Table 2.
Non-pharmacologic interventions following cancer therapy in childhood survivors
| Intervention | Patient population* | Study design and duration of intervention | Measures | Response | Reference |
|---|---|---|---|---|---|
| Cognitive remediation program | Cancer survivors Age range: 6–22 y (N = 31) |
Pilot: single centerIntervention vs control |
Primary: CPT, Digit Span Secondary: WRAT sentence memory and arithmetic |
Improved CPT scores | (26) |
| Cognitive remediation program | Brain tumors, ALL, bone marrow transplant/ total body irradiation, or non-Hodgkin’s lymphoma ≥ 1 y off therapy Age range: 6–17 y (N = 20) |
Multicenter randomized clinical trialIntervention vs controlTwo-hour cognitive remediation sessions—over 4–5 mo 4–5 mo therapy |
Primary: academic achievement; focused attention; working memory; memory recall; vigilance Secondary: parent/ teacher report on attention; participant self-report |
Improved academics: 0.53; Improved attention by parent Conners’ ratio, but not by teachers; no change in attention, memory, recall or vigilance |
(178) |
| Cognitive remediation program | Brain tumors, ALL ≥ 6 mo off therapy Age range: 7–19 y (N = 12) |
Pilot-Single Center Open 15-session, clinic-based training program over 3–6 mo |
Primary: Digit span; CPT; CVLT-C; WRAT3/WJR; CBCL; SSRS | WJR writing sample and SSRS improved; low participation rate |
(179) |
| School-based math intervention | Children on maintenance phase of treatment for ALL Mean age: 6.7 y (intervention); 6.5 y (standard care) (N = 57 enrolled; 32 completed) |
Two Institutions Intervention vs control 40–50 h direct instruction on math concepts |
Primary: FSIQ, processing speed working memory; visual-motor integration; fine motor speed and dexterity; academic achievement | Improved targeted math skills and visual working memory in intervention group vs decline in the comparison group | (181,251) |
| Compensatory memory device | Brain tumors Age range: adolescent (N = 1) |
Memory notebook with log and calendar, orientation + training | Primary: WRAT, memory | Improved academic achievement; Persistent memory deficits |
(252) |
| Computerized training / Captain’s Log † | Brain tumors; ALL > 1 y off therapy Age range: 10–17 y (N = 9) |
Pilot- Single Institution: Open 50 min a week for 3 mo |
Primary: WISC-WMI; CPRS | Improved working memory on Digit-Span forward; improved inattention | (132) |
| Cogmed RM | Brain tumors; ALL > 1 y off therapyAge: 8–16 y (N = 20) |
Pilot: single institutionIntervention (CogmedRM) vs control group (non-adaptive program)25 training sessions on home-based computerized cognitive training program: 3 months | Primary: CPRS, WRAML2 | Improved visual working memory; decreased learning problems by CPRS | (182) |
| Group skills therapy | Brain tumors Age range: 8–18 y (N = 32) |
Single institution: Open Eight, 2-h weekly group sessionstargeting specific skills |
Primary: SSRS, PedsQLCancer; CBCL; CDI | Improved self-control, social skills, quality of life at 6 months | (37) |
| Group skills therapy | Male brain tumor survivors not on active treatmentAge range: 10–14 y (N = 8) | Sixteen, 1 h group sessions focused on development of social skillsSingle institution: Open Child and parent intervention |
Primary: Child and parent survey on social skills | Improved social skills | (167) |
| Social skills intervention | Brain tumors ≥ 6 mo off therapy Age range: 8–14 y (N = 13) |
Single institution: OpenThree sessions with group social skill training Child and parent intervention |
Primary: SSRS, CBCL, Miami Peds quality of life, IQ Secondary: Program evaluation |
Small/medium effect sizes on social competence, total competence and problem behaviors | (166) |
| Social skills | Pediatric cancer - newly diagnosed Age range: 5–13 y (N = 64) |
Two institutions Intervention vs controlSeveral specific 60-min social skills training vs Standard school reintegration services | Primary: CDI, CBCL, SSSC | Higher perceived classmate and teacher social support, decreased internalizing/externalizing behaviors | (164) |
| Psychological intervention |
Newly diagnosed leukemia/lymphoma, solid tumors, or brain tumors Median age: 5 y (N = 19) |
Pilot Intervention vs control Pre- and 2-mo postintervention |
Primary: anxiety, post-traumatic stress disorder | Reduced anxiety and parental post- traumatic stress disorder symptoms | (253) |
* In many studies, more patients than reported here were screened for eligibility; however, for consistency, we report on only those patients included in the final analysis. ADD = attention deficit disorder; ALL = acute lymphoblastic leukemia; CDI = child development inventory; CPRS = Conners Parent Rating Scale; CPT = Conners Continuous Performance Test; CTRS = Conners Teacher Rating Scale; CVLT = California Verbal Learning Test; CVLT-C = California Verbal Learning Test, Children’s Version; DKEF = Dellis-Kaplan Executive Function Test; FSIQ = full-scale intelligence quotient; IQ = intelligence quotient; SSRS = Social Skills Rating System; WRAT = Wide Range Achievement Test.
† Captain’s Log (http://www.braintrain.com); SSSC =Social Support Scale for Children; WRAML2= Wide Range Assessment of memory and learning 2nd edition; WISC-WMI= Working memory Index.