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Survivors of childhood ALL need continued support for neurocognitive impairments
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Survivors of childhood acute lymphoblastic leukemia experience persistent and significant neurocognitive impairment into adulthood, according to study results.
The findings suggest continued monitoring of brain health to ensure successful development and detect early onset of decline is warranted, researchers said.
The study included 567 survivors of childhood ALL (mean age, 33 years) treated at St. Jude Children’s Research Hospital who survived 10 or more years after diagnosis. Mean time since diagnosis was 26 years. Patients were recruited for neurocognitive testing.
Neurocognitive domains assessed included intelligence, attention, academic skills, memory, processing speed and executive function.
Impairment rates across neurocognitive domains ranged from 28.6% to 58.9%. Patients who were treated with chemotherapy experienced impairment across all domains (all P values <.006).
Among those not treated with cranial radiation therapy, dexamethasone was associated with impaired attention (relative risk=2.12; 95% CI, 1.11-4.03) and executive function (RR=2.42; 95% CI, 1.20-4.91). The impact cranial radiation therapy had on intelligence, academic and memory function was dependent upon young age at diagnosis.
Self-reported behavior problems increased by 5% (RR=1.05; 95% CI, 1.01-1.09) for all survivors for each year from diagnosis. Researchers noted that impairment was associated with a decrease in education and unemployment.
Kevin R. Krull
“Survivors of childhood leukemia experience high rates of severe and pervasive neurocognitive impairment well into adulthood,” Kevin R. Krull, PhD, of the department of epidemiology and cancer control at St. Jude Children’s Research Hospital, and colleagues wrote. “Although survivors appear to adapt to some of these difficulties, deficits continue to have significant impact on their psychosocial functioning. Ongoing services to support survivors of childhood cancer are needed as they transition into adulthood. Resources for success in higher education and vocational placement may improve this transition and future quality of life. Continued monitoring by health professionals is recommended to identify neurocognitive problems that may emerge with time. Treatment of these problems may enhance long-term maturation and quality of life.”
Disclosure: The researchers report no relevant financial disclosures.
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