Cancer treatments, including surgery, chemotherapy, radiation and immunotherapy, place children and adolescents at risk for long-term cognitive problems, also known as cognitive late effects. Rather than wait to assess your child years after the end of treatment or when academic and cognitive difficulties become more pronounced, the team at Children's Hospital of Philadelphia’s (CHOP) Cancer Center Oncology Neuropsychology Screening Program team assesses for cognitive problems or vulnerabilities earlier — usually soon after treatment is complete — so that the appropriate interventions and supports can be put into place at home, in school and in the community. At CHOP’s Cancer Center, early assessment and monitoring of potential cognitive late effects is part of routine follow-up cancer care and can help remediate or reduce the negative impact of cognitive late effects.

Overview of cognitive late effects after cancer treatment

Cognitive late effects, such as attention, learning and processing speed problems, can arise months or even years after the completion of treatment. Late effects can significantly affect quality of life in areas such as academic underperformance, difficulty with independent living skills, difficulty with social relationships, or increased anxiety or frustration. Cognitive problems can change over time and often become more apparent during key transition periods — for example, the transition to kindergarten or middle school — because of the increase in cognitive demands.

Who is most at risk for cognitive late effects?

Cognitive late effects have been identified in survivors of many forms of cancer, but we know the risk tends to be higher in those treated for brain tumors, leukemia, lymphoma and neuroblastoma. Children who are treated at younger ages are at greater risk.

Treatments that increase risk:

• Brain radiation or total body radiation
• Chemotherapy, particularly intrathecal treatment and high-dose IV methotrexate, cytarabine and vincristine
• Prolonged use of corticosteroids
• Brain surgery

What does screening and evaluation involve?

The Oncology Neuropsychology Screening Program provides an abbreviated neuropsychological evaluations that is often scheduled on the same day as your child’s routine oncology visit. All the evaluations involve paper-and-pencil or computerized tests. Many children find the tasks engaging and enjoyable.

Areas of functioning that are assessed:

• Overall intelligence / developmental level
• Language
• Attention/concentration
• Processing speed
• Executive functioning (organization, problem solving, multi-tasking)
• Fine motor skills
• Foundational academics (reading and math)
• Behavior
• Social-emotional functioning

For most patients seen through the screening program, our team provides a recommended plan for future follow-up and ongoing monitoring after the initial evaluation. Depending on findings from the screening evaluation, recommendations can include school supports, home activities to further develop skills, or referrals for additional services in the Cancer Center, such as education coordination, Oncology Psychology, and the EXCEL Clinic. In some cases, a referral for a more comprehensive neuropsychological evaluation may also be warranted.