Attention and executive functioning in children and adolescents treated for high-risk acute lymphoblastic leukemia: A report from the Children's Oncology Group (COG)

Authors

Kristina K. Hardy, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, USA.
Leanne Embry, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
John A. Kairalla, Department of Biostatistics, University of Florida, Gainesville, Florida, USA.
Christina Sharkey, Department of Psychology, The Catholic University of America, Washington, USA.
Anthony R. Gioia, Neuropsychology Department, Kennedy Krieger Institute, Baltimore, USA.
Danielle Griffin, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, USA.
Carly Berger, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, USA.
Hannah S. Weisman, Neuropsychology Department, Kennedy Krieger Institute, Baltimore, USA.
Robert B. Noll, University of Pittsburgh Department of Pediatrics, Pittsburgh, USA.
Naomi J. Winick, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Document Type

Journal Article

Publication Date

8-23-2024

Journal

Pediatric blood & cancer

DOI

10.1002/pbc.31179

Keywords

Acute lymphoblastic leukemia; executive functioning; late effects of cancer treatment

Abstract

OBJECTIVES: Survivors of childhood B-acute lymphoblastic leukemia (B-ALL) are at risk for difficulties with attention and executive functioning (EF) as a late effect of treatment. The present study aimed to identify treatment and demographic factors associated with risk for difficulties with EF in youth treated for high-risk B-ALL. METHOD: Children and adolescents with B-ALL treated on Children's Oncology Group (COG) protocol AALL0232 were randomized to high-dose or escalating-dose methotrexate (MTX), and either dexamethasone or prednisone during the induction phase. Neuropsychological functioning was evaluated via protocol AALL06N1, including performance-based and parent-report measures, for 177 participants (57% female, 81% white; mean age at diagnosis = 8.4 years; SD = 5.0) 8-24 months following treatment completion. RESULTS: Mean scores for all attention and EF measures were within the average range, with no significant differences as a function of MTX delivery or steroid treatment (all p > 0.05). In multivariable models, participants with US public insurance exhibited significantly greater parent-reported EF difficulties than those with US private or non-US insurance (p ≤ 0.05). Additionally, participants diagnosed under 10 years of age performed significantly more poorly on measures of attention (i.e., continuous performance task, p ≤ 0.05) and EF (i.e., verbal fluency and tower planning task, p ≤ 0.05). CONCLUSIONS: For survivors of pediatric B-ALL, treatment-related factors were not associated with attention or EF outcomes. In contrast, outcomes varied by demographic characteristics, including age and insurance type, an indicator of economic hardship. Future research is needed to more directly assess the contribution of socioeconomic status on cognitive outcomes in survivors.

APA Citation

Hardy, Kristina K.; Embry, Leanne; Kairalla, John A.; Sharkey, Christina; Gioia, Anthony R.; Griffin, Danielle; Berger, Carly; Weisman, Hannah S.; Noll, Robert B.; and Winick, Naomi J., "Attention and executive functioning in children and adolescents treated for high-risk acute lymphoblastic leukemia: A report from the Children's Oncology Group (COG)" (2024). GW Authored Works. Paper 5442.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5442

Department

Psychiatry and Behavioral Sciences