Evaluation of Cognitive Function in Chilhood Cancer Patients

BACKGROUND: Survival rates of children with cancer are currently increasing. The long-term effects of chemotherapy as primary treatment for childhood cancer patients urge physicians’ considerations. Cognitive dysfunction, as one of devastating long-term effects of chemotherapy, is known to disrupt quality of life in childhood cancer patients. METHODS: The objective of this study was to investigate cognitive function in childhood cancer patients. This cross-sectional study was conducted from April to November 2019 at Haji Adam Malik General Hospital, Medan, North Sumatera. Fifty-four childhood cancer patients who received chemotherapy were enrolled. Cognitive function in childhood cancer patients were measured with Wechsler Intelligence Scale for Children-Revised (WISC-R) test, composed of Full scale IQ (F IQ), Verbal scale IQ (V IQ), and Performance scale IQ (P IQ) scores. RESULTS: The WISC-R test results showed median F IQ, V IQ, and P IQ scores of 86 (47-114), 85 (44-115), and 85 (22-113), respectively. There was no significant difference of IQ scores between male and female patients. Children with age of diagnosis <6 years old had higher F IQ and V IQ [89 (80-105) vs. 84.5 (47-114) and 93.5 (79-109) vs. 81 (44-115); P=0.04 and P=0.02, respectively). There was no correlation between chemotherapy duration and intrathecal (IT) methotrexate administration with cognitive function. However, administration of high dose intravenous (IV) methotrexate had a negative correlation with F IQ, V IQ, and P IQ (r=-0.436, r=-0.381, and r=-0.392; P=0.007, P=0.017, and P=0.015, respectively). CONCLUSION: High dose IV methotrexate compromises cognitive function in childhood cancer patients, therefore evaluation of cognitive function is warranted.

[1]  M. Monje,et al.  Methotrexate Chemotherapy Induces Persistent Tri-glial Dysregulation that Underlies Chemotherapy-Related Cognitive Impairment , 2019, Cell.

[2]  R. Ibrahim,et al.  Chemotherapy induced cognitive impairment in hematological malignancies , 2018, QJM: An International Journal of Medicine.

[3]  C. Ikonomidou.  Chemotherapy and the pediatric brain , 2018, Molecular and Cellular Pediatrics.

[4]  Rajanandh Muhasaparu,et al.  Effect of Cancer Chemotherapy on Cognitive Function , 2018, International Journal of Cancer Research.

[5]  B. van Calster,et al.  Intellectual development of childhood ALL patients: a multicenter longitudinal study , 2017, Psycho-oncology.

[6]  Y. T. Cheung,et al.  Chemotherapy Pharmacodynamics and Neuroimaging and Neurocognitive Outcomes in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  Lyn M. Balsamo,et al.  Chemotherapy-only treatment effects on long-term neurocognitive functioning in childhood ALL survivors: a review and meta-analysis. , 2015, Blood.

[8]  Mai Saleh,et al.  Exploration of Cognitive Functioning in a Pilot Sample of Childhood Cancer Patients in Egypt , 2015 .

[9]  B. Lange,et al.  Developing interventions for cancer-related cognitive dysfunction in childhood cancer survivors. , 2014, Journal of the National Cancer Institute.

[10]  Shelli R. Kesler,et al.  Prevalence, mechanisms, and management of cancer-related cognitive impairment , 2014, International review of psychiatry.

[11]  Cheng Cheng,et al.  Genetic mediators of neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  A. Hutchinson,et al.  Objective and subjective cognitive impairment following chemotherapy for cancer: a systematic review. , 2012, Cancer treatment reviews.

[13]  F. Vargha-Khadem,et al.  The impact of therapy for childhood acute lymphoblastic leukaemia on intelligence quotients; results of the risk-stratified randomized central nervous system treatment trial MRC UKALL XI , 2011, Journal of hematology & oncology.

[14]  T. Ahles,et al.  International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. , 2011, The Lancet. Oncology.

[15]  A. Veerman,et al.  Effects of chemotherapy on neurocognitive function in children with acute lymphoblastic leukemia: A critical review of the literature , 2009, Pediatric blood & cancer.

[16]  K. Krull,et al.  Brief report: effect of intravenous methotrexate dose and infusion rate on neuropsychological function one year after diagnosis of acute lymphoblastic leukemia. , 2006, Journal of pediatric psychology.

[17]  R. Butler,et al.  Neuropsychologic effects of cranial irradiation, intrathecal methotrexate, and systemic methotrexate in childhood cancer. , 1994, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  L. Janzen,et al.  Neurodevelopmental sequelae of pediatric acute lymphoblastic leukemia and its treatment. , 2008, Developmental disabilities research reviews.