Sick kids live longer, but brain function may suffer

Child with cancer

Survival rates continue to rise for children living with once-fatal chronic pediatric health conditions such as cancer. But their survival comes at a cost: many experience long-term neurocognitive deficits. In related news, an online stress management program for children with cancer receives funding.

In a first-of-its-kind review of meta-analytic results across conditions, Vanderbilt researchers documented how the brain is affected by six conditions in an effort to identify directions for future research and clinical care. They are:

  • leukemia,
  • brain tumors,
  • sickle cell disease,
  • congenital heart disease,
  • type 1 diabetes, and
  • traumatic brain injury.
Bruce Compas, Ph.D.

Bruce Compas, Ph.D.

“What we have is a hidden epidemic,” said lead investigator Bruce Compas, Ph.D., Patricia and Rodes Hart Professor of Psychology and Human Development at Vanderbilt’s Peabody College and VKC investigator. “For the 4 million children with these conditions, the functioning of the prefrontal cortex is disrupted significantly, affecting learning, memory, and decision-making. We found that an alarming number are performing academically below 80 percent of their peers, and have lost 3 to 12 IQ points.”

Stacked Odds

During their medical journey, children may face multiple short- and long-term disruptions to the functioning of their prefrontal cortex, which impact their learning and behavior, sometimes for life. For the study, Compas and his colleagues measured the effects of three key factors that hinder brain function:

  • the chronic health condition itself;
  • the treatments for the condition, e.g., surgery, medications, chemotherapy and radiation therapy; and
  • the prolonged stress associated with having a chronic health condition, which can be compounded for children who are also growing up in poverty.

Impact on IQ

The results, published in American Psychologist, confirm a troubling trend. Pediatric brain tumor survivors placed academically below 80 percent of their peers, with a loss of 12 IQ points. Survivors of severe traumatic brain injury, as well as acute lymphocytic leukemia and certain types of congenital heart disease, also were found to have large neurocognitive side effects, including impact on full-scale IQ.

Children with sickle cell disease experienced medium to large impact on brain function, while those with type-1 diabetes experienced small but significant deficits. Now that research is shining a light on the magnitude of the problem, new interventions can be developed for before, during, and after treatment.

Coping is Key

“When a child is diagnosed with a life-threatening condition, the parents’ lives can go into chaos,” said Compas, who also serves as professor of pediatrics. “They are only focused on if their child is going to survive. In our work, we often meet with families within hours of the diagnosis. We evaluate the child’s cognitive ability and work with the surgical and medical teams to come up with treatment and interventions that offer the best cognitive outcome. It’s a remarkable partnership.”

Compas directs a team of researchers at the Vanderbilt Stress and Coping Research Lab who work with children and families struggling with a broad range of difficulties that can interfere with cognitive function, from depression to abuse to a cancer diagnosis. In longitudinal studies, he and his team have found that methods based in cognitive behavioral therapy and computer-based cognitive remediation programs are effective in equalizing the debilitating impact of stress on the brain.

 

The Stress Factor

“Stress is the common thread among all of the conditions we study, and stress piles on to the neurocognitive deficits children are already experiencing,” Compas said. “At the present time, we don’t have solutions for all of the chronic health conditions that impact learning and behavior. But as new collaborations are formed, we are making progress and are coming up with better solutions than we could have in our individual siloes.”

Collaborators:

  • Sarah S. Jaser, assistant professor of Pediatric Endocrinology, Vanderbilt University Medical Center;
  • Kristen Reeslund, assistant professor, Vanderbilt University School of Medicine;
  • Niral Patel, clinical/translational research coordinator, Pediatric Neurology, Vanderbilt University Medical Center; and
  • Janet Yarboi, doctoral candidate in Clinical Psychology, Vanderbilt Stress and Coping Research Lab, Vanderbilt’s Peabody College.

Download the study, “Neurocognitive Deficits in Children with Chronic Health Conditions,” or read it online at American Psychologist.

This research is supported by the National Institutes of Health.

Online stress management program for kids with cancer receives funding

Compas and his team have received funding for an internet-based education program that will teach pediatric cancer patients and their families how to cope and manage the stress associated with a serious chronic childhood condition.

The nonprofit organization Alex’s Lemonade Stand Foundation (ALSF) awarded Compas a $300,000, 3-year Psychosocial: Family Impact Grant to develop and test the online program. Many families facing chronic illness also struggle with psychosocial disorders like chronic stress, depression, and anxiety, which negatively affect their brain function and overall mental health. This program will be a valuable resource for families in need of coping skills and healthy ways to communicate about the effects of cancer, Compas believes.

“When a frightening diagnosis comes in, the families are reeling from the shock, and many are not able to meet with a therapist in person or as a family,” Compas says. “We are using all we have learned about the power of coping skills to create something many families can benefit from, and can be shared across conditions.”

Compas and his team will develop and test the program with families facing cancer, in hopes that it can be useful to them as well as families experiencing chronic stress as a result of other life circumstances like poverty, depression and abuse. The grant is 1 of 4 ALSF Psychosocial grants awarded to researchers across North America.

The study is being conducted in partnership with colleagues at the University of Washington and Nationwide Children’s Hospital researchers with expertise in pediatric oncology; stress, coping and family communication in pediatric cancer; internet interventions in pediatric populations; and family-focused interventions to build coping and parenting skills.

Alex’s Lemonade Stand Foundation, a nonprofit dedicated to finding better and safer treatments—and, ultimately, cures—for all kids with cancer, recognizes the importance of investing in research that enables better quality of care and life for children battling cancer and their families.

Joan Brasher is a public affairs officer of Vanderbilt University and editor of the Peabody Reflector. “Sick kids lives longer, but brain function may suffer” is republished from ResearchNews@Vanderbilt, May 16, 2017; “Online stress management program for kids with cancer receives funding” is republished from ResearchNews@Vanderbilt, June 6, 2017.

 

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