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Cognitive/School QuickFact

Childhood cancer survivors can be at risk for the following neurocognitive late effects:

  • Functional deficits in:
    • Executive function (planning and organization)
    • Sustained attention
    • Memory (particularly visual, sequencing, temporal memory)
    • Processing speed
    • Visual motor integration
  • Learning deficits in math and reading (particularly reading comprehension)
  • Diminished IQ
  • Behavioral change

If your patient does not have a Survivor Health Plan (SHP), please refer him/her to the appropriate survivor clinic. 

Important factors in determining risk for neurocognitive late effects:

  • Age of patient at time of treatment
  • High dose antimetabolite therapy
  • Total dose of radiation to the head
  • Combination of antimetabolites and radiation
  • Premorbid or family history of learning or attention problems

Generally, patients are at highest risk of developing neurocognitive late effects if treated at a young age with cancer present in the central nervous system.

Chemotherapy

Table 1

Functional Deficits

Learning deficits

Diminished IQ

Behavioral change

Alkylating Agents                       

Busulfan

Carmustine

   BCNU   

Chlorambucil

Cyclophosphamide

   Cytoxan

Ifosphamide

Lomustine

   CCNU

Mechlorethamine

Melphalan

Procarbazine

Thiotepa

 

Dacarbazine

    DTIC

Temozolomide

 

 

 

 

Heavy Metals

Cisplatin

Carboplatin

 

 

 

 

 

Antimetabolites

Cytarabine

   Ara-C

Mercaptopurine

   6MP

Thioguanine

   6TG

Methotrexate

 

X

X

X

X

Anthracycline antibiotics

Daunorubicin

Doxorubicin

   Adriamycin

Epirubicin

Idarubicin

Mitoxantrone

 

 

 

 

 

Chemotherapy

Table 2

 

Functional Deficits

Learning deficits

Diminished IQ

Behavioral change

Anti-tumor antibiotics                

Bleomycin

Dactinomycin

 

 

 

 

 

Corticosteroids

Dexamethasone

   Decadron

Prednisone

 

 

 

 

 

Enzymes

Asparaginase

 

 

 

 

 

Plant alkaloids

Vincristine

Vinblastine

 

 

 

 

 

Epipodophyllotoxins

Etoposide

   VP16

Teniposide

   VM26

 

 

 

 

 

 

Radiation

Functional Deficits

Learning deficits

Diminished IQ

Behavioral change

All Radiation                               

 

 

 

 

TBI

X

X

X

X

Head/Brain

X

X

X

X

Neck

 

 

 

 

Thorax

 

 

 

 

Abdomen

 

 

 

 

Pelvis

 

 

 

 

Extremity

 

 

 

 

 

Surgery

Functional Deficits

Learning deficits

Diminished IQ

Behavioral change

Neurosurgery - Brain                 

X

X

X

X

For recommendations on how to screen for all potential late effects, please refer to The Children’s Oncology Group Long-Term Follow-Up Guidelines.

  

 

Health Links - Teaching Handouts from The Children's Oncology Group  

Educational Issues

 

Visit  www.survivorshipguidelines.org   to find many of the Health Links translated into other languages. 


References:

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links Version 4.0. October, 2013. www.survivorshipguidelines.org.

 

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 1/30/2015 4:08:08 PM
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