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Special Contribution
August 2007

Guidelines for Identification of, Advocacy for, and Intervention in Neurocognitive Problems in Survivors of Childhood Cancer: A Report From the Children's Oncology Group

Author Affiliations

Author Affiliations: Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada (Dr Nathan); Division of Pediatrics, City of Hope National Medical Center, Duarte, California (Dr Patel); Division of Pediatric Hematology-Oncology, University of California–San Francisco School of Medicine (Dr Goldsby); Departments of Pediatric Oncology, Washington University Medical Center, St Louis, Missouri (Ms Harvey), and Rainbow Babies and Children's Hospital, Cleveland, Ohio (Dr Jacobsen); Departments of Pediatrics, Feinberg School of Medicine, Children's Memorial Hospital, Chicago, Illinois (Dr Dilley); Yale University of Medicine, New Haven, Connecticut (Dr Kadan-Lottick), Children's Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Okcu), and University of Miami Miller School of Medicine, Miami, Florida (Dr Armstrong); Children's Cancer and Blood Disorders Center, Children's Hospital of the King's Daughters, Norfolk, Virginia (Dr McKinley); Letizia, Ambrose & Falls, PC, New Haven, (Ms Millham); College of Nursing, University of Arizona Health Sciences Center, Tucson (Dr Moore); Departments of Psychiatry and Family Medicine, University of Iowa Hospitals and Clinics, Iowa City (Dr Woodman); and Division of AIDS and Health and Behavior Research, National Institute of Mental Health, National Institutes of Health, Rockville, Maryland (Dr Brouwers). Group Information: A list of members of the Children's Oncology Group Long-term Follow-up Guidelines Task Force on Neurocognitive/Behavioral Complications After Childhood Cancer appears on page 17 of the document at http://www.survivorshipguidelines.org/pdf/LTFUGuidelines.pdf.

Arch Pediatr Adolesc Med. 2007;161(8):798-806. doi:10.1001/archpedi.161.8.798

With modern therapies and supportive care, survival of childhood cancer has increased considerably. Patients who have survived cancers involving the central nervous system or who have received therapy toxic to the developing brain are at risk of long-term neurocognitive sequelae. Negative outcomes are observed most frequently in survivors of acute lymphoblastic leukemia and brain tumors. The Children's Oncology Group Long-term Follow-up Guidelines Task Force on Neurocognitive/Behavioral Complications After Childhood Cancer has generated risk-based, exposure-related guidelines designed to direct the follow-up care of survivors of pediatric malignancies based on a comprehensive literature review and expert opinion. This article expands on these guidelines by reviewing the risk factors for the development of neurocognitive sequelae and describing the expected pattern of these disabilities. We herein present recommendations for the screening and management of neurocognitive late effects and outline important areas of school and legal advocacy for survivors with disabilities. Finally, we list resources that can guide patients, their parents, and their medical caregivers as they face the long-term neurocognitive consequences of cancer therapy.