In a new study led by Yale Cancer Center, researchers report many survivors of childhood cancers receive systemic therapies associated with cognitive effects and chronic health conditions that may impact long-term cognitive outcomes with downstream effects on education, employment, and income. The results were published online today in the Journal of Clinical Oncology (JCO).
“Cognitive outcomes in survivors of childhood cancers have been largely understudied,” said Nina S. Kadan-Lottick, MD, MSPH, Associate Professor of Pediatrics (Hematology/Oncology) and Disease Aligned Research Team (DART) Leader for Pediatric Cancer at Yale Cancer Center and senior author of the study. “In this study, we wanted to explore cognitive functioning after specific extracranial solid tumor and lymphoma diagnoses to discuss possible associated risk factors and highlight research gaps to help provide clinical guidance for affected survivors.”
Researchers examined previous studies that investigated long-term (>2 years off-therapy and/or 5 years from diagnosis) cognitive outcomes in survivors of childhood (diagnosed <21 years) extracranial solid tumors and lymphomas with at least 10 patients within the diagnostic subcategory back to 1990. The studies suggested survivors of osteosarcoma, neuroblastoma, Wilms tumor, non-Hodgkin lymphoma, Hodgkin lymphoma, and Langerhans cell histiocytosis have increased risk of cognitive impairment. Co-morbid health conditions were frequently associated with cognition. For pediatric survivors of Ewing Sarcoma, Retinoblastoma, and soft tissue sarcomas, the data was less convincing for similar impairment.
“Given the older age at diagnosis of many childhood extracranial solid tumors and lymphomas as well as toxicities associated with certain therapies, we concluded patients may benefit from vocational services, occupational therapy, physical therapy, and/or hearing or visual rehabilitation in addition to surveillance for cognitive difficulties,” added Kadan-Lottick. “However, larger prospective studies are needed that better delineate the severity of cognitive impairment, contributory risk factors, and effective interventions to reduce impairment.”
Lead author of the study is Rebecca Foster, PhD. Other study authors include Daniel J. Zheng, MD, and Kelli L. Netson-Amore, PhD.