TABLE 5.
Intervention Studies
Reference | Study Design | Population, N | Intervention | Domain(s) Assessed | Outcome | Limitations |
---|---|---|---|---|---|---|
Butler et al. (2008) | Randomized (2:1); Tested before, after, and 6 mo. post; Wait-list control group | 161 childhood cancer survivors that had CNS treatment | 20 2-hour sessions over 4–5 mo focused on cognitive training | 5 indices: Academics, brief attention, WM, memory, vigilance | Improvements found in academics & parent report attention after intervention compared to control group. | Moderate compliance; No long-term follow-up; Wide variation in cancer diagnoses and treatment types. |
Conklin et al. (2007) | Double-blind, crossover in clinic testing sessions; Subjects served as own controls | 122 survivors of BT or ALL with attention problems | Received either MPH (60 mg) or placebo before testing | NP battery, focused on attention, and processing speed | Improvements in selective attention, impulsivity, cognitive flexibility, and processing speed, but not sustained attention. | Combined ALL and BT groups; Heterogeneous treatment types. |
Conklin et al. (2010) | 12-month, open-label MPH trial. If participants declined medication or were not classified as responders, they were in control group | 122 survivors of BT or ALL (control group = 58) with attention problems. | After 3-week trial, those who responded well to MPH continued taking it for 12 mo. Pre- and post-NP testing occurred. | IQ, achievement, attention, and behavior indices | Improvements in attention through objective, parent-report, teacher-report, and self-report measures, as well as parent-report social skills and behavior problems. | Groups not randomized; MPH group biased towards those who responded to MPH initially; Heterogenous treatment types; Combined BT and ALL participants for analyses. |
Hardy et al. (2011) | Tested at baseline, post-intervention, and three months post intervention | Nine survivors of childhood cancer, including six PF tumor survivors | Computerized, home-based, 12-week cognitive training intervention | Attention, working memory | Working memory and parent-reported attention scores improved from baseline to post-assessment | Combined ALL and BT groups; Small sample size; Variable compliance. |
Jain et al. (2008) | Cross-sectional data comparing standard CRT with IMRT; Standard treatment control group | 25 survivors of medulloblastoma | Treated with either standard CRT or IMRT, and were evaluated afterwards | IQ, visuomotor, and processing speed indices. | No differences between IMRT and standard CRT group on any NP variables; both groups performed below norms on processing speed. | Small sample size; Not randomized into groups; No long-term follow-up. |
Mulhern et al. (2004b) | Randomized, 3-week, double-blind, crossover study; Subjects were own controls | 83 long-term survivors of childhood ALL (n = 40) or BT (n = 43) | Received low-dose MPH, moderate-dose MPH, and placebo for one week each | Social skills and attention (both teacher & parent report) | Significant improvement with MPH compared to placebo; no effect for high-dose over low-dose MPH. | Combined ALL and BT groups; No long-term follow-up; Wide range of ages at treatment. |
Patel et al. (2009) | Pre/post testing, intervention in between; No control group | 12 survivors of childhood cancer w/CNS involvement (9-CNS tumors) | 15 sessions focused on learning strategies and problem solving | IQ, attention, memory, academics, social skills, and behavior indices | Gains were seen in all attention scores, though none statistically significant | Small sample size; No control group; Wide range of ages and diagnoses; Moderate compliance. |
Thompson et al. (2001) | Baseline testing, then repeat next day after receiving MPH or placebo; Used placebo control group | 32 survivors of childhood ALL (n = 7) or BT (n = 25) | Baseline NP testing; then randomly assigned to MPH or placebo, did NP tests again. | Baseline: IQ, achievement, attention, and memory. MPH/Placebo: Attention, and memory | Improvements for MPH over placebo noted in overall attention and omission indices. | Small sample size; Combined ALL and BT groups; No long-term follow-up. |
Note. Mo = months; CNS = central nervous system; BT = brain tumor; ALL = acute lymphoblastic leukemia; MPH = methylphenidate; NP = neuropsychological; IMRT = intensity-modulated radiation therapy; and CRT = cranial radiation therapy.