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Screening for Neurocognitive Impairment in Pediatric Cancer Long-Term Survivors

Kevin R. Krull, M. Fatih Okcu, Brian Potter, Neelam Jain, ZoAnn Dreyer, Kala Kamdar, Pim Brouwers

From the Department of Child Psychology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Texas Children's Cancer Center, Houston, TX; and Division of AIDS and Health and Behavior Research, National Institute of Mental Health, Rockville, MD

Corresponding author: Kevin R. Krull, PhD, Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 332 N Lauderdale St, MS 735, Memphis, TN 38105-2794; e-mail: kevin.krull{at}stjude.org

Purpose Recent studies suggest that up to 40% of childhood cancer survivors may experience neurocognitive problems, a finding that has led the Children's Oncology Group to recommend regular evaluation. However, for a variety of reasons, including costs, time restraints, health insurance, and access to professional resources, these guidelines are often difficult to implement. We report reliability and validity data on a brief neurocognitive screening method that could be used to routinely screen patients in need of comprehensive follow-up.

Patients and Methods Two hundred forty consecutive patients were screened during their annual visits to a long-term survivor clinic using standard neurocognitive measures and brief parent rating. From this total, 48 patients had a second screening, and 52 patients had a comprehensive follow-up evaluation. Test-retest reliability and predictive and discriminative validity were examined.

Results Good test-retest reliability was demonstrated, with an overall r = 0.72 and all individual subtest correlations greater than r = 0.40. Although means tended to improve from first to second testing, no significant changes were detected (all P > .10). The screen accurately predicted global intellect (F_6,45 = 11.81, P < .0001), reading skills (F_6,45 = 4.74, P < .001), and mathematics (F_6,45 = 3.35, P < .008). Parent rating was a marginal indicator of global intellect only.

Conclusion The brief neurocognitive screening was a better predictor of child functioning than specific parent rating. This brief measure, which can be completed in 30 minutes, is a practical and reliable method to identify cancer survivors in need of further neurocognitive follow-up.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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