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Long-term Effects on School

Issue

Effects of Cancer Treatment on School Performance and Learning

Background

During the past several years, professionals working in the field of pediatric oncology have seen the cure rates for childhood cancer improve significantly. This is wonderful news for all those involved in the lives of children struggling with cancer. However, as parents and medical professionals have seen more and more children survive cancer and its rigorous treatment, they also have become aware of the effects of cancer treatment that may pose problems for children, adolescents, and young adults as they adjust to life after a serious illness.

Specifically, researchers have found that cancer treatment may negatively affect children’s abilities to process, learn, and retain new information. These effects may be short-term or long-term. Short-term effects are temporary and eventually disappear. However, some long-term effects, or “late effects,” do not appear until two to five years after completing therapy and may not disappear over time.

Thus, greater attention by researchers has been focused on understanding “cognitive late effects,” modifying treatment regimens to reduce these effects, and developing strategies to address potential challenges posed by cancer and its treatment. This section will focus specifically on what late effects may be experienced, who is at risk for them, and what can be done to minimize them.

Information

What Types of Learning Problems Do Childhood Cancer Patients Experience?

The possible learning difficulties faced by children treated for cancer often are related to a decline in IQ (Intelligence Quotient), or a child's potential to learn. However, several other problems have been observed. These include: declines in nonverbal abilities, impairments in short-term memory, poor eye-hand coordination, decreased speed in processing information and responding, sequencing problems, difficulties with attention and concentration, and declines in verbal comprehension.

Who Is at Risk?

It is clear that not all childhood cancer patients will experience brain changes and/or associated learning and school problems. It seems that certain groups of children with cancer are at particular risk for learning problems related to their illness or treatment:

  1. Treatment area: Patients who require treatment that targets the brain, such as those with a brain tumor or leukemia, appear to be at greatest risk for learning problems.

  2. Age: The negative effects of cancer treatment on children's cognitive abilities appear greatest for those treated in infancy and early childhood, and the risks decrease gradually as the age at treatment increases.

  3. Type and aggressiveness of the treatment: Some types of chemotherapy are associated with lower risk. Cranial radiation is associated with greater risk of declines in intellectual and other abilities. For children with brain tumors, the amount of radiation received, the location of the tumor, and possible effects of surgery (as well as other neurological problems they may experience) may influence the types of learning problems that develop and how serious they are.

  4. Gender: Some research indicates females may be more vulnerable to the negative effects of cancer treatment on learning than males.

What Can Be Done To Minimize Learning Problems in Children Treated for Cancer?

Pediatric oncologists have attempted to modify treatment protocols to reduce the risk of learning problems in children with cancer, especially during vulnerable periods of development. Additionally, psychologists and other medical professionals have been studying ways to reduce the impact of cancer treatment on learning and school performance:

  1. Evaluate the child's capacity to learn (intelligence) as well as their functioning in a number of important areas such as memory, attention, and visual-motor skill, and language development. This is best done by a neuropsychologist or psychologist who is experienced in working with children with special medical problems. It also is very helpful to continue having children and adolescents followed over time by such professionals within comprehensive cancer treatment centers, because children can continue experiencing changes in their functioning several years after cancer treatment has ended.

  2. Recent research by psychologists suggests that "cognitive remediation" may be helpful in minimizing learning problems of children treated for cancer. This type of intervention involves training sessions with educational therapists which focus on improving memory, attention, and math skills. Children are taught strategies which assist with organization, redirecting attention once distracted, and rehearsing information to be retained. More research is needed to determine the effectiveness of these programs.

  3. It is important for parents and school personnel to remember that the learning problems faced by children who have undergone cancer treatment are often quite different from those of students with more traditional learning and attention problems. While some medications which have been helpful for children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) may have potential benefits for children treated for cancer, the effectiveness of this medical intervention has not yet been supported by systematic research. However, clinical reports are promising. It is best to discuss the potential advantages and disadvantages of such medications with the child's pediatrician and a child psychiatrist, as well as the neuropsychologist who evaluates the child.

Other suggestions for parents and teachers regarding children's school performance include:

Resources

Brown, R. et al. (1992). Chemotherapy for acute lymphocytic leukemia: cognitive and academic sequelae. Journal of Pediatrics, 121, 885-889.

Butler, R., Rizzi, L. (1995). The remediation of attentional deficits secondary to treatment for child-hood cancer. Newsletter of the Society of Pediatric Psychology, 19: 5.

Copeland, D. (1992). Neuropsychological and psychosocial effects of childhood cancer and its treatment. CA- A Cancer Journal for Clinicians, 42, 283-295.

Copeland, D. et al. (1996). Neuropsychologic effects of chemotherapy on children with cancer: A longitudinal study. Journal of Clinical Oncology, 14, 2826-2835.

Constine, L. et al. (1988). Adverse effects of brain irradiation correlated with MR and CT imaging. International Journal of Radiation Oncology and Biological Physics, 15, 319-330.

Moore, B. et al. (1992). Neurophysiological indices of cognitive impairment in long-term survivors of pediatric cancer. Archives of Neurology, 49: 809-817.

Moore, B., Ater, J., Copeland, D. (1992). Improved neuropsychological outcome in children with brain tumors diagnosed during infancy and treated without cranial irradiation. Journal of Child Neurology, 7: 281-290.

Mostow, E. et al. (1991). Quality of life in long-term survivors of central nervous system tumors of childhood and adolescence. Journal of Clinical Oncology, 9: 592-599.

Mulhern, R. et al. (1992). Long-term survivors of leukemia treated in infancy: Factors associated with neuropsychological status. Journal of Clinical Oncology, 10, 1095-1102.

Mulhern, R. (1994). Neuropsychologcial late effects. In D. J. Bearison & R. K. Mulhern (Eds.), Pediatric Psychooncology, 99-121.

Silber, J. H. et al. (1991). Whole-brain irradiation and decline in intelligence: The influence of dose and age on IQ score. Journal of Clinical Oncology, 10, 390-396.

Key Words

late effects, cognitive, learning



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