Everyday executive function in standard-risk acute lymphoblastic leukemia survivors

Area of Science:

• Pediatric Oncology
• Neuropsychology
• Childhood Cancer Survivorship

Background:

• Executive function (EF) is crucial for daily functioning.
• Long-term neurocognitive effects of childhood cancer treatment are a significant concern for survivors.
• Standard risk acute lymphoblastic leukemia (SR-ALL) survivors require ongoing monitoring for cognitive deficits.

Purpose of the Study:

• To compare parent-rated executive function (EF) in pediatric SR-ALL survivors and healthy controls (HC).
• To investigate the relationship between age at diagnosis/assessment and EF difficulties in SR-ALL survivors.
• To identify specific EF domains affected in SR-ALL survivors.

Main Methods:

• Compared 256 SR-ALL survivors (assessed ~9 years post-treatment) with matched HC using the Behavior Rating Inventory of Executive Function (BRIEF).
• Utilized profile analysis to compare EF scale scores between groups.
• Employed chi-square tests, odds ratios, and regression models to analyze prevalence and risk factors.

Main Results:

• SR-ALL survivors and HC had similar mean EF scores, except for flexibility and initiation.
• Survivors showed 2-3 times higher rates of clinical impairment in flexibility, initiation, working memory, and emotional control.
• Older age at assessment correlated with higher risk of working memory and self-monitoring deficits; no effect of age at diagnosis or treatment regimen.

Conclusions:

• While most SR-ALL survivors do not exhibit severe, widespread EF deficits, a notable subset experiences significant executive dysfunction.
• Metacognitive functions appear particularly vulnerable to disruption as SR-ALL survivors age.
• Findings underscore the need for tailored neurocognitive monitoring and potential cognitive interventions for SR-ALL survivors.