Cognition, psychosocial functioning, and health-related quality of life among childhood cancer survivors

Cerebral blood flow and structural connectivity after working memory or physical training in paediatric cancer survivors - Exploratory findings

Paediatric cancer survivors often suffer from cognitive long-term difficulties. Consequently, strengthening cognition is of major clinical relevance. This study investigated cerebral changes in relation to cognition in non-brain tumour paediatric cancer survivors after working memory or physical training compared to a control group. Thirty-four children (≥one-year post-treatment) either underwent eight weeks of working memory training (n = 10), physical training (n = 11), or a waiting period (n = 13). Cognition and MRI, including arterial spin labelling and diffusion tensor imaging, were assessed at three time points (baseline, post-training, and three-month follow-up). Results show lower cerebral blood flow immediately after working memory training (z = -2.073, p = .038) and higher structural connectivity at the three-month follow-up (z = -2.240, p = .025). No cerebral changes occurred after physical training. Short-term changes in cerebral blood flow correlated with short-term changes in cognitive flexibility (r = -.667, p = .049), while long-term changes in structural connectivity correlated with long-term changes in working memory (r = .786, p = .021). Despite the caution given when interpreting data from small samples, this study suggests a link between working memory training and neurophysiological changes. Further research is needed to validate these findings.

Visual-Motor Functions and Associated Cognitive Outcomes in Pediatric Cancer Survivors

INTRODUCTION

Pediatric cancer survivors are at high risk for visual-motor and cognitive deficits that persist throughout life. These domains are related to academic performance. The current study examined (i) whether both visuomotor and cognitive functions and (ii) whether visuomotor functions alone mediate the relationship between age and cognitive functions.

METHODS

In total, there were 210 participants (7-17 years): 70 posterior fossa tumors (Mage = 12.1  ±  3.2 years, 44% female) and 70 acute lymphoblastic leukemia (Mage = 12.3  ±  3.4 years, 45% female) survivors and 70 (Mage = 12.2 ± 3.3 years, 41% female) healthy controls. Visual motor integration, motor coordination and visual perception were assessed using the Beery VMI test. Working memory, attention and planning were assessed using CANTAB.

RESULTS

Impaired motor function is significantly more pronounced than cognitive impairment in both groups of cancer survivors (effect size from 25 to 30% for visual-motor and from 5 to 7% for cognitive functions). A multiple regression model revealed that age and visual motor functions are significant predictors of attention (in the ALL group β = -0.490, t = -4.88, p = 0.000) and working memory (in the PFT group β = 0.264, t = 2.72, p = 0.008; in the ALL group β = 0.215, t = 2.24, p = 0.028).

CONCLUSIONS

In children who have experienced acute lymphoblastic leukemia and tumors of the posterior cranial fossa, visual-motor dysfunction is more pronounced than cognitive impairment. In addition, there is an association between visual-motor function disorders and working memory. These findings can be used to develop more specific rehabilitation protocols.

Factors Associated with Psychological Well-Being Among Children Under 18 Years Old with Cancer: A Scoping Review

Background

Cancer diagnosis and treatment can have severe psychological impacts on children that can affect various aspects of their emotional, social and cognitive functioning. Many children with cancer experience long-term psychological distresses. The psychological well-being (PWB) is a critical aspect of their overall health. Understanding the factors that influence their psychological state can help in developing effective interventions to support them.

Purpose

This scoping review aimed to identify and summarize the factors associated with PWB among children with cancer.

Methods

This study applied a scoping review using the guidelines outlined in the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A comprehensive literature search was conducted across multiple databases, including PubMed, CINAHL, Taylor and Francis, and Scopus. Inclusion criteria were included by keywords Psychological well-being OR Psychological AND Children OR Child OR Pediatric OR Childhood AND Adolescent OR Teenagers OR Youth AND Cancer OR Neoplasms OR Tumors OR Malignancy OR Cancer Survivors AND predictor OR factors OR determinant. Studies were included if they investigated psychological well-being in children (aged 0-18 years) with cancer. The Arksey and O'Malley framework for scoping reviews guided the methodology, including study selection, data extraction, and thematic analysis. The quality of the evidence was evaluated using the Joanna Briggs Institute (JBI) and the Mixed Methods Appraisal Tool (MMAT) critical appraisal checklist.

Results

12 articles met the inclusion criteria and were included in the review. The factors most frequently reported in several categories are age (sociodemographic), psychological function (individual factors), age at diagnosis (health and history), parent attachment and school status (environmental factors).

Conclusion

This review found several aspects that describe the PWB of the articles reviewed. These aspects consist of anxiety, depression, distress, well-being, and self-esteem. From these aspects, many predictors were obtained, which were classified into four categories of factors related to the PWB of children with cancer.

Child outcomes after prenatal exposure to platinum and taxane-based chemotherapy: an unplanned interim analysis of the international network on cancer, infertility, and pregnancy study

Background

Platina and taxanes are frequently used chemotherapeutic agents to treat cancer, also when diagnosed during pregnancy. This report presents an interim analysis of the largest series of children prenatally exposed to platinum and/or taxane agents and aims to determine their physical health and neurocognitive outcomes.

Methods

As part of a multicentre, prospective cohort study (ClinicalTrials.gov: NCT00330447), children born between 2000 and 2022 were assessed between 2005 and 2024 at ages 1.5-18 years (interim analysis; median length of follow-up, 3.2 years (IQR 3.0-6.4)) by a comprehensive neurocognitive test battery, parent-reported questionnaires, and a physical assessment. Mixed-effects regression and Type III Analysis of Variance models were used to investigate associations between these outcomes and platinum/taxane cumulative dose and agent type, with best-fit models corrected for age and covariates (gestational age at birth, chemotherapy timing, other chemotherapy, sex, parental education level, maternal death).

Findings

In total, 144 children were included (13% exposed to platinum, 62% to taxanes, 25% to both). Of these, 101 were assessed at age 1.5 years, 96 at age 3, 63 at age 6, 32 at age 9, 18 at age 12, 7 at age 15, and 2 at age 18 years. Neurocognitive outcomes were within normal ranges across all ages, compared with test-specific normative data. Eight children (6%) reported ototoxicity, seven (5%) reported chronic medical conditions, three (2%) had congenital malformations, and two (1%) were diagnosed with Attention-Deficit Hyperactivity Disorder. Thirty-three children (23%) needed extra neurocognitive support, of which 64% were born preterm. Children prenatally exposed to paclitaxel scored lower on visuospatial (β = 0.64 ± 0.21, p = 0.0052) and verbal memory (β = 0.68 ± 0.27, p = 0.015) than those exposed to docetaxel.

Interpretation

In this interim analysis, we found normal neurocognitive outcomes and no increase in congenital malformations nor medical conditions after prenatal exposure to platinum/taxane-based chemotherapy. However, owed to the limited number of older children, further investigation regarding their potential neurotoxicity and its long term effects is necessary in follow-up studies with larger samples.

Funding

Kom Op Tegen Kanker, KWF Kankerbestrijding, Stichting Tegen Kanker, Cooperatio program, Research Foundation Flanders.

Attention and executive functioning in children and adolescents treated for high-risk acute lymphoblastic leukemia: A report from the Children's Oncology Group (COG)

OBJECTIVES

Survivors of childhood B-acute lymphoblastic leukemia (B-ALL) are at risk for difficulties with attention and executive functioning (EF) as a late effect of treatment. The present study aimed to identify treatment and demographic factors associated with risk for difficulties with EF in youth treated for high-risk B-ALL.

METHOD

Children and adolescents with B-ALL treated on Children's Oncology Group (COG) protocol AALL0232 were randomized to high-dose or escalating-dose methotrexate (MTX), and either dexamethasone or prednisone during the induction phase. Neuropsychological functioning was evaluated via protocol AALL06N1, including performance-based and parent-report measures, for 177 participants (57% female, 81% white; mean age at diagnosis = 8.4 years; SD = 5.0) 8-24 months following treatment completion.

RESULTS

Mean scores for all attention and EF measures were within the average range, with no significant differences as a function of MTX delivery or steroid treatment (all p > 0.05). In multivariable models, participants with US public insurance exhibited significantly greater parent-reported EF difficulties than those with US private or non-US insurance (p ≤ 0.05). Additionally, participants diagnosed under 10 years of age performed significantly more poorly on measures of attention (i.e., continuous performance task, p ≤ 0.05) and EF (i.e., verbal fluency and tower planning task, p ≤ 0.05).

CONCLUSIONS

For survivors of pediatric B-ALL, treatment-related factors were not associated with attention or EF outcomes. In contrast, outcomes varied by demographic characteristics, including age and insurance type, an indicator of economic hardship. Future research is needed to more directly assess the contribution of socioeconomic status on cognitive outcomes in survivors.

Processing speed in patients with pediatric cancer: Psychosocial considerations

Pediatric cancer treatments may contribute to slower processing, while cultural considerations (e.g., SES) can influence outcomes and tend to be disproportionately lower in racial/ethnic minorities. Given increased risk for certain cancers in Hispanic/Latine children and rising Spanish exposure in the United States, the purpose of this study was to examine differences in processing speed between cancer survivors based on household language exposure: English vs. mixed language (ML; i.e. monolingual Spanish-speaking or bilingual Spanish/English-speaking). 128 patients ages 8-21 with leukemia/lymphoma completed screening. As expected, SES was lower in patients from ML households based on parental education (U = 355.00, p<.001) and estimated household income (U = 1031.500, p<.001). Despite this, processing speed (assessed using the written and oral trials of the Symbol Digit Modalities Test; SDMT) was average (SDMT-W x̅=-.13, SDMT-O x̅=.32), with no significant differences between language groups (F(2,120)=0.966, p=.384). Post-hoc analyses revealed time since diagnosis did not predict performance on oral trial for either group or the whole sample, while poorer performance on written trial was noted among the English-only group when further from diagnosis (SDMT-W F(1,57)=7.829, p=.007). Stable ML group trajectory regardless of time since diagnosis may reflect resiliency among children with Spanish exposure.

Development of working memory, processing speed, and psychosocial functions in patients with pediatric cancer

Many patients after pediatric cancer suffer from long-term cognitive difficulties. This study investigates the development of cognitive and psychosocial functions between diagnosis and one year after cancer treatment and reveals insight into the association between cognitive and psychosocial development and various risk factors. This retrospective clinical record review included fifty-seven patients, aged 4-16 years, that were examined at the beginning of the cancer treatment (T1) and one year after cancer treatment (T2) to evaluate the development of working memory (WM), processing speed (PS), psychosocial functions, and quality of life (QoL). About half of the patients showed stable/favorable cognitive development (PS 51.9%; WM 41.4%). The other half exhibited a non-favorable cognitive development, with a decrease of performance between T1 and T2. In 51.6-77.4%, psychosocial functions remained stable/increased between T1 and T2 and QoL scores remained stable in 42.9-61.9%. Changes in prosocial behavior correlated with the development of PS (r = 0.472, p = 0.010). Age at T1 predicted PS at T2 (p = 0.020) and sex predicted peer relations at T2 (p = 0.046). About half of the patients showed stable/favorable whereas the other half experiencing non-favorable cognitive development. The observed disparities in initial and subsequent cognitive performances highlight the importance of early individualized patient monitoring and interventions. IMPACT: We investigated the cognitive and psychosocial development of pediatric cancer patients between diagnosis and one year after termination of cancer treatment. About half of the patients showed stable or favorable cognitive development in processing speed and working memory. The other half exhibited a non-favorable cognitive development, with decreasing performance. Baseline working memory and processing speed was negatively correlated with the respective change score. Changes in prosocial behavior were positively correlated with the development of processing speed. Early individualized patient monitoring and intervention is of crucial importance after pediatric cancer and its treatment.

Development and psychometric analysis of a pediatric cancer survivors Psychosocial Late Effects Scale (PCSLES)

PURPOSE

Although the physiological late effects of childhood cancer survivors are more obvious, appropriate assessment of psychosocial effects is needed. Therefore, it was aimed to develop a scale to evaluate psychosocial late effects in cancer survivors and to test its validity and reliability.

DESIGN AND METHODS

This methodological study was conducted with 100 children and adolescents who survived were collected at the oncology center in the south of Türkiye in 2022. Data were collected with the "Personal Information Form" and "Pediatric Cancer Survivors Psychosocial Late Effects Scale (PCSLES)" IBM SPSS 24.0 and IBM AMOS 24.0 software programs were used for data analysis, and descriptive statistics were used to analyze numeric variables. Exploration and confirmatory factor analyses were performed to determine the scale's factorial structure.

RESULTS

The factorial analysis was used to test the structural validity of the scale. A four-factor structure consisting of 17 items was developed. The Cronbach's alpha coefficient for "1" was 0.89, "2" was 0.87, "3" was 0.80, "4" was 0.82 and the total score was 0.92. Fit indices resulting from the study were χ2/SD: 1.497, root mean square error of approximation (RMSEA): 0.071, goodnessof-fit index (GFI): 0.85, comparative-of-fit index (CFI): 0.94, and normed fit index (NFI): 0.85.

CONCLUSION

The scale is a valid and reliable scale that can be used to determine psychosocial late effects in pediatric cancer patients.

PRACTICE IMPLICATIONS

Utilizing the PCSLES can assist in identifying the psychosocial symptoms of child survivors/adolescents and facilitate the planning of appropriate interventions.

Multi-omics analysis of the gut microbiome and metabolites associated with the psychoneurological symptom cluster in children with cancer receiving chemotherapy

BACKGROUND

Children with cancer receiving chemotherapy commonly report a cluster of psychoneurological symptoms (PNS), including pain, fatigue, anxiety, depression, and cognitive dysfunction. The role of the gut microbiome and its functional metabolites in PNS is rarely studied among children with cancer. This study investigated the associations between the gut microbiome-metabolome pathways and PNS in children with cancer across chemotherapy as compared to healthy children.

METHODS

A case-control study was conducted. Cancer cases were recruited from Children's Healthcare of Atlanta and healthy controls were recruited via flyers. Participants reported PNS using the Pediatric Patient-Reported Outcomes Measurement Information System. Data for cases were collected pre-cycle two chemotherapy (T0) and post-chemotherapy (T1), whereas data for healthy controls were collected once. Gut microbiome and its metabolites were measured using fecal specimens. Gut microbiome profiling was performed using 16S rRNA V4 sequencing, and metabolome was performed using an untargeted liquid chromatography-mass spectrometry approach. A multi-omics network integration program analyzed microbiome-metabolome pathways of PNS.

RESULTS

Cases (n = 21) and controls (n = 14) had mean ages of 13.2 and 13.1 years. For cases at T0, PNS were significantly associated with microbial genera (e.g., Ruminococcus, Megasphaera, and Prevotella), which were linked with carnitine shuttle (p = 0.0003), fatty acid metabolism (p = 0.001) and activation (p = 0.001), and tryptophan metabolism (p = 0.008). Megasphaera, clustered with aspartate and asparagine metabolism (p = 0.034), carnitine shuttle (p = 0.002), and tryptophan (p = 0.019), was associated with PNS for cases at T1. Gut bacteria with potential probiotic functions, along with fatty acid metabolism, tryptophan, and carnitine shuttle, were more clustered in cancer cases than the control network and this linkage with PNS needs further studies.

CONCLUSIONS

Using multi-omics approaches, this study indicated specific microbiome-metabolome pathways linked with PNS in children with cancer across chemotherapy. Due to limitations such as antibiotic use in cancer cases, these findings need to be further confirmed in a larger cohort.

Cardiorespiratory fitness and health-related quality of life in survivors of childhood central nervous system tumours

PURPOSE

We assessed cardiorespiratory fitness and health-related quality of life (HRQoL) in survivors of childhood central nervous system (CNS) tumours.

METHODS

Participants were recruited from the National Children's Cancer Service in Children's Health Ireland at Crumlin. Inclusion criteria included diagnosis of a primary CNS tumour, aged between 6 and 17 years, between 3 months and 5 years post completion of oncology treatment, independently mobile, and deemed clinically appropriate to participate by treating oncologist. Cardiorespiratory fitness was assessed using the six-minute walk test. HRQoL was assessed with the PedsQL Generic Core Scales, Version 4.0.

RESULTS

Thirty-four participants (n = 16 male) were recruited, with a mean age of 12.21 ± 3.31 years and a mean time since completion of oncology treatment of 2.19 ± 1.29 years. Mean six-minute walk distance (6MWD) achieved was 489.56 ± 61.48 m, equating to the 8^th percentile overall. 6MWD was significantly reduced when compared to predicted population norms (p < 0.001). PedsQL parent proxy-report and child-report scores were significantly lower when compared to healthy paediatric norms (p < 0.001 - p = 0.011). A significant positive correlation was found between 6MWD and both parent proxy-report (r = 0.55, p < 0.001) and child-report (r = 0.48, p = 0.005) PedsQL total scores.

CONCLUSION

Survivors of childhood CNS tumours present with impaired cardiorespiratory fitness and HRQoL. Higher levels of cardiorespiratory fitness are associated with higher levels of HRQoL.

IMPLICATIONS FOR CANCER SURVIVORS

Routine screening of cardiorespiratory fitness and HRQoL in survivors of childhood CNS tumours may be beneficial. Healthcare providers should encourage and provide education on the potential benefits of physical activity to improve overall quality of life.

Evaluation of health-related quality of life and its domains in pediatric patients with cancer

BACKGROUND

Health-related quality of life has emerged as a significant component in pediatric oncology research during the last several decades. Measures of health-related quality of life provide a thorough assessment of the child's response to medical therapy, disease course, and adjustment outcomes in the context of pediatric oncology.

METHODS

The aim of the present study was to assess the cancer-specific health-related quality of life in cancer pediatric patients and to evaluate the contribution of its domains and some of the anthropometric, sociodemographic, and treatment-related variables on the overall quality of life, by using the PedsQL™ 3.0 Cancer Module.

RESULTS

The study included 110 cases. The mean value of the PedsQL™ 3.0 Cancer Module score was 49.3 ± 12.0. The lowest mean score of quality of life was for the "procedure anxiety" (8.7 ± 23.9), followed by the "worry" domains (16.6 ± 28.5). Higher "frequency of hospital visits" was associated with increased feeling of pain and treatment anxiety yet decrease in suffering from nausea and vice versa. The longer period of hospital admission for more than half of the recommended treatment period was associated with reduced pain suffering on the expense of increase in feeling of worry as well as communication problems. The perceived physical appearance was better among those patients who spent a treatment period for 3-6 months when compared to those who spent a treatment period less than 3 months or more than 6 months. There was a highly significant association between all the eight-cancer-specific quality-of-life domains except the pain domain- and the overall quality-of-life log scores. Nausea problem followed by worry and cognitive problems was the most effective domains on the overall quality-of-life score.

CONCLUSION

Cancer pediatric patients suffered low quality of life especially for anxiety procedure and worry domains with special consideration for the impact of nausea, worry, and cognitive problems on their perception of quality of life.

Comparison of Neurocognitive Functioning and Fine Motor Skills in Pediatric Cancer Survivors and Healthy Children

Background: The late treatment outcomes of pediatric brain tumors and of hematopoietic and lymphoid tissue tumors are an important focus of both rehabilitation and research. Neurocognitive and motor disorders induce further learning problems impeding social-emotional adaptation throughout a whole lifespan. Core deficits in short-term and working memory, visuospatial constructional ability, verbal fluency, and fine motor skills underlie distorted intellectual and academic achievement. This study aimed to assess the individual differences in cognitive ability and fine motor skills of pediatric tumor survivors and the age-matched healthy controls. Methods: A total of 504 tumor survivors after treatment and 646 age-matched healthy controls underwent neurocognitive and fine motor assessments. Findings: The group of tumor survivors scored significantly worse in both neurocognitive and fine motor skill in compared with the healthy control group. The pediatric brain tumor survivors (PBT group) performed worse in cognitive (p < 0.001 for verbal fluency and p < 0.001 for visuospatial constructional ability) and motor tests (p < 0.001) compared to the healthy controls. Hematopoietic and Lymphoid Tissues tumors survivors (THL group) performed worse in verbal fluency (p < 0.01) and visuospatial constructional test (p < 0.001) compared to the control group. Furthermore, the PBT group had worse results in visuospatial constructional ability (p < 0.05) and fine motor (p < 0.001) ability than the THL group. Significant differences between females and males were found in fine motor test performance in the PBT group (p < 0.05), as well as in verbal fluency (p < 0.01) and visuospatial constructional ability (p < 0.01) in the control group. Neurocognitive and fine motor skill characteristics in the THL group did not correlate with age.

Personal and Social Resources Are Linked to Cognition and Health-Related Quality of Life in Childhood Cancer Survivors

Personal and social resources may buffer the adverse effects of childhood cancer and its impact on cognition and quality of life. While childhood cancer survivors show domain-specific cognitive difficulties, little is known about their personal and social resources. We therefore investigated personal and social resources and their association with cognitive and quality-of-life outcomes in childhood cancer survivors. Seventy-eight survivors of childhood cancer of different etiologies (aged 7−16 years; ≥one year since treatment) and fifty-six healthy controls were included. Cognitive outcome was assessed by neuropsychological tests; personal and social resources, as well as health-related quality of life, were assessed by standardized questionnaires. In the social resource domain, peer integration was worse in survivors than in controls (puncorr < 0.04, d = 0.33). Personal resources and all other subscales of social resources did not significantly differ between survivors and controls. In survivors, the global resource score was significantly correlated with processing speed (r = 0.39, pcorr < 0.001) and quality of life (parent: r = 0.44; self-report: r = 0.46; pscorr < 0.001). In controls, no association occurred between resources and cognitive outcome, and the correlation between the global resource score and quality of life did not withstand correction for multiple comparison (parent: r = 0.28; self-report: r = 0.40, psuncorr < 0.001). After an adverse event such as childhood cancer, resources might play a particularly buffering role on cognitive performance and quality of life (when compared to the everyday life of healthy controls). This highlights the importance of interventions that strengthen the resources of children and their families, even years after cancer. Such resource-focused intervention could help to counteract long-term sequelae in cognitive outcomes and health-related quality of life.

Long-Term Follow-Up of Pediatric CNS Tumor Survivors—A Selection of Relevant Long-Term Issues

Introduction: Survivors of pediatric central nervous system (CNS) tumors are at high risk for late effects and long-term morbidity. The quality of survival became increasingly important, as advances in diagnostics, multimodal treatment strategies, and supportive care have led to significant increases in long-term survival. Aim: This review aims to provide a global overview of the potential late effects and long-term follow-up care of CNS tumor survivors, directed to trainees and practitioners with less targeted training in pediatric oncology. Late effects in CNS tumor survivors: A specific focus on CNS tumor survivors relies on cognitive and psychosocial late effects, as they may have an impact on education, professional career, independent living, and quality of life. Further important late effects in CNS tumor survivors include endocrine, metabolic, cardiovascular, and cerebrovascular diseases. Conclusions: Comprehensive long-term follow-up care is essential for pediatric CNS tumor survivors to improve their quality of survival and quality of life. An individualized approach, taking all potential late effects into account, and carried out by an interdisciplinary team, is recommended, and should continue into adulthood. Existing recommendations and guidelines on long-term follow-up care guide the multidisciplinary teams.

Binge Drinking, Tobacco, and Marijuana Use Among Young Adult Childhood Cancer Survivors: A Longitudinal Study

Objectives: Substance use among young adult childhood cancer survivors (YACCSs) has been found to increase during survivorship, resulting in increased risk of developing long-term negative health outcomes. This investigation sought to determine various risk and protective factors of tobacco, alcohol, or marijuana use over time among a sample of YACCSs. Methods: 127 YACCSs (57% Hispanic, 55% female, average age at diagnosis 12.4 years) who were diagnosed with any cancer type (except Hodgkin lymphoma) at two large pediatric medical centers in Los Angeles County between 2000 and 2007 responded to two surveys separated by ∼5 years. Bivariate logistic regression models were used to assess independent clinical and psychosocial Time 1 variables associated with each substance use outcome at Time 2. Time 1 variables significant at p < .10 were included in multivariable logistic regression models for each Time 2 substance use variable. Results: Rates of 30-day use increased over time for binge drinking alcohol (from 25.6% to 37.7%), marijuana (from 10.6% to 22.1%), and cigarette/tobacco (from 8.9% to 12.2%). Of the following Time 1 variables, marijuana use, cigarette use, and binge drinking were associated with Time 2 marijuana, cigarette, and binge drinking, respectively. Of the following clinical factors, receipt of more intensive cancer treatment was associated with decreased tobacco use. All other psychosocial and clinical factors analyzed were not associated with any increase or decrease in substance use. Conclusions: A greater emphasis on early health education efforts regarding the health risks of tobacco, alcohol, and marijuana use is needed in this at-risk population.

Impact of non-CNS childhood cancer on resting-state connectivity and its association with cognition

INTRODUCTION

Non-central nervous system cancer in childhood (non-CNS CC) and its treatments pose a major threat to brain development, with implications for functional networks. Structural and functional alterations might underlie the cognitive late-effects identified in survivors of non-CNS CC. The present study evaluated resting-state functional networks and their associations with cognition in a mixed sample of non-CNS CC survivors (i.e., leukemia, lymphoma, and other non-CNS solid tumors).

METHODS

Forty-three patients (off-therapy for at least 1 year and aged 7-16 years) were compared with 43 healthy controls matched for age and sex. High-resolution T1-weighted structural magnetic resonance and resting-state functional magnetic resonance imaging were acquired. Executive functions, attention, processing speed, and memory were assessed outside the scanner.

RESULTS

Cognitive performance was within the normal range for both groups; however, patients after CNS-directed therapy showed lower executive functions than controls. Seed-based connectivity analyses revealed that patients exhibited stronger functional connectivity between fronto- and temporo-parietal pathways and weaker connectivity between parietal-cerebellar and temporal-occipital pathways in the right hemisphere than controls. Functional hyperconnectivity was related to weaker memory performance in the patients' group.

CONCLUSION

These data suggest that even in the absence of brain tumors, non-CNS CC and its treatment can lead to persistent cerebral alterations in resting-state network connectivity.