scholarly journals Long-Term Efficacy of Methylphenidate in Enhancing Attention Regulation, Social Skills, and Academic Abilities of Childhood Cancer Survivors

2010 ◽  
Vol 28 (29) ◽  
pp. 4465-4472 ◽  
Author(s):  
Heather M. Conklin ◽  
Wilburn E. Reddick ◽  
Jason Ashford ◽  
Susan Ogg ◽  
Scott C. Howard ◽  
...  
Keyword(s):  
Social Skills ◽  
Acute Lymphoblastic Leukemia ◽  
Cancer Survivors ◽  
Behavioral Problems ◽  
Lymphoblastic Leukemia ◽  
Cancer Control ◽  
Childhood Cancer Survivors ◽  
Control Group ◽  
Parent Ratings

Purpose Methylphenidate (MPH) ameliorates attention problems experienced by some cancer survivors in the short term, but its long-term efficacy is unproven. Patients and Methods This study investigates the long-term effectiveness of maintenance doses of MPH in survivors of childhood brain tumors (n = 35) and acute lymphoblastic leukemia (n = 33) participating in a 12-month MPH trial. Measures of attention (Conners' Continuous Performance Test [CPT], Conners' Rating Scales [CRS]), academic abilities (Wechsler Individual Achievement Test [WIAT]), social skills (Social Skills Rating System [SSRS]), and behavioral problems (Child Behavior Checklist [CBCL]) were administered at premedication baseline and at the end of the MPH trial while on medication. A cancer control group composed of patients who were not administered MPH (brain tumor = 31 and acute lymphoblastic leukemia = 23) was assessed on the same measures 2 months apart. Results For the MPH group, repeated measures analysis of variance revealed significant improvement in performance on a measure of sustained attention (CPT indices, P < .05); parent, teacher, and self-report ratings of attention (CRS indices, P < .05), and parent ratings of social skills or behavioral problems (SSRS and CBCL indices; P < .05). In contrast, the cancer control group only showed improvement on parent ratings of attention (Conners' Parent Rating Scale indices; P < .05) and social skills (SSRS and CBCL indices; P < .05). There was no significant improvement on the academic measure (WIAT) in either group. Conclusion Attention and behavioral benefits of MPH for childhood cancer survivors are maintained across settings over the course of a year. Although academic gains were not identified, MPH may offer benefits in academic areas not assessed.

scholarly journals Clinical utility of complex assessment with evoked potentials in acute lymphoblastic leukemia survivors: comparison of various treatment protocols

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Slawomir Kroczka ◽  
Konrad Stepien ◽  
Izabela Witek-Motyl ◽  
Kinga Kwiecinska ◽  
Eryk Kapusta ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Evoked Potentials ◽  
Lymphoblastic Leukemia ◽  
Objective Assessment ◽  
Harmful Effect ◽  
Diagnostic Methods ◽  
Joint Analysis ◽  
Control Group ◽  
The Impact

Abstract Background One of the greatest success of pediatric hematology is a prominent improvement of survival in acute lymphoblastic leukemia (ALL). Therefore, special attention needs to be paid to long-term side effects of the treatment such as neurotoxicity. One of the few diagnostic methods that allow an objective assessment of sensory systems are evoked potentials (EP). Methods The analyzed group consisted of 167 ALL long-term survivors, aged 4.9–28.4 years, without auditory, visual and sensory deviations. Patients were treated with New York (NY, n = 35), previous modified Berlin-Frankfurt-Münster (pBFM, n = 47) and BFM95 (n = 85) protocols. In order to assess the impact of radiotherapy on recorded EP, a joint analysis of NY and pBFM groups was performed. The control group consisted of 35 patients, aged 6–17 years. The analyzed patients underwent a complex assessment with visual EP (VEP), somatosensory EP (SEP) and brainstem auditory EP (BAEP) in accordance with current standards. Results ALL treatment contributed to the shortening of wave I latency (1.59 vs 1.90, P = 0.003) and prolongation of I-III (2.23 vs 2.04, P = 0.004) and I-V (4.57 vs 4.24, P = 0.002) interwave latencies of BAEP. A significant effect was also noticed in P100 (106.32 vs 101.57, P < 0.001) and N135 (151.42 vs 138.22, P < 0.001) latencies of VEP and N18 amplitude (3.24 vs 4.70, P = 0.007) and P25 latency (21.32 vs 23.39, P < 0.001) of SEP. The distribution of abnormalities between protocols was similar in BAEP (NY - 68.6%, pBFM - 61.7%, BFM95–69.4%, P = 0.650), VEP (NY - 68.6%, pBFM - 42.5%, BFM95–58.3%, P = 0.053) and significantly different for SEP (NY - 62.9%, pBFM - 36.2%, BFM95–53.0%, P = 0.045). The harmful effect of radiotherapy was most clearly marked in numerous disturbances of SEP parameters. Conclusions The presented analysis indicates a high frequency of subclinical abnormalities in EP regardless of the analyzed protocol. To our knowledge current study is the largest and one of the most complex research examining the role of EP in ALL patients. The obtained results indicate the possibility of using a single, objective and non-invasive measurement of EP in ALL survivors in order to stratify the risk of developing sensory abnormalities in adulthood.

Computerized intervention for amelioration of cognitive late effects among childhood cancer survivors.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10034-10034
Author(s):  
Heather M. Conklin ◽  
Jason M. Ashford ◽  
Kellie N. Clark ◽  
Karen Martin-Elbahesh ◽  
Kristina K. Hardy ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Rating Scale ◽  
Lymphoblastic Leukemia ◽  
Childhood Cancer Survivors ◽  
Control Group ◽  
Parent Rating ◽  
Spatial Span ◽  
Computerized Intervention ◽  
Study Results

10034 Background: Children treated for cancer with CNS-directed therapy are at significant risk for attention and working memory (WM) problems. There is empirical support for pharmacotherapy and therapist-delivered cognitive rehabilitation; yet, the reach of these approaches is limited by medical contraindications, need for facility proximity and high resource utilization. A computer-based WM intervention has demonstrated efficacy for healthy individuals with attention disorders. We investigated this approach with childhood cancer survivors. Methods: Sixty-eight survivors of childhood acute lymphoblastic leukemia (ALL) or brain tumor (BT) with identified WM deficits were randomly assigned to a computerized WM intervention (18 males/16 females, 23 ALL/11 BT, age= 12.21±2.47) or a wait-list control group (18 males/16 females, 24 ALL/10 BT, age= 11.82±2.42). Participants in the intervention group were asked to complete 25 training sessions at home with weekly, phone-based coaching support. Cognitive assessments were completed pre- and post-intervention. Results: Among 34 participants randomized to intervention, 30 (88%) were adherent while 4 were removed from intervention because they failed to complete training in the allotted time. Survivors who completed the intervention demonstrated significantly greater improvements than controls on measures of attention (e.g., WISC-IV Spatial Span Forward 3.30±3.87 vs 1.33±2.20, p= .02, ES= .63), WM (e.g., WISC-IV Spatial Span Backward 3.13±3.19 vs 0.80±2.46, p= .002, ES= .82) and processing speed (e.g., Conners’ CPT Hit Reaction Time -2.10±8.04 vs 2.36±6.68, p= .02, ES=.60), and showed greater reductions in parent reported executive dysfunction (e.g., Conners’ Parent Rating Scale, III -6.73±8.25 vs .13±8.86, p= .003, ES= .80). No group differences in academic fluency were found (e.g., Woodcock Johnson III Math Fluency 0.90±4.59 vs 1.90±7.18, p= .52, ES= .17). Conclusions: Study results suggest computerized intervention is feasible and efficacious for childhood cancer survivors, with some evidence for generalized benefits. Computerized training may offer a safer, less time intensive and more portable alternative to existing interventions. Clinical trial information: NCT01217996.

Dexrazoxane and heart function among long-term childhood cancer survivors: A Children’s Oncology Group study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10513-10513
Author(s):  
Eric Jessen Chow ◽  
Sanjeev Aggarwal ◽  
David R Doody ◽  
Richard Aplenc ◽  
Saro Armenian ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cancer Diagnosis ◽  
Heart Function ◽  
Lymphoblastic Leukemia ◽  
Childhood Cancer Survivors ◽  
Left Ventricular ◽  
Lv Function ◽  
Cardioprotective Effects

10513 Background: Dexrazoxane (DRZ) has cardioprotective effects among doxorubicin (DOX) treated childhood cancer survivors up to 5 years after therapy. However, longer-term data are lacking. Methods: P9404, P9425, P9426, and DFCI 95-01 were randomized trials of acute lymphoblastic leukemia and Hodgkin lymphoma, where patients were randomly assigned to DOX±DRZ. P9754 enrolled osteosarcoma patients who all received DOX+DRZ. In all studies, DRZ was given as an intravenous bolus before DOX (10:1mg ratio). DOX doses ranged from 100-600 mg/m2 across these 5 trials. A subset of COG institutions prospectively assessed cardiac function in long-term survivors from these trials, plus a matched group of osteosarcoma survivors treated with DOX alone. Echocardiograms (left ventricular [LV] Biplane ejection fraction [EF], shortening fraction [SF]) and blood biomarkers (b-type natriuretic peptides [BNP], N-terminal [NT] proBNP) were all analyzed centrally, with DRZ status masked. Lower LV function was defined as EF<50% or SF<30%. T-test, rank-sum, and multivariate regression adjusted for sex, cancer diagnosis age, current age, DOX dose, and chest radiotherapy were used to examine differences and associations by DRZ status. Results: Among 173 participants assessed (52% DRZ+; 54% male; mean DOX 294±96 mg/m2) 17.6±2.4y since cancer diagnosis, DRZ+ participants were slightly younger (27.8 vs 29.6y, p=0.02), but baseline characteristics otherwise did not differ significantly by DRZ status. DRZ status was associated with higher FS (34.7±3.6% vs 33.4±4.3%, p=0.04) and EF (63.4±5.4% vs 61.4±5.5%, p=0.01), and lower BNP (median 10.4 pg/mL [IQR 6.0-18.0] vs 13.0 [IQR 6.0-28.2], p=0.03) and NT-proBNP (median 30.8 pg/mL [IQR 18.9-58.2] vs 47.1 [IQR 23.0-83.1], p<0.01). In stratified analyses, the cardioprotective effects associated with DRZ tended to be more pronounced in females (vs males) and those who received DOX ≥300 mg/m2 (vs <300mg/m2). Results from multivariate models were similar: DRZ was associated with higher SF (1.4% [95% CI 0.2, 2.6]) and EF (2.7% [95% CI 0.8, 4.6]), and reduced BNP (-4.0 pg/mL [95% CI -7.6, -0.4]) and NT-proBNP (-20.7 pg/mL [95% CI -33.5, -7.9]). Overall, DRZ was associated with a reduced risk of having lower LV function (odds ratio 0.27 [95% CI 0.08-0.96]). Conclusions: After >17y, childhood cancer survivors treated with DOX+DRZ had better LV systolic function and less myocardial wall stress compared with those treated with DOX alone. DRZ may preferentially benefit females and those treated with greater DOX doses.

Evaluation of long-term cardiac side effects of anthracycline chemotherapy by conventional and non-conventional echocardiographic methods in childhood cancer survivors

2019 ◽  
Vol 29 (7) ◽  
pp. 904-909 ◽  
Author(s):  
Tamer Yoldaş ◽  
Şule Yeşil ◽  
Selmin Karademir ◽  
Gürses Şahin ◽  
Utku Arman Örün ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Tissue Doppler Imaging ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Childhood Cancer Survivors ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Control Group

AbstractObjective:Anthracycline chemotherapeutic agents carry the well-recognised risk of cardiac toxicity. The aim of this study was to determine the long-term effect of anthracycline chemotherapy on the biventricular function in childhood cancer survivors using tissue Doppler imaging and two-dimensional speckle tracking echocardiography.Patients and Methods:The study included 45 survivors of childhood cancers and 50 healthy age-matched control patients. Cardiac function was prospectively studied with conventional echocardiography, tissue Doppler imaging, and speckle tracking echocardiography after completion of treatment. The same analysis was performed on matched controls.Results:There was no difference in age, gender, height, and weight between the study and control groups. The mean anthracycline dose was 240 ± 106 mg/m2 and the mean remission duration was 8.2 ± 5 years (1–20 years) in the study group. Conventional echocardiography showed similar ejection fraction, shortening fraction, and left ventricle end-diastolic diameter in both groups. Mitral lateral and septal tissue Doppler imaging showed normal but according to control group relatively sub-normal systolic and diastolic function in patient group. The global longitudinal and circumferential strain and strain rates were significantly lower in the patient group compared to control group. Correlation analysis revealed a negative and significant correlation between total anthracycline dose and global longitudinal and circumferential strain and strain rates.Conclusion:Sub-clinical systolic and diastolic dysfunction may not be detected by conventional echocardiographic methods which are frequently used in daily practice. Sub-clinical systolic and diastolic dysfunction may be detected more sensitively by echocardiographic method such as speckle tracking echocardiography in childhood cancer survivors.

scholarly journals Clinical Utility of Complex Assessment With Evoked Potentials in Acute Lymphoblastic Leukemia Survivors: Comparison of Various Treatment Protocols

2020 ◽  
Author(s):  
Slawomir Kroczka ◽  
Konrad Stepien ◽  
Izabela Witek-Motyl ◽  
Kinga Kwiecinska ◽  
Eryk Kapusta ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Evoked Potentials ◽  
Lymphoblastic Leukemia ◽  
Objective Assessment ◽  
Harmful Effect ◽  
Diagnostic Methods ◽  
Joint Analysis ◽  
Control Group ◽  
The Impact

Abstract Background: One of the largest success in a pediatric hematology is a prominent improvement of survival in acute lymphoblastic leukemia (ALL). Simultaneously, it encourages to focus on long-term effects of the treatment such as neurotoxicity. One of the few diagnostic methods that allow an objective assessment of sensory organization are evoked potentials (EP).Methods: We analyzed the group consisted of 167 ALL long-term survivors, aged 4.9-28.4 years, without auditory, visual and sensory deviations. Patients were treated with New York (NY, n=35), previous modified Berlin-Frankfurt-Münster (pBFM, n=47) and BFM95 (n=85) protocols. In order to assess the impact of radiotherapy on recorded EP, a joint analysis of NY and pBFM groups was performed. The control group consisted of 35 patients, aged 6-17 years. The analyzed patients underwent a complex assessment with visual EP (VEP), somatosensory EP (SEP) and brainstem auditory EP (BAEP) in accordance with current standards.Results: ALL treatment contributed to the shortening of wave I latency (1.59 vs 1.90, P=0.003) and prolongation of I-III (2.23 vs 2.04, P=0.004) and I-V (4.57 vs 4.24, P=0.002) interwave latencies in BAEP. A significant effect was also noticed in P100 (106.32 vs 101.57, P<0.001) and N135 (151.42 vs 138.22, P<0.001) latencies for VEP and N18 amplitude (3.24 vs 4.70, P=0.007) and P25 latency (21.32 vs 23.39, P<0.001) for SEP. The distribution of abnormalities between protocols was similar in BAEP (NY - 68.6%, pBFM - 61.7%, BFM95 - 69.4%, P=0.650), VEP (NY - 68.6%, pBFM - 42.5%, BFM95 - 58.3%, P=0.053) and significantly different for SEP (NY - 62.9%, pBFM - 36.2%, BFM95 - 53.0%, P=0.045). The harmful effect of radiotherapy was most clearly marked in numerous disturbances of SEP parameters.Conclusions: The presented analysis indicates a high frequency of subclinical abnormalities in EP regardless of the analyzed protocol. To our knowledge current study is the largest and one of the most complex research examining the role of EP in ALL patients. The obtained results indicate the possibility of using a single, objective and non-invasive measurement of EP in ALL survivors in order to stratify the risk of developing sensory abnormalities in adulthood.

scholarly journals Metabolic disorders in medulloblastoma and acute lymphoblastic leukemia survivors

2015 ◽  
Vol 12 (3) ◽  
pp. 3-9
Author(s):  
Tat'yana Yur'evna Tseloval'nikova ◽  
Mariya Gennadievna Pavlova ◽  
Aleksey Vadimovich Zilov ◽  
Nadezhda Aleksandrovna Mazerkina ◽  
Ol'ga Grigor'evna Zheludkova ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Childhood Cancer ◽  
Metabolic Disorders ◽  
Causes Of Death ◽  
Lymphoblastic Leukemia ◽  
Childhood Cancer Survivors ◽  
Childhood Cancers ◽  
Complex Treatment

The childhood cancer morbidity has been steadily increasing over the last few decades. However, the recent more effective complex treatment approaches have led to a dramatic improvements in the survival rate in childhood cancers. Currently many childhood cancer survivors require a life-long follow-up. Therefore, today doctors of various specialties are faced with different long-term consequences after the complex treatment for cancer. Among the various complications metabolic disorders should be eparately identified as risk factors for cardiovascular diseases, which are the most frequent causes of death. This article describes the current understanding of the various metabolic changes in the patients after treatment for medulloblastoma and acute lymphoblastic leukemia in childhood, the mechanisms of their development and treatment issues.

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