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Examining a Novel Neuropsychological Screening Tool in Pediatric Cancer Patients and Survivors
Rachel S Werk1, Shria K Haldipurkar1, Jennifer L Reichek1
1Division of Hematology, Oncology, NeuroOncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Insights
The Clinical Neuropsychology Collaborative for Childhood Cancers (CNC3) developed a caregiver report questionnaire (CNC3-CRQ) to screen for neurocognitive deficits in pediatric cancer patients and survivors. This tool effectively identifies children needing neuropsychological evaluations.
Area of Science:
- Neuropsychology
- Pediatric Oncology
- Cognitive Screening
Background:
- Childhood cancer patients and survivors face significant risks of neurocognitive deficits due to cancer and its treatments.
- Identifying these deficits is crucial for timely intervention and support.
Purpose of the Study:
- To evaluate the effectiveness of the novel CNC3 Caregiver Report Questionnaire (CNC3-CRQ) in identifying neurocognitive impairment in pediatric cancer patients and survivors (PCP/PCS).
- To compare the CNC3-CRQ's performance against formal neuropsychological testing.
Main Methods:
- The CNC3-CRQ was administered to parents of children undergoing comprehensive neuropsychological assessments.
- Results were analyzed against formal neuropsychological test data to assess the CNC3-CRQ's accuracy in detecting at-risk individuals.
Main Results:
- Formal testing revealed high rates of mild (76.6%) and moderate (46.9%) neurocognitive impairment among participants.
- The CNC3-CRQ demonstrated 83.3% sensitivity in identifying at-risk patients, with 73% screening positive.
- Specific domains like processing speed, memory, and visual-spatial skills on the CNC3-CRQ correlated significantly with moderate deficits.
Conclusions:
- The CNC3-CRQ serves as a valuable and efficient screening tool for pediatric cancer patients and survivors.
- It aids in decision-making for referrals to specialized neuropsychology services.
Background:
Childhood cancer patients and survivors are vulnerable to neurocognitive deficits based on malignancy, treatment, and associated comorbidities. This study assessed a novel parent-report cognitive screening tool developed by the Clinical Neuropsychology Collaborative for Childhood Cancers (CNC3) intended to support decision-making when referring for neuropsychological evaluations, comparing it with formal neuropsychological test performance among pediatric cancer patients (PCP) and survivors (PCS).
Methods:
The CNC3 Caregiver Report Questionnaire (CNC3-CRQ) was administered to parents of children completing comprehensive neuropsychological assessments. Results were examined in relation to the children's performance on administered neuropsychological measures to evaluate the CNC3-CRQ's effectiveness in identifying those at risk for neurocognitive impairment.
Results:
Of 64 participants, 58 (90.6%) had completed therapy and 26 (40.6%) had a history of central nervous system tumor. Formal neuropsychological testing revealed relatively high rates of both mild impairment (>1SD below the population mean) and moderate impairment (>2SD below) in 49 patients (76.6%) and 30 patients (46.9%), respectively. Youden's J analyses were conducted to determine optimal symptom-percentage cutoffs for each cognitive domain assessed by the CNC3-CRQ, relative to performance on formal neuropsychological testing. A cumulative positive screen on the CNC3-CRQ was calculated based on domain positivity, with 47 (73%) patients screening positive. The CNC3-CRQ demonstrated 83.3% sensitivity and components of domains of processing speed, memory, and visual-spatial skills were significantly associated with moderate deficits on formal neuropsychological examinations.
Conclusion:
The CNC3-CRQ is a helpful, efficient tool to identify PCP and PCS who would benefit from referral to neuropsychology services.
