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Post-PICU Cognitive and Psychological Outcomes in Children Receiving Treatments for Acute Lymphoblastic Leukemia
Kristin Canavera1, Saad Ghafoor2, Kimberly Fan2
1Department of Pediatrics, Ochsner Hospital for Children, New Orleans, LA.
Insights
Children treated for acute lymphoblastic leukemia (ALL) with pediatric intensive care unit (PICU) admissions experienced worse neurocognitive and psychological outcomes. Further research is needed to identify risk factors for post-intensive care syndrome in pediatric patients.
Area of Science:
- Pediatric Oncology
- Critical Care Medicine
- Neuropsychology
Background:
- Childhood acute lymphoblastic leukemia (ALL) treatment can impact long-term neurocognitive and psychological health.
- Pediatric intensive care unit (PICU) admissions may represent a significant stressor during ALL treatment.
Purpose of the Study:
- To investigate the neurocognitive and psychological outcomes in children treated for ALL.
- To specifically examine the impact of pediatric intensive care unit (PICU) admissions on these outcomes.
Main Methods:
- Observational study of 296 children (ages 3-21) treated for ALL between 2007 and 2017.
- Neurocognitive and psychosocial outcomes were assessed prospectively at the end of cancer therapy.
- Data on 104 patients with PICU admissions were retrospectively abstracted.
Main Results:
- Children with ALL and PICU admissions showed significantly lower functioning in cognitive domains (working memory, processing speed, executive functions, attention, math, fine motor skills) and daily living skills compared to normative samples.
- The PICU group had worse performance on sustained attention and a higher frequency of at-risk status for learning and memory problems (25% vs 12%).
- Critical illness severity did not correlate with neurocognitive or psychological outcomes.
Conclusions:
- Children with ALL, regardless of PICU admission, exhibit diminished cognitive and psychological outcomes post-treatment.
- Identifying risk factors for post-intensive care syndrome (PICS-p) and associated impairments in pediatric ALL survivors is crucial for future research and intervention.
Objectives:
To examine neurocognitive and psychological outcomes associated with post-PICU admissions in children treated for childhood acute lymphoblastic leukemia (ALL).
Design:
Observational study from October 2007 to March 2017.
Setting:
Pediatric onco-critical care unit.
Patients:
All patients in this study (n = 296; ages 3-21) were treated for ALL on the St. Jude Total Therapy 16 clinical trial (NCT00549848) from 2007 to 2017. Of these, 104 patients were admitted to the PICU during protocol-directed therapy. All patients completed protocol-directed neurocognitive monitoring prospectively, at the end of cancer-directed therapy. Data on PICU stays were abstracted retrospectively from the medical record.
Interventions:
None.
Measurements And Main Results:
Demographic and critical illness variables were abstracted from institutional databases and medical records. Neurocognitive and psychosocial outcomes were prospectively obtained at the end of treatment. Children who had a PICU admission experienced significantly lower functioning compared to normative samples in several areas of cognitive functioning (working memory, processing speed, executive functions, inattention, math achievement, fine motor dexterity, and speed), daily living skills, and internalizing problems (all ps < 0.05). Compared with those without PICU admissions, patients with PICU admissions had worse performance on a measure of sustained attention (p = 0.017). The frequency of patients at risk for problems with learning and memory was significantly higher in the PICU group compared with the non-PICU group (25% vs 12%, p = 0.006). Critical illness symptom severity was not associated with neurocognitive or psychological outcomes.
Conclusions:
Children with ALL, with or without a PICU admission, experienced lower cognitive and psychological outcomes following treatment. Future research is needed to continue identifying risk factors for post-intensive care syndrome (PICS-p) and post-PICU cognitive and psychological impairments in pediatric patients.
