Attention, Thinking, or Memory Problems in Childhood Cancer

chemo brain

Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Cognitive problems, also known as cognitive dysfunction or “chemo brain,” occur when one has trouble processing information, which includes mental tasks related to attention span, thinking, and short-term memory.

Up to 75% of individuals with cancer experience cognitive problems during treatment, and up to 35% have issues that continue for months after treatment has finished.

Young children (age 5 and younger) are more likely to have long-term cognitive problems, especially those who receive radiation therapy that is directed at the head, neck, or spinal cord; total body radiation; and/or chemotherapy delivered directly into the spine (intrathecal chemotherapy) or the brain (intraventricular chemotherapy). These cognitive problems can occur months or years after treatment ends and can continue into adulthood.

These difficulties generally vary in severity and often make it difficult to accomplish daily activities. If your child is experiencing serious cognitive problems, it is important that you discuss this with their doctor or a member of their health care team regarding ways to manage these issues.

 

Signs and Symptoms

Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.

Cognitive problems include difficulties in many areas, including:

  • Behavioural and emotional changes, such as irrational behaviour, inappropriate anger or crying, mood swings, and socially inappropriate behaviour
  • Decreased attention span and attention deficit disorders
  • Decreased nonverbal and verbal memory skills
  • Decreased overall intelligence (lower IQ)
  • Decreased receptive language skills (the ability to understand or comprehend language) and expressive language skills (the ability to put thoughts together in a way that makes sense)
  • Delayed development, including delayed social, emotional, and behavioural development
  • Difficulties with judgment and reasoning
  • Difficulty with spatial orientation
  • Learning disabilities
  • Lower academic achievement (especially in reading, language, and mathematics)
  • Memory loss or difficulty remembering things (especially details like names, dates, or phone numbers)
  • Mental “fog” or disorientation
  • Problems performing multiple tasks (multitasking)
  • Problems with comprehension or understanding
  • Processing information slower
  • Severe confusion (delirium)
  • Trouble concentrating, focusing, or paying attention (short attention span)

The severity of symptoms will generally depend on the child’s age, coping abilities, history of depression or anxiety, stress level, and access to emotional and psychological resources.

 

Causes

Although many cancer survivors use the term “chemo brain” to describe difficulty thinking clearly after their cancer treatment, those who do not have chemotherapy report similar symptoms.

This phenomenon was very interesting to the medical community, and ongoing research into the wide range of cognitive problems experienced by people with cancer has shown that although it is know that these symptoms can be caused by chemotherapy, they can also be as a result of a number of other factors, including:

  • Brain cancer
  • Brain surgery, during  which areas of the brain may be damaged or disrupted during a biopsy or the removal of a cancerous tumour
  • Emotional responses, such as anxiety, depression or stress
  • Hormone therapy, immunotherapy, and other medications such as antibiotics, anti-nausea medications, pain medications, antidepressants, anti-anxiety medications, heart medications, immunosuppressants, and medications to treat sleep disorders.
  • Infections, especially those of the central nervous system (brain and spinal cord), and infections that cause a high fever
  • An insufficiency of specific vitamins and minerals such as folic acid, iron, or vitamin B
  • Other brain or nervous system disorders unrelated to cancer
  • Other cancers that have metastasised (spread) to the brain
  • Other conditions or symptoms related to cancer or cancer treatments, including anaemia, fatigue, hypercalcaemia (high blood calcium), and electrolyte (a mineral in your body, such as potassium and sodium) imbalances that can lead to dehydration or organ failure, and sleep problems.
  • Radiation treatment to the head and neck, or total body irradiation

 

Management/Treatment

Cognitive problems caused by reversible conditions such as anaemia or an electrolyte imbalance normally resolve once the condition is treated. Cognitive problems caused by medications should also be resolved once the medication is stopped. Cognitive problems related to brain cancer usually improve with treatment, but some symptoms may continue.

Unfortunately, cognitive problems related to chemotherapy (“chemo brain”), radiation therapy, or other cancer treatments may continue indefinitely. Management of these long-term cognitive problems may include:

  • Cognitive rehabilitation (also known as neuropsychological rehabilitation) and cognitive training, may help your child improve their cognitive skills and find ways to cope with cognitive problems
  • Your child may receive occupational therapy, speech therapy, behaviour therapy, social skills training, cognitive rehabilitation, and/or medications (such as methylphenidate for attention deficit disorders) to help treat cognitive problems.
  • Your child having to take medication such as cognition-enhancing drugs commonly used to treat Alzheimer’s disease, antidepressants, stimulants, or opiate antagonists (drugs that block the actions of narcotics, such as morphine)

Some children may need to learn new ways of learning in school or maintaining attention. Additional in-school options such as specialised reading and mathematics instruction, special education programs, and IEPs (individualised education programs) would also benefit your child and are recommended if available.

Early intervention offers the most benefit, so it is important for you to be aware of possible cognitive problems and to talk with your child’s paediatrician, oncologist, or another member of their health care team as soon as you suspect a problem.

 

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