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Chemotherapy Could Affect Children's Learning Ability
Dec. 15, 1999 (Los Angeles) -- Children with leukemia who undergo chemotherapy of the central nervous system (CNS) may have an increased risk of learning problems several years later, say the authors of a new study. However, other experts caution that these findings are not definitive and should not prevent parents from allowing their children to have this treatment.
The CNS consists of the brain and spinal cord. Pediatric cancer specialists usually administer CNS chemotherapy to leukemia patients to prevent the disease from spreading to these organs.
Ronald T. Brown, PhD, and colleagues at Women's and Children's Hospital in Adelaide, Australia, compared 16 children who received CNS chemotherapy for leukemia to 10 children who had other forms of cancer and did not receive chemotherapy to the CNS. They tested the children at the time they were diagnosed with cancer and every year for four years, comparing verbal and nonverbal reasoning abilities, math scores, and academic achievement. The children ranged in age from 2 to 15.
Over this four-year period, academic skills declined in the children who received CNS chemotherapy. These children also did not show the gradual improvement in reasoning skills expected with increasing maturity, and which was seen in the other children. "The data suggest that problems can take place," Brown, who is professor of pediatrics at the Medical University of South Carolina in Charleston, tells WebMD. "We always recommend that these kids receive some type of yearly evaluation to make sure there's no detriment of function." The risk is especially high in children who are younger than five years old, because their brains are still in a rapid stage of development.
Chemotherapy to the CNS affects highly specific functions, including handwriting, math skills, attention, and "the ability to take things in the head and put them on the paper," says Daniel Armstrong, PhD, director of the Mailman Center for Child Development at the University of Miami School of Medicine. On the other hand, says Armstrong, who was not involved in this study, the new forms of chemotherapy "allow children to go into remission and stay in remission, so there's a real miracle side to all of this."
According to Roger Berkow, MD, of Children's Hospital in Birmingham, Ala., there is a 50% chance that leukemia will spread to the brain or spinal cord if the child does not receive CNS chemotherapy. With chemotherapy, the risk is only 5%. "Once the disease is in the CNS, the chances of cure go down drastically," he tells WebMD. To deny a child this treatment "would be totally devastating. ... I wouldn't want people to even consider that," he warns. "Every child needs to be considered individually. There is no guarantee that a disability will even occur."
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