Cognitive deficits in children treated for leukaemia
Article Abstract:
Besides medical complications, children with leukemia experience a variety of psychological problems and other complications. Absences from school due to medical care or frequent infections can lead to social isolation. Teachers often perceive children with leukemia or other cancers differently in terms of academic performance and social adjustment. Parents may feel that school attendance becomes less critical, and children's mobility or sports activities may be restricted. These risk factors may add to the effects of chemotherapy and radiotherapy on central nervous system function. It is difficult to separate the effects of these factors from those of medical treatment, since rigorously controlled studies cannot be done for ethical reasons. However, many studies have attempted to address whether parental reports of deficits in mathematics, problem solving, attention, and concentration skills are related to chemotherapy and radiation therapy. This article reviews the problems with such studies and the conclusions from this research. Radiation appears to be associated with deficits. Younger children are apparently more vulnerable, and some studies suggest that girls may be affected more than boys. It is still unclear whether deficits are general or are confined to specific skills, but it does appear that concentration and attention skills and problem solving abilities are most likely to be affected. It is also unclear whether deficits are progressive, or they become stable or resolve. Only a few studies have addressed deficits in children surviving for more than five years, but these studies suggest a need for ongoing support and remedial help for these survivors. Probably the most effective interventions for children with leukemia will include not only remedial help for academic skills but also assistance with interpersonal skills to improve self-esteem, coping skills, and interactions with peers. Interventions concerned with the social and emotional experiences of the family would also most likely be beneficial. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1991
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Importance of 6-mercaptopurine dose in lymphoblastic leukaemia
Article Abstract:
Lymphoblastic leukemia is a cancer of the blood characterized by the overgrowth of lymphoblasts, a cell that normally gives rise to lymphocytes, a type of immune cell. The survival of children with lymphoblastic leukemia has improved in recent years. The dose regimen of chemotherapeutic agents necessary to maintain control over the cancer was not established until 1980. Prior to that time, clinicians tended to use doses of anticancer agents that did not cause suppression of bone marrow function. In 1980, a new protocol, or regimen, for the treatment of lymphoblastic leukemia resulted in higher rates of chemotherapy-related death and disability, but also a 20 percent improvement in survival. The two anticancer agents used in the maintenance phase of treatment were 6-mercaptopurine and methotrexate, with the former given in a larger dose. The effect of 6-mercaptopurine on prognosis and sex-related tolerance of the drug were assessed in 75 patients with lymphoblastic leukemia. Thirty children were diagnosed with the disease before 1980, whereas the remaining 55 were diagnosed after 1980. The survival of patients diagnosed after 1980 improved by 18 percent, and their total dose of 6-mercaptopurine was 22 percent higher. According to the protocol, the dose of 6-mercaptopurine should have only increased by nine percent. Among the children in the later group, higher doses and fewer reductions in the dose of 6-mercaptopurine were prescribed to boys. These findings suggest that the increased dose of 6-mercaptopurine was probably responsible for the improved prognosis of lymphoblastic leukemia after 1980. In addition, boys tend to tolerate 6-mercaptopurine better than girls and this may explain the sex-related differences in prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1991
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