The biological mechanisms responsible for these impacts are not yet well-understood. Direct effects of radiation and other treatments on brain tissue were long believed to explain neurodevelopmental, cognitive, and psychosocial impacts such as memory impairment.6 But non-brain-directed therapy is also associated with increased risks of neurocognitive impacts among survivors of childhood cancers.6

The treatment protocols used with the CCSS cohort are now older than 20 years.6 However, despite reductions in treatment intensity over that period, other studies have shown that the pattern of cognitive impairment remains quite similar.6 Nor can the causal directions of the reported associations be determined because of the cross-sectional nature of the study, Zebrack cautions.

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“We can’t know whether being unemployed causes impaired task function and depression or if depression and impaired function reduces survivors’ ability to become employed,” he explains. “But the association observed still serves as a rationale for developing and implementing psychosocial support interventions for childhood cancer patients that can be implemented while going through treatment—to possibly prevent or diminish the likelihood of these long-term effects occurring, or during off-treatment survivorship, when these young people may need and benefit from support as they may struggle with depression or inability to secure a job.”

Bryant Furlow is a medical journalist based in Albuquerque, New Mexico.


1. Late effects of treatment for childhood cancer—for health professionals (PDQ). National Cancer Institute Web site. Updated May 18, 2015. Accessed August 11, 2015.

2. Williams KA. Adolescent and young adult oncology: an emerging subspecialty. Clin J Oncol Nurs. 2013;17(3):292-296. doi:10.1188/13.CJON.292-296.

3. Robison LL, Hudson MM. Survivors of childhood and adolescent cancer: life-long risks and responsibilities. Nat Rev Cancer. 2014;14(1):61-70.

4. Coccia PF, Altman J, Bhatia S, et al. Adolescent and young adult oncology. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2012;10(9):1112-1150.

5. Casillas J. National Cancer Policy Forum/LIVESTRONG workshop on addressing the needs of adolescents and young adults with cancer . National Academies of Sciences Enginerring Medicine Web site. Accessed August 11, 2015.

6. Prasad PK, Hardy KK, Zhang N, et al. Psychosocial and neurocognitive outcomes in adult survivors of adolescent and early young adult cancer: a report from the Childhood Cancer Survivor Study [published online ahead of print July 6, 2015]. J Clin Oncol. 2015;33(23):2545-2552. doi:10.1200/JCO.2014.57.7528.