Cognitive and adaptive functioning outcomes after cancer diagnosis in early childhood: A systematic review

EJC paediatric oncology Pub Date : 2025-05-05 DOI:10.1016/j.ejcped.2025.100237

Jessica Beamish, Josephine Drijver, Marita Partanen

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引用次数: 0

Abstract

Objectives

About one quarter of children who are diagnosed with cancer are under four years old, which is a uniquely critical period in neurodevelopment. Younger age at diagnosis is a known risk factor for poorer long-term cognitive and functional outcomes, indicating that the combined impact of cancer and treatment may disproportionally affect this age group. To date, synthesis of the literature in this area has been limited by heterogeneous findings and methodologies. To help guide clinical practice and future research, this review aimed to describe the cognitive and adaptive functioning outcomes of young children with cancer, as well as summarise the impact of risk factors.

Methods

We conducted a systematic review, according to PRISMA guidelines, of cognitive and adaptive functioning outcomes in cancer patients who were younger than four years at diagnosis. We searched PubMed, EMBASE and PsycINFO and included relevant articles. This review was registered in PROSPERO [CRD42024502629].

Results

There were 5747 records retrieved, and 54 papers were included after full-text review, representing 8083 participants. Long-term impairments in the domains of processing speed, attention, executive and adaptive functioning were reported in brain tumour, haematological and solid tumour groups. Brain tumour survivors also show deficits in IQ. Cranial radiotherapy was the most consistently associated risk factor with poorer cognitive and adaptive functioning. Risk of bias analysis showed most studies were classified as ‘strong’ quality, but there was variability in study sample size and design.

Conclusion

Children diagnosed with cancer in early childhood are at high risk of cognitive and adaptive functioning deficits, potentially reflecting diffuse neurodevelopmental injury. However, outcomes are highly variable, with limited understanding of risk factors beyond medical treatment. The results support the recommended guidelines for early neuropsychological monitoring for all diagnostic groups to identify vulnerable patients and to implement timely interventions.

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儿童早期癌症诊断后的认知和适应功能：一项系统综述

大约四分之一被诊断患有癌症的儿童在四岁以下，这是神经发育的一个独特的关键时期。较年轻的诊断年龄是导致较差的长期认知和功能结果的已知风险因素，表明癌症和治疗的综合影响可能不成比例地影响这一年龄组。迄今为止，这一领域的文献综合受到异质性发现和方法的限制。为了帮助指导临床实践和未来的研究，本综述旨在描述幼儿癌症患者的认知和适应功能结果，并总结危险因素的影响。方法：根据PRISMA指南，我们对诊断时年龄小于4岁的癌症患者的认知和适应功能结果进行了系统评价。我们检索了PubMed， EMBASE和PsycINFO并收录了相关文章。本综述已在PROSPERO注册[CRD42024502629]。结果共检索到5747条记录，经全文审阅后纳入54篇论文，代表8083名受试者。在脑肿瘤、血液病和实体瘤组中，报告了处理速度、注意力、执行和适应功能领域的长期损伤。脑瘤幸存者也表现出智商缺陷。颅放射治疗是认知和适应功能较差的最一致的相关危险因素。偏倚风险分析显示，大多数研究被归类为“强”质量，但研究样本量和设计存在差异。结论早期诊断为癌症的儿童认知和适应功能缺陷的风险较高，可能反映了弥漫性神经发育损伤。然而，由于对药物治疗之外的危险因素的了解有限，结果是高度可变的。研究结果支持对所有诊断组进行早期神经心理监测的推荐指南，以识别易感患者并及时实施干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

EJC paediatric oncology

CiteScore

0.20

自引率

0.00%

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