Processing efficiency in pediatric cancer survivors: A review and operationalization for outcomes research and clinical utility

Abstract

Objective Childhood cancer and cancer‐related treatments disrupt brain development and maturation, placing survivors at risk for cognitive late effects. Given that assessment tools vary widely across researchers and clinicians, it has been daunting to identify distinct patterns in outcomes across diverse cancer types and to implement systematic neurocognitive screening tools. This review aims to operationalize processing efficiency skill impairment—or inefficient neural processing as measured by working memory and processing speed abilities—as a worthwhile avenue for continued study within the context of childhood cancer. Methods A comprehensive literature review was conducted to examine the existing research on cognitive late effects and biopsychosocial risk factors in order to conceptualize processing efficiency skill trends in childhood cancer survivors. Results While a frequently reported pattern of neurobiological (white matter) and cognitive (working memory and processing speed) disruption is consistent with processing efficiency skill impairment, these weaknesses have not yet been fully operationalized in this population. We offer a theoretical model that highlights the impacts of a host of biological and environmental factors on the underlying neurobiological substrates of cancer survivors that precede and may even predict long‐term cognitive outcomes and functional abilities following treatment. Conclusion The unified construct of processing efficiency may be useful in assessing and communicating neurocognitive skills in both outcomes research and clinical practice. Deficits in processing efficiency may serve as a possible indicator of cognitive late effects and functional outcomes due to the unique relationship between processing efficiency skills and neurobiological disruption following cancer treatment. Continued research along these lines is crucial for advancing childhood cancer outcomes research and improving quality of life for survivors.

Clinical significance of cerebral microbleeds in patients with germinoma who underwent long-term follow-up

“…These include age at onset, radiation therapy, radiation dosage to the supratentorial lesion, cochleae, optic nerve, cerebellum, vermis and pons, resection, and chemotherapy [13,45,46]. Consistent with the results of this study, small vessel lesions such as CMBs and lacunar infarcts, which involve white matter damage, and decreased regional cerebral blood ow [11,12,42] are the underlying pathologies of process speed decline.…”

“…Along with working memory, which refers to the ability to retain information for short periods of time, it is a function that is more likely to be impaired in the long-term survivors of pediatric cancer. These impairments can reduce learning social development, academic performance, and future vocational attainment, thereby directly affecting the patient's social functioning [42][43][44]. In an analysis of long-term survivors after treatment for pediatric brain tumors, multiple factors have been found to affect processing speed.…”

Parents' Distress & Demands for Children with Cancer-Related Cognitive Impairment in Western China: A qualitative study

“…The occurrence rate of cancer-related cognitive impairment among childhood cancer survivors ranges from approximately 40 to 60%, particularly prevalent in cases of brain tumors and leukemia 5 . This impairment is primarily manifested as altered cognitive functions, including decreased abilities in neurocognitive domains such as attention, executive function, and learning capacity 6,7 . Research suggests that as these children with cognitive impairments age, they face heightened risks of lower educational attainment, professional achievements, and employment rates.…”