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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 409-410

Addressing neuropsychological issues in cancer survivors: A step beyond treatment, the need of the hour


Sir HN Reliance Hospital and Research Centre, Mumbai, Maharashtra, India

Date of Submission18-Apr-2021
Date of Decision20-Apr-2021
Date of Acceptance01-May-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Shweta Bansal
Sir HN Reliance Hospital and Research Centre, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_80_21

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How to cite this article:
Bansal S. Addressing neuropsychological issues in cancer survivors: A step beyond treatment, the need of the hour. Cancer Res Stat Treat 2021;4:409-10

How to cite this URL:
Bansal S. Addressing neuropsychological issues in cancer survivors: A step beyond treatment, the need of the hour. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Sep 25];4:409-10. Available from: https://www.crstonline.com/text.asp?2021/4/2/409/320251



Over the years, childhood acute lymphoblastic leukemia (ALL) has become a highly curable disease, and the population of survivors is steadily increasing.[1],[2] However, with increased survival, the long-term side effects are also becoming increasingly obvious, including impaired neuropsychological and neurocognitive functioning.

We read with interest the article by Abraham et al.[3] titled, “Neuropsychological functioning in long term survivors of pediatric acute lymphoblastic leukemia: A prospective cross-sectional study,” and the accompanying editorial by Datta and Mukherjee[4] In this study, the authors meticulously studied the patient population and provided important information on the various aspects of neuropsychological issues among the survivors. The study population had received around 18 Gy radiation as central nervous system (CNS) prophylaxis therapy.[3]

The study has certain limitations, including the small sample size and the absence of a control group, which could have helped in eliminating the various confounding factors. The authors included intelligence and verbal intelligence quotient scales, but academic performance scales, which could have given important information regarding the performance ability of the survivors, were not included. Moreover, in the “Discussion” section, the authors compared the verbal memory results of adult survivors in their cohort with those of other studies where no cranial radiation was used.[3],[5] The contrast in the visuoconstructive and visuomotor abilities between adult and adolescent survivors is surprising; the authors reported that adult survivors had more deficits than adolescent survivors. Other published studies, however, have shown significant visuomotor impairment in children treated with whole-brain radiation therapy.[6],[7] These discrepancies could either be due to the small sample size of Abraham et al.'s study or may be due to ethnic differences between the study populations. Therefore, further studies with a larger sample size and appropriate controls will definitely help validate these interesting findings.

Despite the mentioned limitations, the study has many merits. This study on the psychological functioning of ALL survivors in India was detailed and the first of its kind. A noteworthy finding from this study was that the lower the age at diagnosis, the greater was the impact on neuropsychological functioning of patients receiving cranial radiation therapy. The study also suggested that patients who survive for longer periods have improved verbal working memory, suggesting a role of interventional studies among survivors. Longitudinal studies in a larger population will help in better understanding these results and refining the CNS prophylactic therapies pertaining to age as well. Abraham et al.'s study definitely sets a precedent and will help guide other future studies from India in this area.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pandey A, Ahlawat S, Singh A, Singh S, Murari K, Aryan R. Outcomes and impact of minimal residual disease (MRD) in pediatric, adolescent and young adults (AYA) with acute lymphoblastic leukemia treated with modified MCP 841 protocol. Cancer Res Stat Treat 2020;3:183-91.  Back to cited text no. 1
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2.
Nayak L. Optimizing acute leukemia treatment in resource-constrained settings. Cancer Res Stat Treat 2020;3:287-9.  Back to cited text no. 2
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3.
Abraham J, Veeraiah S, Radhakrishnan V. Neuropsychological functioning in long term survivors of pediatric acute lymphoblastic leukemia: A prospective cross – Sectional study. Cancer Res Stat Treat 2021;4:19-28.  Back to cited text no. 3
  [Full text]  
4.
Datta SS, Mukherjee A. “My cancer is cured, but I do not feel normal”: A commentary on neuropsychological outcomes of pediatric acute lymphocytic leukemia in India. Cancer Res Stat Treat 2021;4:119-20.  Back to cited text no. 4
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5.
Conklin HM, Krull KR, Reddick WE, Pei D, Cheng C, Pui CH. Cognitive outcomes following contemporary treatment without cranial irradiation for childhood acute lymphoblastic leukemia. J Natl Cancer Inst 2012;104:1386-95.  Back to cited text no. 5
    
6.
Annett RD, Hile S, Bedrick E, Kunin-Batson AS, Krull KR, Embry L, et al. Neuropsychological functioning of children treated for acute lymphoblastic leukemia: Impact of whole brain radiation therapy. Psychooncology 2015;24:181-9.  Back to cited text no. 6
    
7.
Jankovic M, Brouwers P, Valsecchi MG, van Veldhuizen A, Huisman J, Kamphuis R, et al. Association of 1800 cGy cranial irradiation with intellectual function in children with acute lymphoblastic leukaemia. ISPACC. International Study Group on Psychosocial Aspects of Childhood Cancer. Lancet 1994;344:224-7.  Back to cited text no. 7
    




 

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