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Screening for neurocognitive impairment in pediatric cancer long-term survivors
Kevin R Krull1, M Fatih Okcu, Brian Potter
1Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 332 N Lauderdale St, MS 735, Memphis, TN 38105-2794, USA. kevin.krull@stjude.org
Insights
A brief neurocognitive screening tool effectively identifies childhood cancer survivors needing follow-up care. This reliable method is practical for routine use, improving upon parent ratings for predicting cognitive function.
Area of Science:
- Neuroscience
- Pediatric Oncology
- Psychometrics
Background:
- Childhood cancer survivors (up to 40%) may experience neurocognitive deficits.
- Current guidelines recommend regular neurocognitive evaluation.
- Implementation challenges include cost, time, insurance, and resource access.
Purpose of the Study:
- To assess the reliability and validity of a brief neurocognitive screening method.
- To provide a practical tool for routine screening of childhood cancer survivors.
- To identify patients requiring comprehensive neurocognitive follow-up.
Main Methods:
- Screened 240 patients in a long-term survivor clinic.
- Utilized standard neurocognitive measures and brief parent ratings.
- Examined test-retest reliability, predictive, and discriminative validity in a subset of patients.
Main Results:
- Demonstrated good test-retest reliability (overall r = 0.72).
- The screen accurately predicted global intellect, reading, and mathematics skills.
- Parent rating was a less effective predictor of global intellect.
Conclusions:
- The brief neurocognitive screen is a reliable and practical tool.
- It outperforms parent ratings in predicting child functioning.
- This 30-minute screening method aids in identifying survivors needing further neurocognitive assessment.
Purpose:
Recent studies suggest that up to 40% of childhood cancer survivors may experience neurocognitive problems, a finding that has led the Children's Oncology Group to recommend regular evaluation. However, for a variety of reasons, including costs, time restraints, health insurance, and access to professional resources, these guidelines are often difficult to implement. We report reliability and validity data on a brief neurocognitive screening method that could be used to routinely screen patients in need of comprehensive follow-up.
Patients And Methods:
Two hundred forty consecutive patients were screened during their annual visits to a long-term survivor clinic using standard neurocognitive measures and brief parent rating. From this total, 48 patients had a second screening, and 52 patients had a comprehensive follow-up evaluation. Test-retest reliability and predictive and discriminative validity were examined.
Results:
Good test-retest reliability was demonstrated, with an overall r = 0.72 and all individual subtest correlations greater than r = 0.40. Although means tended to improve from first to second testing, no significant changes were detected (all P > .10). The screen accurately predicted global intellect (F(6,45) = 11.81, P < .0001), reading skills (F(6,45) = 4.74, P < .001), and mathematics (F(6,45) = 3.35, P < .008). Parent rating was a marginal indicator of global intellect only.
Conclusion:
The brief neurocognitive screening was a better predictor of child functioning than specific parent rating. This brief measure, which can be completed in 30 minutes, is a practical and reliable method to identify cancer survivors in need of further neurocognitive follow-up.
