Managing Chemo Brain in Pediatric Survivors of Childhood Cancer

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The impairment known as "chemo brain" may affect patients soon after diagnosis or much later.
The impairment known as "chemo brain" may affect patients soon after diagnosis or much later.

Cancer-associated cognitive impairment, commonly known as chemo brain, is an adverse effect of cancer and its treatment that survivors experience to varying degrees. Symptoms generally include attention and concentration difficulties, reduced processing speed and executive function, and compromised short-term memory.1 Chemo brain affects more than one-third of all survivors of childhood cancers.

Cognitive dysfunction may arise at or soon after a cancer diagnosis; however, deficits may also arise several years later. Chemotherapy was thought to be the only cause of chemo brain, but research suggests that several types of cancer treatment, and even the cancer diagnosis itself, can cause these impairments.1 Children with cancer diagnosed at a young age appear to experience more chemo brain complications than any other patient group. As the childhood cancer survivor population increases, awareness of the potential long-term effects of cancer and its treatments is important.2

Support

Childhood cancer poses many challenges for everyone affected. Each phase of a cancer diagnosis poses its own difficulties, and children and their families need to feel supported throughout. While a child is undergoing treatment or is in the hospital, support is readily available in the form of hospital-based emotional support and interventions.2

Unfortunately, many childhood cancer survivors and their families describe additional challenges that appear once treatment is over or when the survivor is in remission.2 Experiencing adverse effects after treatment can be distressing, as they may be unexpected, occurring when families believe that their cancer journey has come to an end. Acknowledging that “this is real” and not imagined provides a child with additional support and reassurance.1 

When a child experiences chemo brain or other cognitive deficits, keeping the mind active can help. When it comes time to introduce — or re-introduce —the child to school, slowly implementing learning can help the child feel less overwhelmed during reintegration to the school environment, as it can be a very anxiety provoking time.3 A meeting with administration, teachers, and counselors prior to a classroom visit can be extremely helpful to create a plan for moving forward. Making these people aware of potential long-term adverse effects of the diagnosis and treatment is very important. A one-on-one aid or assistant for a child may be essential, and an individualized education plan (IEP) and classroom/testing accommodations (504 plan) are 2 significant requests to make. Psychological testing may also be imperative.3

Once reintegration into the school environment begins, the child's progress should be continuously monitored by parents and teachers. This allows for making necessary adjustments to accommodate changes in the child's learning capabilities, as chemo brain may not become apparent immediately. 

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