For many survivors of childhood brain tumors, leukemia, sickle cell disease, and other serious illnesses, neuropsychological deficits resulting from treatments deeply affect their quality of life. These cognitive side effects often remain with children throughout their school years and into adulthood, but Duke studies into early, nonpharmacologic interventions are showing promise for mitigating their impact.

“Treatments for children who have brain tumors or cancer are exciting and lifesaving,” says Melanie J. Bonner, PhD, a clinical psychologist and Director of Duke Pediatric Neuropsychology Clinic. “Unfortunately, those same treatments have side effects that affect cognitive function. The goal of our research program and approach to patient care is to recognize that the diseases themselves cause enough problems for children and their families, and to search for ways to address these troubling side effects without the use of additional medications when possible.”

Nonpharmacologic interventions that are part of Bonner’s clinical practice and ongoing research program include:

• Providing a home-based, computerized cognitive training program for children that employs visually appealing, video game-like exercises to target core cognitive skills. The program combines cognitive neuroscience with computer game design and personal support.
• Maximizing patients’ individual education plans to ensure they receive speech, physical, and occupational therapy, as well as specific academic interventions in their school setting.
• Teaching educators about the potential impact of illness and treatment on children’s ability to focus in school, so that cognitive problems aren’t misinterpreted as behavioral issues.
• Establishing a standard of care in partnership with providers at Duke’s specialty clinics that includes neuropsychological assessments pre- and post-treatment and educating clinicians on the importance of addressing cognitive functioning as part of patients’ comprehensive treatment plans.

In studying the effectiveness of interventions on neurocognitive functioning, Bonner and colleagues first learned that medications used to treat ADHD were effective for managing some cognitive deficits, but many families didn’t want to add more medications to their children’s existing regimen. “That’s what spurred us to look at nonpharmacologic interventions,” she says.

The most common cognitive side effects of treatments involving radiation, chemotherapy, and medications are deficits in attention, concentration, processing speed, and working memory—all of which are critical for learning. “Almost all of our patients who have undergone treatment for cancer, brain tumors, or sickle cell disease have encountered some impact on their academic functioning, and because children spend so much time in school, this is a real problem for them and their families that needs to be addressed,” says Bonner.

Additional studies currently planned or underway include: evaluating the feasibility of implementing cognitive interventions in the school and clinic settings; assessing the availability of disability services in higher education settings so that patients continue to have resources if/when they pursue college; evaluating resources needed for young adult patients who transition care from a pediatric to adult program; and evaluating the financial impact of cognitive and psychosocial interventions on patients.

“We’re at a point in healthcare where we’re thinking not only about primary outcomes—whether we can treat the disease—but we’re also asking how we can help children have a good quality of life in the context of their treatment.”