Neurocognitive Late Effects in Children with Cancer

Disruption in the child’s cognitive and educational development during treatment for cancer has the potential to adversely impact quality of life well into the child’s future. Fortunately, most children with cancer are able to successfully resume their premorbid cognitive and educational trajectories following treatment completion. However, subgroups of survivors remain at risk for prolonged disruption as well as for developing new deficits in the years following completion of cancer therapies. Research over the past three decades has helped us to identify some of the biological, clinical, and patient-related risk factors associated with neurocognitive impairment and has increased our understanding of the types of neurocognitive late effects that may be experienced by childhood cancer survivors. More recently, these lines of research have led us to begin to evaluate potential prevention and intervention approaches to address these problems in the subpopulations most at risk. In this chapter, we present information on the disease, treatment, and patient-related factors relevant in understanding neurocognitive outcomes in high-risk survivors of childhood cancer. We also provide information on common areas of neurocognitive dysfunction, general considerations and clinical practice in the neuropsychological evaluation of children with cancer, and an overview of research investigating a variety of interventions and approaches to prevent or reduce neurocognitive dysfunction.