July 7, 2017 | by Samantha Bonar
Sunita Patel, Ph.D., a neuropsychologist in the Population Sciences and Supportive Care Medicine departments at City of Hope, has received a $1.22 million grant from the American Cancer Society to test a new approach toward preventing long-term chemotherapy-related cognitive side effects in childhood cancer survivors from bilingual and Spanish-speaking families. These families often face language and socioeconomic barriers, which limit access to supportive resources.
As the population of childhood cancer survivors grows, the impact of long-term treatment-related side effects also increases. Cancer treatments for children with leukemia, for example, can cause long-lasting damage to the developing brain, known as “neurocognitive late effects.”
Childhood cancer survivors, especially those from disadvantaged backgrounds, often struggle with learning and development for years after their cancer goes into remission. Previous researchers have tried to improve cognition and school performance working with the children directly and using medications, but the effects are often short-lived.
Patel and her colleagues are taking a new approach — targeting the parents with culturally adapted behavioral strategies for creating a pro-learning environment in the home. Their hope is to provide a set of best practices to help these kids succeed and not just survive.
Children whose cancer treatment included chemotherapies are at risk for developing cognitive problems, particularly in their attention, executive functioning, memory, and processing speed,” Patel explained. “Deficits in such core functions can lead to long-term inadequacies in learning and academic achievement, which subsequently are associated with lowered education attainment and employment as adults.”
Using a randomized clinical trial design, Patel’s four-year study will enroll 138 Latino children from ages 5 to 12 who have been treated for leukemia or lymphoblastic lymphoma, and their bilingual or Spanish-speaking parents, at three pediatric cancer centers in Los Angeles — where nearly 60 percent of children diagnosed with cancer are Latino.
The trial will compare the effects of low- and high-intensity parent-directed interventions on parenting behaviors, as well as the child’s school performance and quality of life. They will test both the magnitude of the benefit and its durability over time.”
Previous research has found that children from disadvantaged and/or predominantly Spanish-speaking homes have worse outcomes, most likely due to differences in environmental factors. In particular, “low-acculturated Latino parents report they want their child to progress but do not know how to effectively enhance their child’s learning and education,” she said. “We think this lack of knowledge and related parenting factors may increase the risk for negative outcomes over the long term.”
Patel’s new study will focus on parental intervention. The low-intensity intervention includes a single session wherein the therapist reviews neurocognitive test results and provides recommendations for progress; this intervention is similar to the recommended standard care. The high-intensity intervention, however, includes eight group training sessions to teach pro-learning parenting skills.”
“In contrast to clinic-based rehabilitation therapists, parents are potentially tremendous agents of ongoing behavioral ‘remediation’ within the child’s natural environment, and might promote and sustain adaptive gains over the long term,” she said.
Patel’s previous randomized pilot trial of the high-intensity intervention with English-speaking parents showed improvements in the child’s academic performance, as well as in parent outcomes.
“Pro-learning parenting behaviors reinforce environmental inputs and experiences that enhance brain development,” Patel added.
Neuroscience has shown us that “activating the brain via targeted, repetitive, progressively challenging activities, such as those offered in the school setting, changes the brain by strengthening existing connections and creating new ones,” she said, and her study will teach and encourage parents to engage their children in such activities.
This brain “plasticity” is particularly evident in young children, she added, and the concept of plasticity “underlies most rehabilitation approaches for brain injury across the lifespan.”
Patel also believes that engagement in relatively challenging cognitive and academic activities on a regular basis will strengthen general skills in mental effort, sustained attention and behavioral persistence — “all behaviors that should benefit the child into adolescence and adulthood. The child’s sense of mastery and self-esteem that comes with experiencing progress as a result of his or her own effort is also beneficial for the long term.”
Patel hopes that results from her trial will help policymakers in making decisions about resource allocation for the care of this vulnerable population of children, and will serve as a model of “a potentially simple and powerful intervention” that other cancer centers and doctors can put into practice.