Communication and swallowing outcomes of children diagnosed with childhood brain tumor or leukemia: A systematic review

Clinical Practice Guideline for the Management of Communication and Swallowing in Children Diagnosed With Childhood Brain Tumor or Leukemia

Childhood brain tumor and leukemia (CBTL) and their treatments can have negative effects on development, including communication and swallowing. Clinical practice guideline recommendations for managing communication and swallowing difficulties in children diagnosed with CBTL were informed by (i) a systematic review using the GRADE approach to rate certainty of evidence; (ii) GRADE Evidence to Decision Framework involving an international panel of experts; and (iii) a Health Professional and Consumer survey. To improve outcomes and quality of life, children with CBLT should have access to communication and swallowing assessment and intervention from cancer diagnosis, throughout and after treatment, and across survivorship.

Development of Communication and Language Skills in Children with Hematological-Oncological Disorders: Challenges and Perspectives

Children with onco-hematological diseases require intensive medical treatments that can affect various aspects of their development. In addition to the disease itself, what influences the course of development most are the neurotoxic effects of therapies and frequent hospitalizations, especially if they occur in the first three years of the child's life. Among these challenges there is the potential for language delay, a condition that can impact their communication abilities and overall development. Background/Objectives: The aim of this study is to examine communicative and linguistic development in a small group of young children diagnosed with different forms of leukemia, rhabdomyosarcoma, and CNS tumors, recruited through the Hematology-Oncology Clinic of the Department of Child and Woman Health (University of Padova). Methods: Child direct (Griffiths III, PinG, PCGO) and parent indirect assessments (PVB, ABAS-II, ASCB) were provided. Results: Griffiths communication subscale scores in children were mainly below average (55.6%), and 44.4% attested at the clinical level in ABAS-II, with the ability to understand being significantly higher than the production of words. However, the two levels of assertiveness-responsiveness obtained balance in 66.7% of cases, and using the Griffiths personal subscale, only 22.2% of children attested below average. Conclusions: Understanding and addressing children's communication needs is crucial to improve the quality of life of these young patients and foster optimal communicative and linguistic development despite the obstacles they face in order to implement interventions designed specifically for this type of population and their respective families, if necessary.

Experiences of families post treatment for childhood brain tumours during medical clinic consultations regarding health-related quality of life, unmet needs and communication barriers: A qualitative exploration

BACKGROUND

Many studies highlight poor health-related quality of life (HRQoL) in children treated for brain tumours and their parents. However, little is known about the extent to which their informational, healthcare and communication needs regarding HRQoL are met during medical outpatient consultations.

AIM

To explore the experiences of families regarding communication with physicians about HRQoL issues during consultations after treatment for childhood brain tumours.

METHODS

Interviews were conducted with 18 families of children and adolescents aged 8-17 years after completion of brain tumour treatment. Participants had completed treatment within the last 5 years and were receiving regular outpatient follow-up care. Thematic analysis was undertaken using the Framework Method.

RESULTS

Five main themes were identified: (i) unmet emotional and mental health needs; (ii) double protection; (iii) unmet information needs; (iv) communication barriers within consultations; and (v) finding a new normal.

CONCLUSION

There was a need to improve communication between clinicians and these families, improve information provision, and overcome barriers to conversing with children within these outpatient consultations. Children and their parents should be supported to voice their current needs and concerns regarding their HRQoL. These findings will inform further development of the UK version of the 'KLIK' patient- and parent-reported outcome (PROM) portal.

Language outcomes in children who underwent surgery for the removal of a posterior fossa tumor: A systematic review

BACKGROUND

Children who underwent posterior fossa tumor removal may have spoken or written language impairments. The present systematic review synthesized the literature regarding the language outcomes in this population. Benefits of this work were the identification of shortcomings in the literature and a starting point toward formulating guidelines for postoperative language assessment.

METHODS

A systematic literature search was conducted, identifying studies with patients who had posterior fossa surgery before 18 years of age. Included studies were narratively synthesized to understand language outcomes by language function (e.g., phonology, morphosyntax) at a group and individual level. Furthermore, the influence of several mediators (e.g., postoperative cerebellar mutism syndrome (pCMS), tumor type) was investigated. A critical evaluation of the language assessment tools was conducted.

RESULTS

The narrative synthesis of 66 studies showed that a broad spectrum of language impairments has been described, characterized by a large interindividual heterogeneity. Patients younger at diagnosis, receiving treatment for a high-grade tumor and/or radiotherapy and diagnosed with pCMS seemed more prone to impairment. Several gaps in language assessment remain, such as a baseline preoperative assessment and the assessment of pragmatics and morphosyntax. Further, there were important methodological differences in existing studies which complicated our ability to accurately guide clinical practice.

CONCLUSION

Children who had posterior fossa surgery seem to be at risk for postoperative language impairment. These results stress the need for language follow-up in posterior fossa tumor survivors.

Communication, academic and social outcomes of childhood cancer survivors with hearing loss: A systematic review

Many children treated for cancer are at risk of hearing loss. However, little is known about how hearing loss impacts their communication, academic and social outcomes. To examine the impact, this systematic review aimed to synthesise and appraise quantitative and qualitative studies reporting on (i) participants with hearing loss treated with platinum-based chemotherapy or cranial radiotherapy during childhood; and (ii) speech, language, academic performance, or social participation findings. Systematic database searches yielded 23 relevant articles that were analysed using narrative synthesis. Difficulties were reported for some but not all communication, academic and social aspects; however, a quality assessment using Grading of Recommendations Assessment, Development and Evaluation (GRADE) revealed low to very low certainty in the findings. Future research should aim to increase the quality of the research evidence and explore how multidisciplinary services can provide evidence-based support for childhood cancer survivors with competing hearing, communication, and social difficulties.

Communication and swallowing management in childhood brain tumour or leukaemia: A survey of health professionals and consumers

Purpose: Brain tumour and leukaemia represent the most common childhood cancers and can result in communication and swallowing difficulties. The purpose of this study was to survey health professionals and consumers regarding the management of communication and swallowing difficulties in children with brain tumour or leukaemia (CBTL).Method: In this study participants completed a survey focussing on (1) communication and swallowing assessment and intervention, (2) multidisciplinary team (MDT) practices and (3) risk factors. Quantitative data were reported using descriptive statistics. Qualitative data were analysed using NVivo12 Qualitative Data Analysis Software.Result: Twenty-four participants were included (22 health professionals; two consumers). Most participants (≥80%) agreed that comprehensive and regular communication and swallowing assessments improved outcomes. Communication and swallowing interventions were reported to improve outcomes by 96% of participants. MDT care was considered essential in improving outcomes. Speech-language pathologists were the primary health professional identified in communication management; additional multidisciplinary health professionals were highlighted in swallowing management. Risk factors were identified across three categories: cancer-related, treatment-related and child-factors.Conclusion: This study collates the expertise and experience of multidisciplinary health professionals and consumers which can be used to guide assessment and intervention for communication and swallowing in CBTL. It also provides perspectives on MDT care and consideration of patient values and risk factors.