Barriers to the use of Methylphenidate in Pediatric Neuro-oncology Services
Alexander J Hagan1, Simon Bailey2,3, Sarah J Verity1,3
1Departments of Paediatric Health Psychology.
Insights
Methylphenidate shows promise for improving neurocognitive deficits in childhood central nervous system (CNS) tumor survivors, but its use is inconsistent due to resource limitations and lack of evidence. Further research and collaboration are needed to advance its application.
Area of Science:
- Neuro-oncology
- Pediatric survivorship
- Neurocognitive rehabilitation
Background:
- Childhood central nervous system (CNS) tumor survivors face significant neurocognitive late effects.
- Methylphenidate may improve neurocognitive function and quality of life in this population.
- Current methylphenidate prescription in neuro-oncology is inconsistent.
Purpose of the Study:
- To investigate neurocognitive assessment and rehabilitation, including methylphenidate use, for childhood CNS tumor survivors in the UK.
- To understand current practices and identify barriers to methylphenidate prescription.
Main Methods:
- A qualitative study using semi-structured questionnaires distributed to clinical psychologists and neuropsychologists.
- Data collected from National Health Service pediatric neuro-oncology principal treatment centers (PTCs).
- Thematic analysis applied to explore collected data.
Main Results:
- Psychology resources were inadequate in many PTCs, limiting methylphenidate access.
- Methylphenidate was primarily prescribed for severe neurocognitive difficulties.
- Clinicians expressed interest in methylphenidate but lacked evidence of efficacy and clear treatment protocols.
Conclusions:
- National collaboration is crucial to advance interventions like methylphenidate for childhood CNS tumor survivors.
- Addressing resource limitations and generating robust evidence are key to wider methylphenidate implementation.
- Improved research summaries and treatment protocols are needed to support methylphenidate use.
Background:
Survivors of childhood CNS tumors are at a significant risk of chronic and multifaceted neurocognitive late effects. Recent findings indicate the potential utility of methylphenidate in addressing neurocognitive and academic plateauing and improving quality-of-life outcomes in this clinical population. However, the prescription of methylphenidate in neuro-oncology services remains inconsistent.
Objective:
To explore the neurocognitive assessment and rehabilitative interventions (including the use of methylphenidate) offered to survivors of childhood CNS tumors within mainland UK.
Method:
We used a semi-structured questionnaire to gather qualitative data from clinical psychologists and neuropsychologists within National Health Service pediatric neuro-oncology principal treatment centers (PTCs) during May 2018. Thematic analytical methods were used to explore themes within the collected data.
Results:
Eleven (58%) of the 19 PTCs returned the completed questionnaire. Respondents reported inadequate resource of psychology in many pediatric neuro-oncology PTCs, which limited the provision of methylphenidate to a restricted proportion of the patient group (i.e., those with the most profound neurocognitive difficulties). Respondents reported an interest in exploring the utility of methylphenidate in their patient group yet described a lack of appropriate evidence of its efficacy. In addition, respondents highlighted the need for the provision of accessible research summaries and treatment protocols addressing the use of methylphenidate.
Conclusion:
We anticipate that national collaboration between clinicians and researchers working in the cancer survivorship field will support the advancement of interventions such as methylphenidate for the growing clinical population of survivors of childhood CNS tumors.
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