Cancer Survivors Diagnosed as Teens at Risk for Cognitive Problems

Long-term cancer survivors who were diagnosed as adolescents often experience emotional distress and neurocognitive dysfunction that interferes with their social development as adults, according to a recent study.

Researchers asked more than 6,000 survivors and siblings participating in the Childhood Cancer Survivor Study to complete a symptom index and neurocognitive questionnaire to assess their level of emotional distress and cognitive dysfunction related to cancer therapy. Survivors who were diagnosed between the ages of 11 and 21 years were significantly more likely than their sibling counterparts to report depression; anxiety; and problems with task efficiency, emotional regulation, and memory. The findings were published in the Journal of Clinical Oncology.

Previous studies have reported that survivors diagnosed in early childhood are at risk for impaired functioning, but this is the first study to focus on survivors diagnosed during adolescence, the authors said. Besides self-reported symptoms of distress and cognitive dysfunction, survivors in the study were less likely than sibling controls to be married or living independently, have college degrees, or work full-time jobs.

“Cancer treatment during this time has the potential to interfere with adolescents’ separation from caregivers, autonomy with regard to planning social and academic schedules, participation in social activities, and maintaining privacy, particularly of their bodies,” the authors wrote. “The long-term impact of disrupted development in these important areas of social, emotional, and functional autonomy is unknown, but it is reasonable to infer that protracted or delayed maturation in these areas may be associated with persistent distress.”

Survivors of central nervous system (CNS) tumors or leukemia, who were more likely to have received cranial radiation therapy (CRT), were at higher risk for distress and neurocognitive problems compared with survivors of lymphoma or sarcoma, likely due to late effects of CRT, the study found.

In the lymphoma/sarcoma group, reported problems varied according to the type of chemotherapy regimen received. For example, treatment with corticosteroids was associated with sleep problems, anxiety, task efficiency, and memory, while those treated with thoracic irradiation for Hodgkin lymphoma were more likely to experience problems with attention and memory, a finding that supports earlier research.

The authors acknowledged several limitations of the study. For example, it is difficult to discern whether emotional distress contributes to neurocognitive impairment or vice versa because they are likely to be related. In addition, the treatment protocols used for participants are more than 20 years old, although recent studies suggest that the risk of cognitive effects has not changed significantly with newer treatments.

Regardless of its limitations, this study revealed that survivors diagnosed in adolescence are as likely as those diagnosed at younger ages to experience poor functional outcomes, the authors said. It also highlighted a lack of evidence on the emotional and behavioral issues specific to this group of survivors.

“This study demonstrated that there are high rates of self-reported impairment in neurocognitive function and psychological distress that are associated with limitation in development of adult social milestones,” the authors concluded. “Accordingly, further follow-up with adolescent and early young adult survivors is necessary.”