New Research Shows How to Minimize Side Effects of Chemo

Key Points:

• Regardless of age, cancer treatments impair learning, memory and attention
• The speed of processing information can also be diminished
• These effects can last for months, or even years, after cancer treatment is finished
• Research study shows Fast ForWord can help prevent learning problems in cancer survivors when used during cancer treatment

The cognitive impact of chemotherapy on children

When any of us are told someone we love has a diagnosis of cancer, “The Emperor of all Maladies” so aptly named by Siddhartha Mukherjee, it is very upsetting. But, when it is a parent who learns of a cancer diagnosis in their child, time seems to stand still for months, often years, as treatments are administered.  The good news is that the overall mortality rate from cancer has decreased markedly in the last 20 years. For children diagnosed with cancer, today’s cure rate exceeds 80% for some types of cancer. Earlier diagnosis and more specifically targeted forms of chemotherapy, combined with evidence-based protocols, mean many children are now miraculous survivors of this age-old, but very complex, illness.

After cancer – what are the implications on learning?

However, the success of targeted chemo and radiation therapy does come with a price. With improved survival rates, oncologists have become more aware of the aftereffects that childhood cancer treatments have on thinking, learning and remembering.  According to Jorg Dietrich at Massachusetts General Hospital and his colleagues at Stanford University and Anderson Cancer Center, conventional cancer therapies like chemotherapy and radiology for brain tumors in patients of any age frequently result in a variety of thinking and memory of problems. These neurocognitive deficits, as they are called, include impaired learning, memory, attention, and negatively impact the speed of information processing.

Increased survival rates = increased studies on effects

Interested specifically in those effects on children treated for cancer, Raymond Mulhern and Shawna Palmer at St. Jude’s Research Hospital have reported that the neurocognitive effects of cancer treatment on children can linger for months, or even years, after cancer treatment has been successfully completed. This new understanding of the long term effects of successful cancer treatment has resulted in an increase in the study and understanding of cancer treatment-related learning problems.  Fortunately, it has also led to an increase in research on effective methods for treating the cognitive aftereffects of successful cancer treatment.

According to Mulhern and Palmer, the two most frequent types of childhood cancers that are associated with neurocognitive disorders after successful treatment are acute lymphoblastic leukemia and brain tumors.  The authors state that although neurocognitive effects of cancer therapy are quite variable – depending on the actual diagnosis and age, length and dosage of therapy – researchers generally agree that a high percentage of children will experience problems with learning and thinking, which can interfere with academic achievement after successful cancer treatment.  Oncologists have been working to change their treatment approach when possible to reduce the cognitive aftereffects, but their primary goal is first to maintain the high cure rate.

Research study: can we counteract these cognitive after effects?

Very recently, an exciting new controlled study was published indicating that the neuroscience-based intervention, Fast ForWord, provides significant improvements in learning to read after chemotherapy and radiation therapy for a kind of brain tumor called meduloblastoma. Ping Zou at St. Jude Research Hospital and his colleagues investigated whether Fast ForWord could prevent learning problems in cancer survivors when used during cancer treatment.

They studied two groups of school-aged children who either used Fast ForWord during their cancer treatment or a standard-of-care without the Fast ForWord intervention. Then, about 2 and one-half to three years after successful completion of chemo and radiation therapy for this type of brain tumor, the survivors received functional measures of brain function as well as a series of educational tests. A control group of 21 typically developing children with no history of cancer were included for comparison. The education tests included assessment of phonological skills (known to be a critical component of reading skill) and a variety of reading measures.  Their brain function was evaluated by using functional brain imaging (fMRI).

The results

During the time of the brain imaging, the researchers found that the tests of phonological skills were significantly higher among the cancer survivors who had received the Fast ForWord reading intervention during their cancer treatment, than among those who received standard-of-care. Even more important, the measures of functional brain activation across those brain areas recognized as important for reading showed a trend towards normalization among the children who received the Fast ForWord intervention.  This led the authors to conclude that the results of the study provide evidence for the long-term value of this type of reading intervention in children after surviving a serious form of brain cancer.

A diagnosis of cancer in a child is frightening and overwhelming, but fortunately the cure rate of many childhood cancers is now very high. With the high cure rates, doctors now recognize that these very effective cancer therapies may have long term aftereffects on learning and thinking. However, the best news is that there are interventions, such as the Fast ForWord programs, specifically designed by neuroscientists to normalize brain functions for learning that can prevent and/or remediate some of these learning problems.  

References:

Dietrich, J.Monje, M., Wefel, J. and Meyers, C. Clinical Patterns and Biological Correlates of Cognitive Dysfunction Associated with Cancer Therapy. The Oncologist. 2008;13:1285–1295

Mukherjee, S. The Emperor of All Maladies: A Biography of Cancer. Scribner; 2010

Mulhern, R. and Palmer, S. Neurocognitive late effects in pediatric cancer. Current Problems in Cancer. July–August 2003, Pages 177–197

Zou, P et al. (2015) Functional MRI in medulloblastoma survivors supports prophylactic reading intervention during tumor treatment. Brain Imaging and Behavior, 2015. Available at: http://link.springer.com/article/10.1007/s11682-015-9390-8. Accessed July 27, 2015.