology
non-CNS treatment
childhood cancer
neurocognitive late effects
learning
treatment effects
pediatric oncology
academic achievement
executive function - Abstract:
- Children who have been treated for cancer are at risk for experiencing cognitive, academic, and behavioral difficulties which may not appear until long after treatment has ended. These difficulties, known as neurocognitive late effects, are believed to result in part from damage to the central nervous system (CNS) caused by the cancer and by neurotoxic treatment methods. Until recently, children whose cancer and treatment protocols did not target the CNS were believed to be protected from such damage. However, research suggests that these cancer survivors may indeed experience some degree of neurocognitive impairment following treatment. Cognitive, academic, and behavioral functioning were examined in a group of 18 long-term cancer survivors treated prior to school-age with only non-CNS-directed chemotherapy and radiation. Survivors’ scores were compared to their healthy siblings and to the normative population. Although the differences were not statistically significant, the healthy siblings outperformed survivors on all measures, including IQ, reading, math fluency, working and auditory memory, and processing speed. Furthermore, survivors were much more likely to be receiving special education services than their siblings. Cancer survivors demonstrated higher levels of parent-reported problems with attention and executive functioning, compared to both siblings and the normative population. Medium to large effect sizes were associated with the differences between survivors’ and siblings’ auditory memory scores and small to medium effects were found between survivors and the normative group in math fluency. In spite of the differences, survivors’ mean scores on all of the measures fell within the average range, and both survivors’ and siblings’ IQs were slightly above average. Exploratory regression analyses suggested that parent education was the only significant predictor of attention and executive functioning, while time since diagnosis was the only significant predictor of survivors’ scores on the auditory memory composite. The small n was a significant limitation in terms of statistical power and the ability to generalize the findings. Nevertheless, results from the study do support the need for future large-scale research with this population of cancer survivors to determine whether they are at risk for later neurocognitive deficits, and if so, which areas of functioning are likely to be affected.