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Late effects: cognitive changes that can result from cancer treatment

Interviews with families and patients show that the diagnosis and treatment of cancer is stressful and exhausting, and it feels as if a child survives the surgery, radiotherapy, chemotherapy and other issues and complications faced undoubtedly been sufficiently addressed. Unfortunately, survivors of childhood brain tumors often develop problems after the first battle is won in the areas of intellectual ability, academic performance, memory and attention. Cognitive changes are common among survivors of brain tumors, however, to the extent that any change will be effective depends on many different factors, including the location of the tumor and surgery, age at diagnosis and radiation therapy.

Neurological problems such as convulsions and muscle coordination problems are relatively common in survivors of childhood brain tumors. This type of disability often develop around the time of diagnosis or after initial surgery, but sometimes for the first time can appear months or years after diagnosis. Radiation injuries to the brain can, in rare cases cause a delay in neurological problems that can take 10 years or more after treatment.

Neurosensory problems such as blurred vision and hearing can also be developed, both early diagnosis and treatment, and years after treatment ends. Radiation therapy can cause visual problems delayed by different mechanisms. Direct damage to the nerves of the eyes (optic nerves), can rarely lead to changes in vision years after treatment. In rare cases, radiation can cause cataracts earlier in the eye that can interfere with normal vision. If your child has had surgery near the eye or the nerves of the eyes or has received radiation to the head, regular visits to an ophthalmologist (eye doctor) are highly recommended. Hearing problems are common after treatment for brain tumors and, in general, remain stable or even decreasing in intensity with time. In certain circumstances, however, hearing problems has been shown to worsen or appear for the first time in years, months after the end of treatment. Children who are treated with the combination of cisplatin, the drug and radiation of the brain appear to be at greater risk of developing hearing problems delayed. Regular hearing tests should be performed for all children at risk of hearing problems and for any child who is having academic difficulties or learning disabilities.

Learning problems are especially common among survivors of a brain tumor and it is difficult and frustrating. Many children with learning disabilities need special education services in school. On the other hand, one can observe a decline in performance over time, especially in children who were treated with radiation to the brain at an early age. Like any other problem area, early detection of a problem is the best way to fight it, and this assessment is best performed by working closely with a pediatric neuropsychologist who has experience working with children with brain tumors. Because symptoms can develop over time, it is extremely important to periodically re-evaluate cognitive functioning in all the survivors who are at high risk, as well as survivors who experience academic difficulties. This is done by administering a battery of tests known as psychometric or neuropsychological tests.

Most major medical centers have trained staff neuropsychologists, as well as many schools can administer these tests. It is essential when you test with a detailed history of prior treatment for their child. This should include the correct diagnosis and the date of diagnosis, names, terms and total dose of all chemotherapy drugs, doses and sites of all prior radiotherapy, the sites of all surgeries, and starting and quitting dates for each treatment. This information can be obtained from the monitoring of cancer treatment equipment for your child. At the end of treatment is a good idea to ask the neuro-oncology team to discuss your child with you the treatment your child received and the final effects that may occur as a result of these therapies. In your case, it may be time to start making arrangements for the treatment of specific follow-up with specialists (eg, a neuropsychologist or a pediatric endocrinologist), in preparation for monitoring child care at the end of planned therapy, helps ensure a smooth transition from one treatment to life after treatment.

“We created a medical information form to be given to all new medical professionals to contact you. It was very helpful that we had our work, even after completion of treatment for years, is a quick and easy to count. ”
-The parents of a brain tumor Survivor

If problems are identified, then the school must provide your child with appropriate services. Although it is now required by federal law, you and members of the medical team has to defend his son to get all the services he or she is entitled.

Late effects are the new problems that can occur months or years after treatment ends. Whether or not a child develops a delayed effect depends on a number of factors. The most important of these factors include the type and amount of treatment received by an individual (eg, radiotherapy, chemotherapy-specific) and ages of children at time of treatment. Other factors include the type of tumor and its location in the brain. In general, children who are treated at an early age (under 7 years) and those receiving more intensive therapy (eg, high doses of radiation in combination with high-dose chemotherapy plus) are more likely to develop late effects .

However, it is important to remember that each person is unique and no two people react the same way that a certain treatment. Equally important is to be at risk for a given problem does not necessarily mean a child will develop the problem. Obviously, the details of cancer treatment your child is essential and will help your child care providers of health, both present and future, to determine the delayed effects of your child may develop over time. Knowledge is power and can help combat the cognitive problems that may arise.

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