Neurocognitive and Behavioral Outcomes of Chinese Survivors of Childhood Lymphoblastic Leukemia

Abstract

BackgroundIncreasing attention has been dedicated to investigate modifiable risk factors of late effects in survivors of childhood cancer. This study aims to evaluate neurocognitive and behavioral functioning in a relatively young cohort of survivors of childhood acute lymphoblastic leukemia (ALL) in Hong Kong, and to identify clinical and socio-environmental factors associated with these outcomes.MethodsThis analysis included 152 survivors of childhood ALL who were ≥5 years post-diagnosis (52% male, mean [SD] age 23.5[7.2] years at evaluation, 17.2[7.6] years post-diagnosis). Survivors completed performance-based neurocognitive tests, and reported their emotional and behavioral symptoms using the Child/Adult Behavior Checklist. Socio-environmental variables (living space, fatigue, physical activity, family functioning, and academic stress) were self-reported using validated questionnaires. Clinical variables and chronic health conditions were extracted from medical charts. Multivariable linear modeling was conducted to test identify factors associated with neurocognitive/behavioral outcomes, adjusting for current age, sex, age at diagnosis and cranial radiation. An exploratory mediation analysis was performed to examine the mediating effects of risk factors on neurocognitive and behavioral outcomes.ResultsAs compared to population norms, a minority of survivors developed mild-moderate impairment in motor processing speed (36.2%), memory (9.2%) and attention measures (4.0%-10.5%). Survivors also reported attention problems (12.5%), sluggish cognitive tempo (23.7%) and internalizing (depressive, anxiety and somatic symptoms) problems (17.1%). A minority of survivors developed mild-moderate treatment-related chronic conditions (n=37, 24.3%). As compared to survivors without chronic conditions, survivors with chronic conditions had more executive dysfunction (B=5.09, standard error [SE]=2.05; P=0.014) and reported more attention problems (B=5.73, SE=1.43; P<0.0001). Fatigue and poor family functioning was associated with multiple measures of behavior problems (all P<0.001). A lower level of physical activity was correlated with more self-reported symptoms of inattention (B= -1.12, SE=0.38, P=0.004) and sluggish cognitive tempo (B=-1.22, SE=0.41, P=0.003). Exploratory analysis showed that chronic health conditions were associated with behavioral measures through fatigue as the mediator.ConclusionThe majority of young Chinese survivors of ALL had normal cognitive and behavioral function. Regular monitoring of behavioral function should be performed on survivors who develop treatment-related chronic conditions. Health behavior and socio-environment factors may be potentially modifiable risk factors associated with health outcomes in survivors.

Predizendo problemas internalizantes e externalizantes em pacientes pediátricos oncológicos: papel da ansiedade e depressão parental

“…Similarly, Hedström et al (2003) found that the most frequently mentioned aspects of distress referred to the emotional dimension by children, parents and nurses were categorized as confinement, feeling of alienation, besides worry before medical procedures, which are emotions linked to social withdrawal. If we considered the narrowband syndrome symptoms, our results are consistent with several other studies that have suggested pediatric cancer patients are at risk of developing anxiety (Peng et al, 2021), depression (Peng et al, 2021), and somatization (Peng et al, 2021). Nevertheless, to a lesser extent externalizing problems also were present, corroborating the findings of other studies of children and adolescents with cancer (Hostert, Motta, & Enumo, 2015;Liu et al, 2018).…”

“…Studies of the emotional and behavioral functioning of children after cancer diagnosis indicate that they have increased risk of developing anxiety (Peng et al, 2021;Price et al, 2016), worry about death, confinement and feeling of alienation (Hedström, Haglund, Skolin, & von Essen, 2003), depression (Peng et al, 2021;Price et al, 2016), and somatization (Olagunju, Sarimiye, Olagunju, Habeebu, & Aina, 2016;Peng et al, 2021), as well as hyperactivity/impulsivity and oppositional defiant disorder (Liu et al, 2018). Many symptoms' profiles were also identified among adolescents who were survivors of child cancer, such as behavioral and emotional symptoms, including anxiety, post-traumatic stress symptoms, and cancer-related worry (McDonnell et al, 2017) and they are associated with type of treatment exposures and physical late effects (Brinkman et al, 2016).…”

The systematic analysis and 10-year prediction on disease burden of childhood cancer in China

“…First, learning from the experience of the USA ( 4 ), we should set up an effective system for the prevention and treatment of childhood cancers, better to implement three-grade prevention. Second, some types of childhood cancer have received advanced forms of treatment, even by international standards; nonetheless, due to differences in regional, economic, and social factors ( 34 ), it is difficult to guarantee equality of healthcare, which is a key future goal. China must, therefore, prioritize and strengthen investment in research and medical resources pertaining to childhood cancers, to reduce the immense national disease burdens linked to these conditions.…”

The Psychoneuroimmunology of Stress Regulation in Pediatric Cancer Patients

“…Additional risk to effective cognitive-affective stress appraisal may be conferred by lower engagement in stress buffering behaviours such as socialisation and physical activity that promote adaptive coping [ 74 , 75 , 76 ]. Indeed, in a recent study of childhood Acute Lymphoblastic Leukemia (ALL) survivors, correlations were found between low levels of physical activity and inattention [ 77 ]. Further, disruption to corticolimbic brain regions central to these interpretive processes has been reported in several childhood cancer populations and is thought to be a result of cytotoxic treatments including chemotherapies that are neurotoxic and/or cross the blood brain barrier.…”