INS NYC 2024 Program

Poster	Poster Session 09 Program Schedule 02/16/2024 03:30 pm - 04:45 pm Room: Shubert Complex (Posters 1-60) Poster Session 09: Epilepsy \| Oncology \| MS \| Infectious Disease Final Abstract #57 Preliminary Outcomes of Routine Neuropsychological Screening in a Pediatric Cancer Center Zoe Kearns, Children's Hospital of Philadelphia, Philadelphia, United States Megan Sy, Children's Hospital of Philadelphia; Perelman School of Medicine at the University of Pennsylvania, Philadelpha, United States Category: Medical/Neurological Disorders/Other (Child) Keyword 1: cancer Keyword 2: pediatric neuropsychology Objective: This study describes the implementation and preliminary outcomes of a prevention-based model of neuropsychological assessment. Participants and Methods: Participants included 146 patients ages 3 to 21 (M = 9.60, SD = 4.86) who received abbreviated neuropsychological screening evaluations between 2020 and 2023. Evaluations were offered as part of routine oncological care to patients diagnosed with leukemia (n = 69), lymphoma (n = 33), brain tumor (n = 33) or neuroblastoma (n = 11). More than half (n = 87) were treated with chemotherapy only, 12% (n = 18) had CNS surgery only, and one patient did not receive treatment. The remainder received chemotherapy in combination with other treatments. Patients were initially diagnosed between 2016 to 2022 and were off treatment. Evaluations took place on the same day as oncology appointments. Evaluations included performance-based measures of processing speed, working memory, executive functioning, language, fine motor skills, and achievement and caregiver rating scales. Z-scores were used to compare performance across measures that assessed equivalent constructs. Scores ≥ 1 SD below the mean were considered a weakness. Results: Mean IQ was in the average range (z = .11, range = -2.6 to 2.33). There were no significant between group differences in IQ based on diagnosis (p = .19) or treatment received (p = .88). Of the sample, 82% had one or more weaknesses on performance-based measures. Sixty-four percent demonstrated fine motor weakness (89/138), 49% (44/89) demonstrated processing speed weakness, 41% (46/111) demonstrated EF weakness, 37% (49/134) demonstrated language weakness, 29% (42/144) demonstrated working memory weakness, and 29% (37/128) demonstrated academic weakness. On caregiver ratings, 19% (26/140) had externalizing concerns and 32% had internalizing concerns (46/142). Of 146 patients, only four were referred for more comprehensive evaluation. Of those with cognitive or academic difficulties, 90 received school recommendations, such as initiating an IEP (n = 20) or 504 Plan (n = 32) or amending an existing plan (n = 28). Ten patients were referred to pediatric psychology. Other recommendations included referrals for education coordination, speech therapy, psychiatry consult, and home supports or resources. A minority of caregivers (n = 19) completed post-evaluation questionnaires assessing their perceptions of evaluations. Seventeen rated the screening as moderately or very helpful, 16 reported improved knowledge of their child’s areas of need, and 14 reported improved understanding of long-term effects of cancer treatment. Conclusions: A prevention-based model of neuropsychological assessment emphasizes targeted use of resources to identify emerging difficulties before they become impairing. Neuropsychological screening evaluations can feasibly be provided during oncology appointments, thereby reducing some barriers to service utilization. Neurocognitive vulnerabilities were identified in majority of the patients in this sample, which supports the need for evaluations shortly after treatment completion. While screening evaluations were more abbreviated than traditional comprehensive neuropsychological evaluations, similar types of recommendations could be made based on obtained findings. Future research aims to track neurocognitive and psychosocial functioning over time and to evaluate caregivers’ and other stakeholders’ perceptions of screening evaluations.

Poster

02/16/2024
03:30 pm - 04:45 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease

Final Abstract #57

Preliminary Outcomes of Routine Neuropsychological Screening in a Pediatric Cancer Center

Zoe Kearns, Children's Hospital of Philadelphia, Philadelphia, United States
Megan Sy, Children's Hospital of Philadelphia; Perelman School of Medicine at the University of Pennsylvania, Philadelpha, United States

Category: Medical/Neurological Disorders/Other (Child)

Keyword 1: cancer
Keyword 2: pediatric neuropsychology

Objective:

This study describes the implementation and preliminary outcomes of a prevention-based model of neuropsychological assessment.

Participants and Methods:

Participants included 146 patients ages 3 to 21 (M = 9.60, SD = 4.86) who received abbreviated neuropsychological screening evaluations between 2020 and 2023. Evaluations were offered as part of routine oncological care to patients diagnosed with leukemia (n = 69), lymphoma (n = 33), brain tumor (n = 33) or neuroblastoma (n = 11). More than half (n = 87) were treated with chemotherapy only, 12% (n = 18) had CNS surgery only, and one patient did not receive treatment. The remainder received chemotherapy in combination with other treatments. Patients were initially diagnosed between 2016 to 2022 and were off treatment. Evaluations took place on the same day as oncology appointments.

Evaluations included performance-based measures of processing speed, working memory, executive functioning, language, fine motor skills, and achievement and caregiver rating scales. Z-scores were used to compare performance across measures that assessed equivalent constructs. Scores ≥ 1 SD below the mean were considered a weakness.

Results:

Mean IQ was in the average range (z = .11, range = -2.6 to 2.33). There were no significant between group differences in IQ based on diagnosis (p = .19) or treatment received (p = .88). Of the sample, 82% had one or more weaknesses on performance-based measures. Sixty-four percent demonstrated fine motor weakness (89/138), 49% (44/89) demonstrated processing speed weakness, 41% (46/111) demonstrated EF weakness, 37% (49/134) demonstrated language weakness, 29% (42/144) demonstrated working memory weakness, and 29% (37/128) demonstrated academic weakness. On caregiver ratings, 19% (26/140) had externalizing concerns and 32% had internalizing concerns (46/142).

Of 146 patients, only four were referred for more comprehensive evaluation. Of those with cognitive or academic difficulties, 90 received school recommendations, such as initiating an IEP (n = 20) or 504 Plan (n = 32) or amending an existing plan (n = 28). Ten patients were referred to pediatric psychology. Other recommendations included referrals for education coordination, speech therapy, psychiatry consult, and home supports or resources.

A minority of caregivers (n = 19) completed post-evaluation questionnaires assessing their perceptions of evaluations. Seventeen rated the screening as moderately or very helpful, 16 reported improved knowledge of their child’s areas of need, and 14 reported improved understanding of long-term effects of cancer treatment.

Conclusions:

A prevention-based model of neuropsychological assessment emphasizes targeted use of resources to identify emerging difficulties before they become impairing. Neuropsychological screening evaluations can feasibly be provided during oncology appointments, thereby reducing some barriers to service utilization. Neurocognitive vulnerabilities were identified in majority of the patients in this sample, which supports the need for evaluations shortly after treatment completion. While screening evaluations were more abbreviated than traditional comprehensive neuropsychological evaluations, similar types of recommendations could be made based on obtained findings. Future research aims to track neurocognitive and psychosocial functioning over time and to evaluate caregivers’ and other stakeholders’ perceptions of screening evaluations.