Neurocognitive late effects in children treated for cancer: Psychological impact, identification, and prevention and remediation

Cure rates for childhood cancer have improved significantly over the past three decades, owing success to advances such as multidrug regimens, innovations in treatment are delivery, refinements in surgical techniques, the introduction of conformal and proton radiation, and enhancements in imaging techniques. Whereas the goal of cancer therapy is to cure disease, oncologists strive to carefully balance effective therapy with possible toxicity, in an effort to promote a good quality of life for children as they develop and mature into adults (Askins and Moore 2008). Neurocognitive late effects often occur in pediatric cancer survivors who received central nervous system (CNS) therapies. Children with brain tumors or acute lymphoblastic leukemia, the two most common types of childhood cancer, are at greatest risk for neurocognitive late effects. This chapter will provide an overview of the neurocognitive domains typically affected by cancer and its treatment, impact on day-to-day functioning, and review the literature on the remediation of neurocognitive deficits in childhood cancer survivors. Recommendations for student access to academic supports will also be highlighted.