Survivors of CNS impacting cancers diagnosed in childhood are at significant risk for cognitive impairments. As survival rates improve, efforts to optimize cognitive outcomes take on added importance. Historically, there have been few empirically supported interventions for cancer survivors. Findings from pharmacologic interventions, largely using methylphenidate, have revealed an intervention that is safe and efficacious. However, there remain children for whom stimulant medications are not a viable option due to medical contraindication, parental preference or poor medication response.
Findings from nonpharmacologic, therapist-delivered interventions offer initial encouragement, particularly for improving academic skills; yet, time and financial requirements are high for relatively modest benefits, and individuals must reside in close proximity to providers. Computerized cognitive training offers added advantages of remote administration, decreased personnel resources and standardized implementation. Studies have demonstrated the feasibility, acceptability and efficacy of this approach, with neuroimaging findings suggestive of training-related neuroplasticity. Generalization of benefits to non-trained skills and maintenance of benefits over time are being investigated. Future directions include the use of genetics and neuroimaging to identify cognitive risk early in treatment as well as individualize intervention approaches.
This presentation provided an overview of pharmacologic and nonpharmacologic interventions for cognitive late effects experienced by childhood cancer survivors, including novel interventions currently under investigation.
Heather M. Conklin, PhD
Chief, Neuropsychology Section
Associate Member, Department of Psychology
St. Jude Children’s Research Hospital, Memphis, TN