BACKGROUND: Survivors of childhood CNS tumors are at a significant risk of chronic and multifaceted neurocognitive late effects. Recent findings indicate the potential utility of methylphenidate in addressing neurocognitive and academic plateauing and improving quality-of-life outcomes in this clinical population. However, the prescription of methylphenidate in neuro-oncology services remains inconsistent. OBJECTIVE: To explore the neurocognitive assessment and rehabilitative interventions (including the use of methylphenidate) offered to survivors of childhood CNS tumors within mainland UK. METHOD: We used a semi-structured questionnaire to gather qualitative data from clinical psychologists and neuropsychologists within National Health Service pediatric neuro-oncology principal treatment centers (PTCs) during May 2018. Thematic analytical methods were used to explore themes within the collected data. RESULTS: Eleven (58%) of the 19 PTCs returned the completed questionnaire. Respondents reported inadequate resource of psychology in many pediatric neuro-oncology PTCs, which limited the provision of methylphenidate to a restricted proportion of the patient group (i.e., those with the most profound neurocognitive difficulties). Respondents reported an interest in exploring the utility of methylphenidate in their patient group yet described a lack of appropriate evidence of its efficacy. In addition, respondents highlighted the need for the provision of accessible research summaries and treatment protocols addressing the use of methylphenidate. CONCLUSION: We anticipate that national collaboration between clinicians and researchers working in the cancer survivorship field will support the advancement of interventions such as methylphenidate for the growing clinical population of survivors of childhood CNS tumors.
References
Amidei C, Kushner DS. 2015. Clinical implications of motor deficits related to brain tumors. Neurooncol Pract. 2:179���184. doi:10.1093/nop/npv017
[DOI: 10.1093/nop/npv017]
Braun V, Clarke V. 2006. Using thematic analysis in psychology. Qual Res Psychol. 3:77���101. doi:10.1191/1478088706qp063oa
[DOI: 10.1191/1478088706qp063oa]
Bri��re ME, Scott JG, McNall-Knapp RY, et al. 2008. Cognitive outcome in pediatric brain tumor survivors: delayed attention deficit at long-term follow-up. Pediatr Blood Cancer. 50:337���340. doi:10.1002/pbc.21223
[DOI: 10.1002/pbc.21223]
Conklin HM, Khan RB, Reddick WE, et al. 2007. Acute neurocognitive response to methylphenidate among survivors of childhood cancer: a randomized, double-blind, cross-over trial. J Pediatr Psychol. 32:1127���1139. doi:10.1093/jpepsy/jsm045
[DOI: 10.1093/jpepsy/jsm045]
Conklin HM, Lawford J, Jasper BW, et al. 2009. Side effects of methylphenidate in childhood cancer survivors: a randomized placebo-controlled trial. Pediatrics. 124:226���233. doi:10.1542/peds.2008-1855
[DOI: 10.1542/peds.2008-1855]
Conklin HM, Reddick WE, Ashford J, et al. 2010. Long-term efficacy of methylphenidate in enhancing attention regulation, social skills, and academic abilities of childhood cancer survivors. J Clin Oncol. 28:4465���4472. doi:10.1200/JCO.2010.28.4026
[DOI: 10.1200/JCO.2010.28.4026]
Conners CK, Pitkanen J, Rzepa SR Kreutzer JS, DeLuca J, Caplan B. 2011. Conners 3rd Edition (Conners 3; Conners 2008). Encyclopedia of Clinical Neuropsychology. New York: Springer, New York; 675���678. doi:10.1007/978-0-387-79948-3_1534
de Ruiter MA, van Mourik R, Schouten-van Meeteren AYN, et al. 2013. Neurocognitive consequences of a paediatric brain tumour and its treatment: a meta-analysis. Dev Med Child Neurol. 55:408���417. doi:10.1111/dmcn.12020
[DOI: 10.1111/dmcn.12020]
Delis DC, Kaplan E, Kramer JH. 2001. Delis-Kaplan Executive Function System. San Antonio, Texas: Psychological 10.1037/t15082-000
Emond A, Edwards L, Peacock S, et al. 2016. Social competence in children and young people treated for a brain tumour. Support Care Cancer. 24:4587���4595. doi:10.1007/s00520-016-3301-4
[DOI: 10.1007/s00520-016-3301-4]
Hagan AJ, Verity SJ. 2023. The influence of methylphenidate on sustained attention in paediatric acquired brain injury: a meta-analytical review. Child Neuropsychol. 29:710���741. doi:10.1080/09297049.2022.2112559
[DOI: 10.1080/09297049.2022.2112559]
Hardy KK, Bonner MJ, Willard VW, et al. 2008. Hydrocephalus as a possible additional contributor to cognitive outcome in survivors of pediatric medulloblastoma. Psychooncology. 17:1157���1161. doi:10.1002/pon.1349
[DOI: 10.1002/pon.1349]
Korkman M, Kirk U, Kemp S. 2007. NEPSY���Second Edition (NEPSY���II). San Antonio, Texas: Harcourt Assessment. doi:10.1037/t15125-000
Mabbott DJ, Spiegler BJ, Greenberg ML, et al. 2005. Serial evaluation of academic and behavioral outcome after treatment with cranial radiation in childhood. J Clin Oncol. 23:2256���2263. doi:10.1200/JCO.2005.01.158
[DOI: 10.1200/JCO.2005.01.158]
Manly T, Robertson IH, Anderson V, et al. 1999. TEA-Ch: The Test of Everyday Attention for Children Manual. Bury St. Edmunds, UK: Thames Valley Test.
Mulhern RK, Butler RW. 2004. Neurocognitive sequelae of childhood cancers and their treatment. Pediatr Rehabil. 7:1���14. doi:10.1080/13638490310001655528
[DOI: 10.1080/13638490310001655528]
Musiol K, Bulska W, Bro��ek P, et al. 2019. Quality of life in survivors of childhood brain tumour and the association of children���s diseases on quality of their parents life. Psychooncology. 28:1088���1095. doi:10.1002/pon.5061
[DOI: 10.1002/pon.5061]
National Institute for Health and Care Excellence National Institute for Health and Care Excellence. 2019. Attention deficit hyperactivity disorder: diagnosis and management. National Institute for Health and Care Excellence Clinical Guidelines. London, England: National Institute for Health and Care Excellence.
Nicholls E, Hildenbrand AK, Aggarwal R, et al. 2012. The use of stimulant medication to treat neurocognitive deficits in patients with pediatric cancer, traumatic brain injury, and sickle cell disease: a review. Postgrad Med. 124:78���90. doi:10.3810/pgm.2012.09.2596
[DOI: 10.3810/pgm.2012.09.2596]
Palmer SL. 2008. Neurodevelopmental impact on children treated for medulloblastoma: a review and proposed conceptual model. Dev Disabil Res Rev. 14:203���210. doi:10.1002/ddrr.32
[DOI: 10.1002/ddrr.32]
Public Health England. 2018. Childhood Cancer Statistics, England Annual Report, 2018. London, England: PHE.
Radcliffe J, Bunin GR, Sutton LN, et al. 1994. Cognitive deficits in long-term survivors of childhood medulloblastoma and other noncortical tumors: age-dependent effects of whole brain radiation. Int J Dev Neurosci. 12:327���334. doi:10.1016/0736-5748(94)90081-7
[DOI: 10.1016/0736-5748(94)90081-7]
Schreiber JE, Gurney JG, Palmer SL, et al. 2014. Examination of risk factors for intellectual and academic outcomes following treatment for pediatric medulloblastoma. Neuro Oncol. 16:1129���1136. doi:10.1093/neuonc/nou006
[DOI: 10.1093/neuonc/nou006]
Shortman RI, Lowis SP, Penn A, et al. 2014. Cognitive function in children with brain tumors in the first year after diagnosis compared to healthy matched controls. Pediatr Blood Cancer. 61:464���472. doi:10.1002/pbc.24746
[DOI: 10.1002/pbc.24746]
Verity SJ, Halliday G, Hill RM, et al. 2022. Methylphenidate improves cognitive function and health-related quality of life in survivors of childhood brain tumours. Neuropsychol Rehabil. 2022:1���21. doi:10.1080/09602011.2022.2157446
[DOI: 10.1080/09602011.2022.2157446]
Voon NS, Manan HA, Yahya N. 2022. Diffusion tensor imaging indices as biomarkers for cognitive changes following paediatric radiotherapy: a systematic review and meta-analysis. Strahlenther Onkol. 198:409���426. doi:10.1007/s00066-022-01905-6
[DOI: 10.1007/s00066-022-01905-6]
Wagner AP, Carroll C, White SR, et al. 2020. Long-term cognitive outcome in adult survivors of an early childhood posterior fossa brain tumour. Int J Clin Oncol. 25:1763���1773. doi:10.1007/s10147-020-01725-7
[DOI: 10.1007/s10147-020-01725-7]
Wechsler D. 2012. Wechsler Intelligence Scale for Children-Fifth Edition. San Antonio, Texas: Pearson Education.
Wechsler D. 2014. WISC���V: Technical and Interpretive Manual. Bloomington, MN: Pearson.
Yahya N, Manan HA. 2021. Neurocognitive impairment following proton therapy for paediatric brain tumour: a systematic review of post-therapy assessments. Support Care Cancer. 29:3035���3047. doi:10.1007/s00520-020-05808-z
[DOI: 10.1007/s00520-020-05808-z]
