Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Mavrea-Poulakou Kalliopi
Dissertation committee:
Φλώρα Μπακοπούλου, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αντώνης Καττάμης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλέξανδρος-Σταμάτιος Αντωνίου, Καθηγητής, Παιδαγωγικό Τμήμα Δημοτικής Εκπαίδευσης, ΕΚΠΑ
Roser Pons, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Χριστίνα Κανακά-Gantenbein, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Χρούσος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κόσσυβα Λυδία, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Συγκριτική μελέτη αξιολόγησης νοητικού, μαθησιακού και ψυχοκοινωνικού προφίλ παιδιών και εφήβων επιβιωσάντων από καρκίνο σε σχέση με υγιείς μάρτυρες
Translated title:
Comparative study of assessment of mental, educational and psychosocial profiles of children and adolescents aged 7-14 years with a history of childhood cancer in relation to healthy controls
Summary:
Pediatric cancer treatments such as surgery, radiation therapy, chemotherapy and advanced treatments have resulted in significant improvements in survival rates, however they have multiple sequelae on childhood and adolescent development. Over the past decades, many researchers have studied the effects of several treatments to the neurocognitive function of pediatric cancer survivors. Cognitive impairments of children treated for leukemia and brain tumors are believed to be secondary to the multi-modal treatment approach, in some cases high doses of therapy and aggressive surgery are associated with better cure rates yet more severe morbidity. With the increasing number of pediatric cancer survivors, it has become increasingly important to apprehend the effects of several treatments on brain development to predict the cognitive risks for survivors and choose optimal and less harmful treatment strategies for those newly diagnosed.
Initially a meta‐analysis was conducted to compare the intelligence quotient (IQ) scores between childhood cancer survivors (CCS) of acute lymphoblastic leukemia (ALL), the commonest pediatric cancer, and controls. The meta‐analysis demonstrated clinically signifi‐ cant differences in the cognitive functions between children and adolescent ALL survivors in remission and controls in the domain of intelligence i.e., significantly lower scores of total IQ, verbal IQ and performance IQ of CCS than healthy controls. The mean total IQ range was 85.2‐107.2 in the CCS and 88.4‐114.1 in the controls. The difference in the mean total IQ between controls and CCS ranged from ‐13.8 to 20.6.
A case-control study followed to assess cognitive outcomes of CCS who had been treated for any type of cancer at the Pediatric Hematology/Oncology Unit of the Fist Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, at the tertiary Aghia Sophia Children’s Hospital, the largest pediatric hospital in Greece. Healthy control participants attended the Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care for routine health-care visits, and were recruited prospectively through a follow-up appointment for cognitive assessment at the Clinic for Assessment of Adolescent Learning Difficulties at the same hospital. Children and adolescents, aged 7-15 years, were recruited over four years (2017-2021). For survivors ≥1 year should have elapsed from completion of treatment. Assessment was performed with validated instruments (WISC-III, Greek LAMDA, CBCL/YSR, KIDSCREEN-52).
A total of 219 children and adolescents (70 CCS, 149 controls) were included in the study (sufficient power 87%). CCS had significantly worse scores in full-scale Intelligence Quotient (FSIQ) (p=0.004), verbal IQ (VIQ) (p=0.005) and all its subscales, performance IQ (PIQ) (p=0.021), and in almost all learning parameters than controls. Attention, working memory, writing- and visual-motor coordination, processing accuracy and speed, language acquisition and expression, were all affected negatively. Female CCS demonstrated lower FSIQ (p=0.019) and VIQ (p=0.014) than control females, whereas male CCS retained their total IQ unaffected.
FSIQ, VIQ and PIQ scores were significantly lower in CCS with central nervous system (CNS) tumors than CCS with non-CNS tumors (p=0.003, p=0.044, p=0.010, respectively). PIQ was significantly lower (p=0.042) in radiotherapy than non-radiotherapy treated CCS, whereas radiation load (radiation days and dose) correlated negatively with PIQ subscales. Survivors birth weight correlated positively with PIQ (r=0.401, p=0.019). Survivors with at least one parent of higher (vs. lower) educational level scored higher in FSIQ (p=0.005), VIQ (p=0.003), and in several PIQ subscales. CCS of higher (vs. lower) family income scored significantly higher in several VIQ and PIQ subscales. CCS (vs. controls) had significantly worse scores in all psychosocial scales and in the quality-of-life domains of mood and emotions. Children and adolescents CCS carry a significant burden of cognitive and psychological morbidity.
Main subject category:
Health Sciences
Keywords:
Cancer survivors, Greece, Cancer, Cognitive, Education, Learning, IQ, Quality of life, Intelligence, Chemotherapy, Radiotherapy
Number of references:
206
