Affiliations: Department of Pediatrics, Hematology/Oncology, Oregon
Health and Sciences University, Portland, OR, USA | Departments of Pediatrics, Neurology and Psychiatry,
Oregon Health and Sciences University, Portland, OR, USA
Note: [] Corresponding author: Kellie J. Nazemi, MD, Assistant Professor,
Department of Pediatrics, Hematology/Oncology, Oregon Health and Sciences
University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. Tel.: +1
503 494 1543, E-mail: nazemik@ohsu.edu
Abstract: The neuropsychological sequelae associated with the diagnosis and
treatment of a brain tumor in childhood or adolescence are well described.
Providers in the oncology field have become more aware of these problems in
recent years, and some treatment regimens are now aimed at limiting
neurocognitive toxicity. Nevertheless, the likelihood of cure for many brain
tumors is still relatively low and aggressive treatment courses often cannot be
avoided. The neuropsychological side effects of surgery, radiation,
chemotherapy, and even the tumor itself will remain difficult to avoid until
tumor-directed therapy is improved in dramatic ways. After three decades of
research and a multitude of published studies, the nature of these
neurocognitive deficits and the associated risk factors are well-understood,
but there is a paucity of research aimed at therapeutic interventions. This is
the essential step that must be taken to translate our current understanding
into improved quality of life for children who survive the underlying disease.
Unfortunately, the current standard of care for treatment of these complex
neurobehavioral deficits relies on a strained public school system. Recent
advances and current approaches in treatment interventions for
neuropsychological sequelae are reviewed in this article, including
pharmacologic treatments, cognitive remediation derived from traumatic brain
injury rehabilitation, and comprehensive school re-integration efforts. There
is an acute need for further advances in this field, and a bright future of
individualized school re-integration is within reach.
Keywords: Brain tumor, child, adolescent, late effects, neuropsychologic sequelae, neurocognitive dysfunction, radiation therapy, chemotherapy, cognitive remediation, school re-integration
