Neurocognitive impairment in children treated for cancer: how do we measure cognitive outcomes?

As the number of childhood cancer survivors grows, more attention on the identification and management of late effects, such as neurocognitive decline, is needed. This study, investigating treatment with central nervous system (CNS) stimulants for cognitive changes related to pediatric cancer treatment, confirmed a common concern. How should neurocognitive decline be measured and followed up after cancer therapy? Multiple pediatric standardized cognitive tests are available, but there is no consensus on an efficient way to measure the most common areas of decline, specifically impaired concentration, memory, and mental processing speed. The authors' report recognized 12 pediatric patients at risk for cognitive dysfunction, of whom 3 tested positive for early neurocognitive deficits using 3 subscales of the Wechsler Intelligence Scale for Children-III (WISC-III), which measure working verbal memory (Digit Span), mental processing speed (Symbol Search), and psychomotor speed (Coding). To predict the expected level of performance on WISC-III subscales, the patients' IQ was estimated using the Wide Range Achievement Test-3 reading subtest. Patients were treated with long-acting CNS stimulants and followed up serially using the WISC-III subscales.

Evaluation of the functional assessment of cancer therapy cognitive scale with hematopoietic stem cell transplant patients.

The current study evaluated a newly developed self-report measure of cognitive complaints with cancer patients, the Functional Assessment of Cancer Therapy Cognitive Scale (FACT-Cog). Six or 12 months following hematopoietic stem cell transplantation, participants completed a psychosocial assessment that included the FACT-Cog and a neuropsychological assessment. Using a criterion of two or more times a week, an average of 12 of a total of 50 items were endorsed as complaints on the FACT-Cog. FACT-Cog total, domain, and subscale scores were significantly correlated with measures of depression, fatigue, anxiety, and physical and mental well-being. FACT-Cog scores, with the exception of one subscale, Other People Noticed Deficits, were not significantly correlated with cognitive performance. In general, the FACT-Cog and a commonly used measure of cognitive complaints (European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire-C30 Cognitive Functioning Scale) demonstrated similar psychometric properties. However, the FACT-Cog assesses broader aspects of cognitive complaints, thereby providing greater information about the types of cognitive complaints patients are experiencing.

Cognitive impairment in patients with brain tumors: assessment and intervention in the clinic setting.

Cognitive impairment is the most common neurologic problem associated with brain tumors and is present in many people with brain tumors from the time of diagnosis. Treatment of primary brain tumors with surgery, radiation, chemotherapy, and adjunctive medications such as corticosteroids results in further adverse effects on cognitive function. To plan the best care for patients with brain tumors, healthcare providers must initiate systematic and accurate assessment of cognitive functioning at the first clinic visit and extend assessment throughout the course of illness. This article outlines the range of cognitive dysfunction that may be seen in patients with primary brain tumors and offers information for clinicians seeking to develop their skills and implement a systematic approach to cognitive screening. The use of cognitive screening to guide timely intervention, such as referral to a neuropsychologist and the provision of anticipatory guidance to people with brain tumors and their families, is discussed.