OBJECTIVE: To examine executive control and self-regulation abilities in survivors of childhood acute lymphocytic leukemia (ALL).
METHODS: In this cross-sectional study, thirty-five survivors of childhood ALL from Sahukat Khanum Memorial Cancer Hospital, Children Hospital and Jinnah Hospital, Lahore, Pakistan were selected through convenient sampling technique from March 2013 to February 2014. Thirty-five demographically matched healthy children were recruited from local community as control-group. Trail Making Test (TMT) and Self-regulation Questionnaire was administered to childhood ALL survivors and healthy children by researchers.
RESULTS: Mean age of ALL survivors and healthy children was 14.25±2.71 years 14.34±2.98 years respectively. ALL group showed significant executive control deficit as compared to control group. Mean TMT-part A was 35.25±2.38 seconds and 16.14±2.80 seconds in ALL group and control group respectively (p<0.001) while mean TMT-part B was 105.62±2.38 seconds & 33.42±2.30 seconds in ALL group and control group respectively (p<0.001). In addition, both groups performed significantly different on self-regulation questionnaire. ALL group as compared to control group showed impaired emotional regulation (18.65±1.10 seconds vs. 5.57±0.85 seconds respectively; p<0.001); behavioral regulation (14.97±0.92 seconds vs. 4.68±0.75 second respectively; p<0.001); and cognitive regulation (3.57±0.85 seconds vs. 10.60±1.55 seconds respectively; p<0.001).
CONCLUSION: Survivors of childhood ALL have marked deficits in social cognition. Treatment protocols might also focus on psychosocial deterioration for better patient care.
KEY WORDS: Executive Function (MeSH); Emotion (MeSH); Trail Making Test (MeSH); Self-Regulation Questionnaire (Non-MeSH); Acute Lymphocytic Leukemia (Non-MeSH); Lymphoproliferative Disorders (MeSH); Precursor B-Cell Lymphoblastic Leukemia-Lymphoma (MeSH); Precursor T-Cell Lymphoblastic Leukemia-Lymphoma (MeSH); Pediatric Cancer (Non-MeSH); Child (MeSH)
Woodgate RL, Degner FL, Yanofsky RA. Different perspective to approaching cancer symptoms in children. J Pain Symptom Manage 2003 Sep;26(3):800-17.
Mayo Foundation for Medical Education and Research. Diseases and conditions Leukemia. USA: Mayo Clinic, 2016.
Yasmeen N, Ashraf S. Childhood Acute lymphoblastic Leukemia: Epidemiology and Clinicopathological features. J Pak Med Assoc 2009 Mar;59(3):150-3.
American Cancer Society. Survival rates for childhood Leukemia. USA: 2016.
National Cancer Institute. Childhood Acute Lymphoblastic Leukemia. 2017. USA: US Department of Health and Human Services.
Lofstad EG, Reinfjell T, Hestad K, Diseth HT. Cognitive outcome in children and adolescents treated for acute lymphoblastic leukemia with chemotherapy only. Acta Paediatr 2009 Jan;98(1):180-6. DOI: 10.1111/j.1651-2227.2008.01055.x.
Nazari S, Koupaei MTS, Shafiee A, Kashani ZHG, Bahraminia E, Ansari M, et al. Emotional/Behavioral problems in children with Acute Lymphoblastic Leukemia: a case –control study. Int J Hematol Oncol Stem Cell Res 2014;8(2):14-20.
Williams LK, Lamb KE, McCarthy MC. Behavioral side effects of pediatric acute lymphoblastic leukemia treatment: the role of parenting strategies. Pediatr Blood Cancer 2014;61(11):2065-70. DOI: 10.1002/pbc.25164.
Campbell KL, Scaduto M, Van Slyke D, Niarhos F, Whitlock AJ, Compas EB. Executive Function, Coping, and Behavior in Survivors of Childhood Acute Lymphocytic Leukemia. J Pediatr Psychol 2009;34(3):317-27. DOI: 10.1093/jpepsy/jsn080.
Li Y, Vijayanathan V, Gulinello M, Cole PD. Intrathecal methotrexate induces focal cognitive deficits and increases cerebrospinal fluid homocysteine. Pharmacol Biochem Behav 2010 Jun;95(4):428-33. DOI: 10.1016/j.pbb.2010.03.003.
Pound CM, Clark C, Ni A, Athale U, Lewis V, Halton JM. Corticosteroids, behavior, and quality of life in children treated for acute lymphoblastic leukemia; a multicentered trial. J Pediatr Hematol Oncol 2012 Oct;34(7):517-23.
Sze CI, Lin YC, Lin YJ, Hsieh TH, Kuo MY, Lin CH. The role of glucocorticoid receptors in dexamethasoneinduced apoptosis of neuroprogenitor cells in the hippocampus of rat pups. Mediators Inflamm 2013;2013:628094. DOI: 10.1155/2013/628094.
Jaggi AS, Singh N. Mechanisms in cancer chemotherapeutic drugs-induced peripheral neuropathy. Toxicology 2012 Jan 27;291(1-3):1-9. DOI: 10.1016/j.tox.2011.10.019.
Reddick WE, Shan ZY, Glass JO, Helton S, Xiong X, Wu S, et al. Smaller White-Matter Volumes Are Associated with Larger Deficits in Attention and Learning among Long-Term Survivors of Acute Lymphoblastic Leukemia. Cancer 2006 Feb;106(4):941-9.
Espy KA, Moore IMK, Kaufmann PM, Kramer JH, Matthay K, Hutter JJ. Chemotherapeutic CNS prophylaxis and neuropsychologic change in children with acute lymphoblastic leukemia: a prospective study. J Pediatr Psychol 2001 Jan-Feb;26(1):1–9.
Chan MSM, Roebuckc JD, Yuenb PM, Lib KC, Chan LY. MR Imaging of the brain in patients cured of Acute Lymphoblastic Leukemia-the value of gradient echo Imaging. Am J Neuroradiol 2006 March;27(3):548-52.
Laitt RD, Chambers EJ, Goddard PR, Pyhtinen J, Lanning MB. Magnetic resonance imaging and magnetic resonance angiography in long term survivors of acute lymphoblastic leukemia treated with cranial irradiation. Cancer 1995 Nov 15;76(10):1846–52.
Reitan RM., Wolfson D. The Halstead–Reitan Neuropsycholgical Test Battery: Therapy and clinical interpretation. Tucson, AZ: Neuropsychological Press, 1985.
Meyers CA, Albitar M, Estey E. Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome. Cancer 2005 Aug;104(4):788-93.
Meadows M-E, Chang G, Jones JA, Antin JR, Orav EJ. Predictors of Neuropsychological Change in Patients with Chronic Myelogenous Leukemia and Myelodysplastic Syndrome. Arch Clin Neuropsychol 2013;28(4):363-374. DOI:10.1093/arclin/acs141
Santos J, Pimenta CA, Kurita GP, Braga PE, Sjøgren P. Validation of the Trail Making Test B for the cognitive assessment of patients with cancer in Palliative Care. Open J Stat 2014;4:435-45. DOI: 10.4236/ojs.2014.46042.
Lesnik GP, Ciesielski TK, Hart LB, Benzel CE, Sanders AJ. Evidence for cerebellar-frontal subsystem changes in children treated with intrathecal chemotherapy for Leukemia- Enhanced data analysis using an effect size model. Arch Neurol 1998 Dec;55(12):1561-8.
Novak SP, Clayton RR. The influence of school environment and self-regulation on transitions between stages of cigarette smoking: A multilevel analysis. Healthy Psychol 2001:20(3);196-207.
Büssing A, Girke M, Heckmann C, Schad F, Ostermann T, Kröz M. Validation of the self-regulation questionnaire as a measure of health in quality of life research. Eur J Med Res 2009 May 14;14(5):223-7. DOI:10.1186/2047-783X-14-5-223.
Liu Y, Cao C. The relationship between family history of cancer, coping style and psychological distress. Pak J Med Sci 2014 May;30(3):507-10. DOI: 10.12669/pjms.303.4634.