Screening of Cognitive Symptoms During Treatment for Childhood Leukemia Predicts Post-Treatment Cognitive Functioning

BackgroundThe current study describes the trajectory of caregiver-reported cognitive functioning for children treated for acute lymphoblastic leukemia (ALL) and correlations with post-treatment caregiver-reported and performance-based cognitive functioning.MethodThe PROMIS parent proxy cognitive function questionnaire was collected at four time points during childhood ALL treatment for 40 participants who also completed post-treatment PROMIS parent proxy reports and neurocognitive evaluations.ResultsPatients (52.5% male) were diagnosed with standard (45.0%) or high-risk B-ALL (47.5%) at a mean age of 7.80 years. During the first year of treatment, caregiver reports revealed a statistically significant (p < .01) decline in child cognitive functioning of 0.37 SD (95% CI: [0.12-0.62]) evaluated using mixed-effects linear regression. Caregiver report of cognitive functioning at the end of the first year of treatment correlated with post-treatment ratings (p < .05), after accounting for demographic and clinical factors. Post-treatment caregiver-reported cognitive functioning was significantly associated with estimated IQ (p < .01), attention (p < .05), word reading (p < .05), and calculation (p < .01).DiscussionTreatment for childhood ALL results in subtle changes in caregiver perception of cognitive functioning that are detectable shortly after diagnosis and may persist into survivorship. Furthermore, this study presents preliminary evidence for use of the PROMIS parent proxy cognitive function questionnaire as a screener for cognitive difficulties that may require further neurocognitive monitoring or comprehensive evaluation.