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: 5/6/2019 7:20:30 PM

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