BCS242 Fall 2004

I. Outline to accompany classroom lecture

II. "Road Map" to Moleski article (assigned reading)

III. Contact information for Dr. Adams

I. Outline to accompany classroom lecture

This lecture focuses on the neuropsychological outcomes among individuals treated for brain tumors and a specific type of cancer — leukemia. Most of the lecture will present information on the neuropsychological outcomes in pediatric cancer/brain tumor patients, because this is where most of the research has been conducted. There will be a brief discussion of specific findings related to adult cancer treatment.

The lecture will cover a range of topics related to cognitive outcomes in pediatric cancer patients: the different types of treatment used & how they affect cognitive outcomes, outcomes for IQ and for specific neuropsych areas (e.g., attention, memory, etc.), the educational impact of cancer-related neuropsych deficits, and treatment/remediation of cancer-related cognitive deficits.

1. Review of Terms

Intrathecal Chemotherapy (IT): This is chemotherapy that is able to cross the blood-brain barrier. It therefore can be delivered to the central nervous system (CNS).

Central Nervous System (CNS): Brain & spinal cord

Cranial Radiation Therapy (CRT): High doses of radiation that are administered to the brain/head. Typical ways that CRT is administered are to the "whole brain" (the entire brain/head), focal (delivered to just one targeted area), or craniospinal (CSI) — brain/head and spinal cord together.

Chemotherapy: various medications used to treat cancer. Different chemotherapies are effective for different types of cancers/brain tumors. Some ‘chemo’s’ is oral (a pill you swallow), some is injected. Chemotherapy can be intrathecal (IT) or systemic (does not cross the blood-brain barrier)

Acute Lymphocytic Leukemia (A.L.L.). This is the most common type of leukemia in childhood (represents approx 90% of all childhood leukemia that is diagnosed each year). It is caused by excessive production of immature ‘lymphoblasts’ — a type of cell that is produced in the bone marrow and is a precursor to mature white cells.

2. Types of Cancers that May Lead to Neuropsychological Problems

3. Factors that May Lead to Neuropsychological Problems in Cancer Patients

4. Brain Tumors:

What are they?

Common neurologic/neuropsychologic symptoms of brain tumors

Incidence of Brain Tumors in Children & Adults

5-Year Survival Rates for Primary CNS Malignancy

Brain Tumor: Variables that may impact neuropsychological outcomes

5. Leukemia

What is it?

Incidence of Leukemia in Children & Adults

Acute Lymphoblastic Leukemia

A.L.L. of childhood

neurodevelopmental issues at time of A.L.L. diagnosis

evolution of treatment protocols and survival rates

6. Treatments for Cancer & Brain Tumors (note, section #6 is optional for lecture — it will only be covered if there is time remaining at end of lecture)

Surgery

Radiation Therapy

IT Chemotherapy

Systemic Chemotherapy

7. Acute neuropsychological effects of cancer/brain tumor treatment

8. Cognitive "Late Effects"

definition & description

timeline of cognitive late effects: A.L.L. survivors

timeline of cognitive late effects: two types of brain tumors

variables that influence cognitive late effects

9. Cognitive Late Effects — Neuropsychological Findings

IQ & the controversy over these results

Specific domains of neuropsychological functioning

Areas that are impaired vs. spared

Educational impact of impairment in specific areas

10. Neuropathology of Cognitive Late Effects

Sources of neuropathology

What can happen to the brain during/after treatment?

Variables impacting neuropathological / neuropsychological outcomes

11. Neuropathology of Cognitive Late Effects: What’s white matter got to do with it?

"Normal Appearing White Matter" studies (NAWM)

NAWM and association with IQ outcomes

12. Interventions for Late Effects

During treatment

After Treatment

Cognitive Remediation as an exciting new option

13. Quality of Life Outcomes of Pediatric Cancer/ Brain Tumor Survivors

14. Adult Cancers & Cognitive Late Effects

Dear students,

I recognize that this may be a challenging article. So, here is a ‘road map’ to

help you find your way through this article. It should help you to extract the main information and the important details.

1. First, read the abstract. It will orient you to what this article is all about, and will introduce you to some terms that will be abbreviated later on.

2. Second, skim Table 1. Also, check the key at the bottom of Table 1 (bottom of page 608) — this key contains info on some important abbreviations used in the table. Next, take a look at the different measures that were used in each study that is summarized in the table — do you recognize the names of any of these neuropsych tests? If so, take a look at what the authors reported finding with those neuropsych tests.

3. OK, now you’re ready to dig into the body of the article itself. Ask yourself — what is the main argument that the author (Maria Moleski) is setting up in the first few pages of the paper? Don’t get bogged down in her recitation of every single study — just try to find one sentence that sums up each of the paragraphs on page 603 & 60, and the top paragraph on page 605 . I’ll get you started with paragraph #1 on p. 603: Even though improvements in treatment protocols mean that more children survive A.L.L., these children still have cognitive late effects, so more improvement is necessary.

4. Now onto the next section, "Cognitive Effects of CNS Chemotherapy"

First, note that in the first paragraph of this section, the author sets up her reasons for writing what follows....why is CNS chemotherapy necessary? (because if it wasn’t necessary, kids could skip this form of treatment & the issue of cognitive outcomes would be nonexistent).

5. The remainder of this section deals with the neuropsych. outcomes (also academic) that can be associated with CNS Chemotherapy. You can work on extracting main ideas from these paragraphs as well. But, also make sure you understand enough of the details so that you can explain these main ideas, give examples, or describe some key studies (hint: if Moleski uses a lot of space discussing one article, it’s probably a key study).

Here are some themes to think about

Having been a T.A. for this class myself, I understand that it can be difficult for students to find a way to follow-up with the guest speakers, since these guest lecturers are not available for the BCS242 office hours or other regular contact in class.

If you have any questions about the lecture, you can contact me at any time via e-mail:

heather_adams@urmc.rochester.edu

I will do my best to answer your questions within a 24-hour period, but it is not guaranteed (examples: if I am physically not in the office (e.g., out of town and not checking email), or during on weekends). You are also welcome to ask Dr. Weber or Dr. Como a question, and they can field it themselves or forward it onward to me.