Cancer Control Research
5R01CA078957-05
Mulhern, Raymond K.
LEARNING IMPAIRMENTS AMONG SURVIVORS OF CHILDHOOD CANCER
Abstract
DESCRIPTION (adapted from investigator's abstract): Children surviving some
types of cancer, particularly acute lymphoblastic leukemia (ALL) and brain
tumors, have an increased incidence of learning impairments compared to their
healthy peers in the general population. These impairments, for which there is
no known effective treatment, are of sufficient severity to inhibit normal
academic achievement, vocational attainment, and quality of life. Previous
investigations have suggested a model in which treatment-induced lesions of the
brain, especially in the white matter, are an underlying cause of learning
difficulties that are frequently manifested as deficits in the ability to
sustain attention. The goal of this research proposal is to test the validity
of this model by defining the neuroanatomic substrates of problems with
attention and learning and by assessing the behavioral response of these
problems to pharmacological intervention. To accomplish this goal, quantitative
magnetic resonance imaging (qMRI) of the brain and neuropsychological testing
will be conducted on 625 participating children treated for ALL or malignant
brain tumors at 3 pediatric cancer centers. It is hypothesized that volumes of
normal white matter in patients will be: a) significantly reduced compared to
healthy peers, b) directly associated with the intensity of their central
nervous system treatment, and c) positively correlated with their performance
on measures of sustained attention and learning. A second study hypothesis is
that methylphenidate will be effective in reducing their problems with
attention and learning. This hypothesis will be tested with 200 children
selected from the larger screened sample on the basis of objective problems
with sustained attention and learning with regard to: (a) immediate (1-1/2 hr)
behavioral benefits in our laboratory and (b) short-term (3 week) benefits at
home and school in randomized, placebo-controlled, crossover designs, and then
(c) long-term (12 month) maintenance benefits at home and school. The results
of these studies will have a potentially important impact on childhood cancer
by reducing the cognitive morbidities of cancer and cancer treatment and by
furthering our knowledge of their biological basis.
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