pediatric psycho-oncology resident education lecture series

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  • Slide 1
  • Pediatric Psycho-Oncology Resident Education Lecture Series
  • Slide 2
  • Cognitive & Behavioral Aspects of Pediatric Cancer 1960-1970s:Survival improved chemotherapy, CNS prophylaxis 1980s:Survival, Cognitive Functioning improved chemotherapy, modified CNS treatment 1990s-present: Survival, Cognitive Functioning, Quality of Life improved assessment, focus on academic & psychosocial functioning over time, focus on development of interventions
  • Slide 3
  • Cognitive Risk Factors in Pediatric Cancer Brain tumor CNS disease Cranial irradiation (dose effect) Childs age (young children at greater risk) Time since end of treatment Intrathecal chemotherapy systemic chemo to lesser degree Frequent school absences
  • Slide 4
  • Common Cognitive Impairments/Late Effects Decline in intellectual functioning age & dose related Memory problems (short-term) Attention/concentration difficulties Slower processing speed Visual-spatial/motor problems Arithmetic & other learning problems Problems in executive functioning (working memory, behavioral inhibition, self-monitoring, self-regulation, organization & planning, cognitive flexibility/shifting)
  • Slide 5
  • Current Cognitive Interventions Serial assessment of cognitive functioning School consultation, education, and services 504 plan for accommodations/modifications special education services/IEP (OHI, CD, LD) Tutoring to learn compensatory strategies Cognitive remediation?? (Butler & Copeland, 2002) Medication, e.g. methylphenidate, for attention/concentration & executive functioning difficulties??? (Butler & Mulhern, 2005)
  • Slide 6
  • Cognitive Functioning in Pediatric Blood & Marrow Transplant (BMT) Are pediatric BMT patients at greater risk of developing cognitive problems due to. Myeloblative chemotherapy? Total body irradiation? Treatment history?
  • Slide 7
  • Cognitive Functioning in Pediatric BMT: Longitudinal Studies No significant IQ changes at 1 & 2 years Phipps et al., 2000; Simms et al., 2002 Correlates: pre-BMT functioning, age at BMT, diagnosis, TBI dose, length of time since BMT, Rx regimen, gender
  • Slide 8
  • MCW Transplant Study Kupst et al. (2002) No significant changes in IQ over two years IQ scores were within normal limits No significant changes in Reading or Math Achievement Predictors of Cognitive Outcome: SES, Pre-BMT IQ, Prior Academic Problems Not significantly related: age, previous treatment, GVHD status, TBI Cognitive Development (