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    Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Health Professional Information [NCI] - Late Effects of the Central Nervous System

    Table 3. Central Nervous System Late Effects

    Predisposing Therapy Neurologic Effects Health Screening
    IQ = intelligence quotient; IT = intrathecal; IV = intravenous.
    Platinum agents (carboplatin, cisplatin) Peripheral sensory neuropathy Neurologic exam
    Plant alkaloid agents (vinblastine, vincristine) Peripheral sensory or motor neuropathy (areflexia, weakness, foot drop, paresthesias) Neurologic exam
    Methotrexate (high dose IV or IT); cytarabine (high dose IV or IT); radiation impacting the brain Clinical leukoencephalopathy (spasticity, ataxia, dysarthria, dysphagia, hemiparesis, seizures); headaches; seizures; sensory deficits History: cognitive, motor, and/or sensory deficits, seizures
    Neurologic exam
    Radiation impacting cerebrovascular structures Cerebrovascular complications (stroke, moyamoya, occlusive cerebral vasculopathy) History: transient/permanent neurological events
    Blood pressure
    Neurologic exam
    Neurosurgery-brain Motor and/or sensory deficits (paralysis, movement disorders, ataxia, eye problems [ocular nerve palsy, gaze paresis, nystagmus, papilledema, optic atrophy]); seizures Neurologic exam
    Neurology evaluation
    Neurosurgery-brain Hydrocephalus; shunt malfunction Abdominal x-ray
    Neurosurgery evaluation
    Neurosurgery-spine Neurogenic bladder; urinary incontinence History: hematuria, urinary urgency/frequency, urinary incontinence/retention, dysuria, nocturia, abnormal urinary stream
    Neurosurgery-spine Neurogenic bowel; fecal incontinence History: chronic constipation, fecal soiling
    Rectal exam
    Predisposing Therapy Neuropsychological Effects Health Screening
    Methotrexate (high-dose IV or IT); cytarabine (high-dose IV or IT); radiation impacting the brain; neurosurgery-brain Neurocognitive deficits (executive function, memory, attention, processing speed, etc.); learning deficits; diminished IQ; behavioral change Assessment of educational and vocational progress
    Formal neuropsychological evaluation

    Psychosocial

    Many childhood cancer survivors have adverse quality of life or other adverse psychological outcomes. Incorporation of psychological screening into clinical visits for childhood cancer survivors may be valuable; however, limiting such evaluations to those returning to long-term follow-up clinics may result in a biased subsample of those with more difficulties, and precise prevalence rates may be difficult to establish. A review of behavioral, emotional, and social adjustment among survivors of childhood brain tumors illustrates this point, in whom rates of psychological maladjustment range from 25% to 93%.[59] In a series of CNS malignancy survivors (n = 802) reported from the CCSS, adverse outcome indicators of successful adult adaptation (educational attainment, income, employment, and marital status) were most likely in survivors who report neurocognitive dysfunction.[4] Collectively, studies evaluating psychosocial outcomes among CNS tumor survivors indicate deficits in social competence in the level of social adjustment that worsen over time.[60] In a CCSS study that evaluated predictors of independent living status across diagnostic groups, adult survivors of childhood cancer with neurocognitive, psychological, or physical late effects were less likely to live independently as adults compared with a sibling control group.[61] The presence of chronic health conditions can also impact other aspects of psychological health. In a study that evaluated psychological outcomes among long-term survivors treated with hematopoietic cell transplantation (HCT), 22% of survivors and 8% of sibling controls reported adverse outcomes. Somatic distress was the most prevalent among the domains studied and affected 15% of HCT survivors, representing a threefold higher risk compared with siblings. HCT survivors with severe/life-threatening conditions and active chronic GVHD had a twofold increased risk for somatic distress.[62]

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