[MP3 audio] Alicia Kunin-Batson, Ph.D., describes what is involved in a neuropsychological assessment for childhood cancer survivors.

Some childhood cancer survivors who received radiation therapy to the head or certain types of chemotherapy or steroids as part of their treatment may be at risk for "neurocognitive" late effects.

Neurocognitive late effects can include trouble thinking, learning, problem solving, remembering, paying attention, and concentrating, says Alicia Kunin-Batson, Ph.D., a pediatric neuropsychologist associated with the Long-Term Follow-Up Clinic. Survivors also may have a hard time processing and organizing information, which can affect all areas of academic functioning, she says.

Cranial radiation, certain chemotherapy drugs (such as methotrexate), and steroids (specifically dexamethasone) have been linked to neurocognitive late effects in childhood cancer survivors.

The child's age at the time of treatment is also a major factor. Because the brain—like the rest of the body—continues to develop and grow during childhood, the age at which it is exposed to the intense cancer-killing therapies can have a large impact on how the brain's functioning is altered by the treatment. Treatments can derail a child's neurocognitive development, and the survivor's brain can continue to develop at a slower rate than it normally would, Kunin-Batson says. Therefore, survivors who were treated when they were very young generally experience greater neurocognitive difficulties than those who were treated when they were older.

Academic areas such as math and reading may be affected by childhood cancer treatment. Survivors may have difficulty with math calculation skills and memorizing math facts such as multiplication tables. Reading difficulties tend to involve comprehension.

For some, learning difficulties brought on by cancer treatment can be very subtle, Kunin-Batson says. A person's treatment might have affected such neurocognitive skills as planning, organizing, and thinking abstractly—which typically develop in the teenage years—but the survivor might not notice a difference until high school or college when demands change.

A neuropsychologist who understands the effects of cancer treatment on brain development can help survivors transition back into school and into the next phases of their education. A neuropsychologist can evaluate a child's strengths and weaknesses through a series of game-like tasks and activities and help determine whether the child is eligible for special accommodations such as extra time for tests through a 504 Plan under the Rehabilitation Act or an individualized education plan through the Individuals with Disabilities Education Act.

For more information about neurocognitive late effects, see the Children's Oncology Group's summary on "Educational Issues Following Treatment for Childhood Cancer" (PDF).

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The Growing Up After Cancer section of the Masonic Cancer Center Web site was produced by University of Minnesota School of Journalism and Mass Communication graduate student Nicole Endres. The section's medical content was written under the advisement of Masonic Cancer Center member Joseph Neglia, M.D., M.P.H.