Yale Cancer Center Study Shows Cognitive Impairment for Survivors of Many Pediatric Cancers

Nina S. Kadan-Lottick, MD, MSPH

In a new study led by Yale Cancer Center, researchers report many survivors of childhood cancers receive systemic therapies associated with cognitive effects and chronic health conditions that may impact long-term cognitive outcomes with downstream effects on education, employment, and income. The results were published online today in the Journal of Clinical Oncology (JCO).

“Cognitive outcomes in survivors of childhood cancers have been largely understudied,” said Nina S. Kadan-Lottick, MD, MSPH, Associate Professor of Pediatrics (Hematology/Oncology) and Disease Aligned Research Team (DART) Leader for Pediatric Cancer at Yale Cancer Center and senior author of the study. “In this study, we wanted to explore cognitive functioning after specific extracranial solid tumor and lymphoma diagnoses to discuss possible associated risk factors and highlight research gaps to help provide clinical guidance for affected survivors.”

Researchers examined previous studies that investigated long-term (>2 years off-therapy and/or 5 years from diagnosis) cognitive outcomes in survivors of childhood (diagnosed <21 years) extracranial solid tumors and lymphomas with at least 10 patients within the diagnostic subcategory back to 1990. The studies suggested survivors of osteosarcoma, neuroblastoma, Wilms tumor, non-Hodgkin lymphoma, Hodgkin lymphoma, and Langerhans cell histiocytosis have increased risk of cognitive impairment. Co-morbid health conditions were frequently associated with cognition. For pediatric survivors of Ewing Sarcoma, Retinoblastoma, and soft tissue sarcomas, the data was less convincing for similar impairment.

“Given the older age at diagnosis of many childhood extracranial solid tumors and lymphomas as well as toxicities associated with certain therapies, we concluded patients may benefit from vocational services, occupational therapy, physical therapy, and/or hearing or visual rehabilitation in addition to surveillance for cognitive difficulties,” added Kadan-Lottick.

“However, larger prospective studies are needed that better delineate the severity of cognitive impairment, contributory risk factors, and effective interventions to reduce impairment.”

Lead author of the study is Rebecca Foster, PhD. Other study authors include Daniel J. Zheng, MD, and Kelli L. Netson-Amore, PhD.

About Yale Cancer Center and Smilow Cancer Hospital

Yale Cancer Center (YCC) is one of only 51 National Cancer Institute-designated comprehensive cancer centers in the nation and the only such center in Connecticut. Cancer treatment for patients is available at Smilow Cancer Hospital through 13 multidisciplinary teams and at 15 Smilow Cancer Hospital Care Centers in Connecticut and Rhode Island. Comprehensive cancer centers play a vital role in the advancement of the NCI’s goal of reducing morbidity and mortality from cancer through scientific research, cancer prevention, and innovative cancer treatment.