Disclosures: Sussman reports no relevant financial disclosures. So-called “chemo brain” is a functionally limiting and frustrating consequence of curative treatment for cancer.
For some children, chemotherapy may disrupt essential cognitive functions such as sensory processing, memory and attention.
“Children’s brains are undergoing rapid changes in structural and neurological development. The formation and refinement of neural networks occurs during early childhood and continues through to early adulthood,” Elyse S. Sussman, PhD, professor in the Dominick P. Purpura department of neuroscience and of
otorhinolaryngology — head and neck surgery at Albert Einstein College of Medicine, said in an interview with Healio. “These developmental changes provide the foundation for complex cognitive processing, memory, attention and decision-making. Neurotoxic substances may alter the way brain growth occurs and may interrupt certain essential processes.”
Sussman, along with a team of researchers at Children’s Hospital at Montefiore (CHAM) and Rutgers Cancer Institute of New Jersey, have been awarded a 5-year, $4.6 million grant from the NIH to evaluate the effects of chemotherapy on the brains of children treated for acute lymphoblastic leukemia. The researchers aim to develop interventions that improve cognitive functioning in these children.
Sussman spoke with Healio about the cognitive measures to be used in the study, the tasks and skills that may be impacted by neurotoxic treatment, and potential ways to identify children at increased risk for long-term damage.
Question: What are the goals of your study?
Answer: This study has two main goals. One is to understand the scope of the problem. Not much is known about how these effects occur or why they occur. The first step is to identify which cognitive systems are affected by treatment. Are these children having trouble with sensory input that is coming into the ears? Is there a
problem with working memory, or with the different forms of attention and executive functions, like multitasking, set switching or planning? We’re going to compare the results of our survivor population with healthy controls who are matched by age and sex.
The other big goal here is the longitudinal component. We will take these measures at baseline and then 1 year later to determine if the normal rate of brain development is disrupted in survivors, contrasting the trajectory of growth in the survivors to our matched healthy controls.
Q: How does “chemo brain” usually present in children?
A: Both adults and children often report that it feels like their brain is in a fog. They have thinking and memory problems, and difficulty concentrating. They might have trouble finding the right words or learning new skills. Multitasking is often a problem, as is paying attention and staying on task. Adults may have difficulty going back to work and performing the same tasks they did before their cancer diagnosis. With children, the difficulties mainly affect their performance at school and may have cascading effects on their growth and development. So, at any age, it affects the overall quality of life. A major goal of this project is to better target what system of cognition is being affected so we can better specify techniques for treatment that will minimize these effects.
Q: How do you hope to identify children at increased risk of “chemo brain?”
A: We designed our study to address a big question: Who is most vulnerable to treatment? Somewhere in the realm of 70% of children report these cognitive difficulties. We will look at whether cognitive difficulties differ as a function of age or sex. We want to know if younger children are more vulnerable to neurotoxic drugs than older children and if boys are more vulnerable than girls.
Q: Why do you think this was prioritized by the NIH for this grant?
A: Not enough is known about “chemo brain,” and it is a problem across all types of cancers and all age groups. Children are having difficulty in school, which might result in an inability to get the jobs they might have gotten otherwise. There can be all kinds of quality-of-life issues, as well. This can lead to low self-esteem and other problems — especially for young children, who are just beginning to learn who they are in the world. It is important to use this opportunity to learn how to improve quality of life and help these patients live full lives.
Q: Is there anything else you think is important to add to this discussion?
A: A big goal for us is to understand the source of the cognitive difficulties. We also want to be able to guide clinical trials that could find preventive treatments that may be administered concurrently with chemotherapy. We have discussed potential targets for clinical trials, but we must confirm whether these would be valuable avenues. Also, if we can identify the specific cognitive systems that are affected, such as sensory processes, memory and attention, we can develop better targeted interventional strategies.
Elyse S. Sussman, PhD, can be reached at Albert Einstein College of Medicine, Rose F. Kennedy Center, 1410 Pelham Parkway South, Room 210, Bronx, NY 10461.