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
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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:
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Age of patient at time of treatment
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High dose antimetabolite therapy
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Total dose of radiation to the head
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Combination of antimetabolites and radiation
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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.
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Chemotherapy
Table 1
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Functional Deficits
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Learning deficits
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Diminished IQ
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Behavioral change
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Alkylating Agents
Busulfan
Carmustine
BCNU
Chlorambucil
Cyclophosphamide
Cytoxan
Ifosphamide
Lomustine
CCNU
Mechlorethamine
Melphalan
Procarbazine
Thiotepa
Dacarbazine
DTIC
Temozolomide
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|
|
|
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Heavy Metals
Cisplatin
Carboplatin
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|
|
|
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Antimetabolites
Cytarabine
Ara-C
Mercaptopurine
6MP
Thioguanine
6TG
Methotrexate
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X
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X
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X
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X
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Anthracycline antibiotics
Daunorubicin
Doxorubicin
Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
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Chemotherapy
Table 2
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Functional Deficits
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Learning deficits
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Diminished IQ
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Behavioral change
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Anti-tumor antibiotics
Bleomycin
Dactinomycin
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|
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Corticosteroids
Dexamethasone
Decadron
Prednisone
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|
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Enzymes
Asparaginase
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|
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Plant alkaloids
Vincristine
Vinblastine
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|
|
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Epipodophyllotoxins
Etoposide
VP16
Teniposide
VM26
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|
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Radiation
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Functional Deficits
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Learning deficits
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Diminished IQ
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Behavioral change
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All Radiation
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|
|
|
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TBI
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X
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X
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X
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X
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Head/Brain
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X
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X
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X
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X
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Neck
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|
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Thorax
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|
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Abdomen
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|
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Pelvis
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Extremity
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Surgery
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Functional Deficits
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Learning deficits
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Diminished IQ
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Behavioral change
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Neurosurgery - Brain
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X
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X
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X
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X
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